Two dimensions of top percentile patient satisfaction

Managing patient satisfaction is a key strategic goal for healthcare providers on both sides of the Atlantic.

With patient satisfaction scores being directly linked to financial gain and loss, hospitals in particular are forced to re-evaluate their way of being and consider their patients’ perception of who they are and how they operate. This has great implications to how things are executed because now they can’t afford not to ask themselves: But how does this affect our patients’ satisfaction? In addition to the traditional “Will this improve our clinical outcomes?”; “Will this makes us more efficient?” etc.

But how do you achieve top percentile satisfaction?

In the work Beyond Philosophy did with Memorial Herman Hospital System a few years ago, we came to an important revelation about patient experience and patient satisfaction.

There are two key elements to patient satisfaction: clinical outcome and emotional outcome.

Clinical outcome is defined in a broader sense and entails the effect derived as a result of the medical treatment and associated service standards that hospitals deliver. It has to do anything with the medical procedures and practices, the communication of those, efficiency, timeliness, routines and any practice in the hospital which directly or indirectly impact the patient’s medical wellbeing. This answers the question: What do we do?

Emotional outcome entails the intangible, more difficult to measure effects of the interaction that impact directly or indirectly patients’ emotional wellbeing. It comprises the subtle clues; little details signalling the intent behind the actions (e.g. tone of voice, facial expressions, colour of tiles etc.). This answers the question: How do we do the things we want to do?

Any healthcare provider will tell you that the two are not independent (ask any physician), if fact they are strongly correlated and in some parts are the cause of each other, but never the less they produce 2 distinct effects and are worth paying attention and systematically addressing. Do not expect that if the one goes well the other will follow. A timely service, reduced noise and detailed explanation of the effects of a drug do not guarantee satisfaction.

More importantly, while you can’t always control the clinical outcome (things go wrong, not all conditions have a positive outcome, budgets are short, staff is short etc.), you can always pull the leavers on the emotional outcome dimension to affect satisfaction

Below is a diagram explaining how the 2 dimensions interact and to deliver a patient experience that has a certain type of effect on patient’s behaviour and satisfaction:

1. Negative clinical & negative emotional outcome- this experience is what gets patients to score the hospital low on the satisfaction scale. When admitted, patients are at their most vulnerable and while some become hyper sensitive and others hyper tolerant to the environment waiting to only get through it, all are human and want the best. Being submitted to diagnostics, anticipating results, spending nights alone in an unknown environment…all this makes the hospital experience negative to begin with. Failing to meet expectations, having to deliver negative news all while failing to show care or compassion is essentially rubbing salt to the wound. As a result patient walk out of the experience feeling negative about the hospital and the staff.
2. Positive clinical outcome & negative emotional outcome- this type of experience will get you in the low to average patient satisfaction score range. The reason is that regardless of how quick, accurate, regular or effective you are in delivering the medical treatment, the feeling behind it can significantly leave patients with the impressions that you are merely ticking the box and more importantly, that it is the people who deliver the good experiences, not the hospital. Recommendation boils down to the physician no the hospital brand.
3. Positive emotional & negative clinical experience- interestingly, when the medical treatment is not favourable but the management of the delivery is emotionally positive and engaging, patients tend to score average to high on satisfaction. Under these circumstances patients tend to rationalise the reasons for the poor clinical outcome (e.g. the condition is untreatable, medicine offers no better solutions, it’s a small hospital with lots of patients etc.) and essentially excuse the hospital. Reason is that the emotional outcome serves as compensation and more importantly leaves them with the impression that the intentions were good and in place. It is like going through a tough period with your partner: you are more forgiving and willing to move on when you feel and believe there is love between you and good intentions.
4. Positive clinical & positive emotional outcome- this is the ideal experience you can provide your patients with. This is the reason patients score hospitals in the top quadrant on the satisfaction scale. Patients not only appreciate the staff, but see the experience as purposefully designed and delivered by the hospital.

What are the implications?

• Aim at understanding and managing both dimensions of patient satisfaction: emotional and clinical outcomes
• Emotional outcomes have a significant impact on patient satisfaction that can and should be systematically managed
• Ask yourself and your staff if you know what those emotional outcomes are?
• Ask yourself and your staff how you can design positive emotional outcomes in your experience

To find out more on how to achieve excellence in patient experience listen to Rhonda Dishongh and Qaalfa Dibeehi explain how they achieved success in Memorial Herman Hospital : Dramatic Improvement in Patient Satisfaction: A Case Study from Memorial Hermann Hospital System.