A growing body of evidence indicates that a patient-centred approach to the design, delivery and evaluation of services brings benefits both to the patient and the organisation. Despite this, many healthcare organisations in Australia have struggled to place good patient experience at the centre of what they do. Without action and leadership we miss an opportunity to improve patient outcomes, the quality of care, and reduce costs.
Collecting information which tells health services whether they are genuinely meeting patient needs and delivering good experiences has typically been considered ‘nice to have’ rather than a core indicator of success. Instead, organisations have invested mostly in monitoring financial performance, service demand, patient safety, and quality of care. Investments in gathering, storing and analysing patient-reported measures of care, whether that’s focused on experience or outcomes, have lagged well behind. As a result these measures are largely absent both in real-time monitoring of system and service performance and as a driver of continuous improvement.
Whether it is a tertiary health service in the city or a single clinician in remote Australia, our healthcare organisations exist to improve the lives and health of their patients. If they do not ask patients whether their needs are being met, how can they know that they are succeeding?
A good patient experience is positively associated with patient safety and clinical effectiveness, and with cost savings and reduced demand for health services.
Good for the patient: A robust link with safety and clinical effectiveness
Patient experience has been found in a systematic review of 55 studies, to be consistently and positively associated with patient safety and clinical effectiveness. This held true across a wide range of disease areas, study designs, settings, population groups and outcome measures.1 In particular, patient experience was demonstrated to be positively associated with:
This research, one of the most comprehensive in recent studies in this area, makes a compelling case for including patient experience as one of the ‘central pillars of quality in healthcare’ not divorced from clinical effectiveness and patient safety.
Good for the organisation: Reduce costs, manage demand and grow
Patient-centred care has been linked with cost savings or reduced demand for health services, or both, in a number of recent studies. Decision aids, joint and collaborative care and planning, and the use of patient-centered care models, for example, have appeared to reduce demand or make it easier for the organisation to manage.2 3 4 5 6 Patient-centred care has been linked specifically to:
Experience from the US healthcare market indicates that better patient experience is associated with better financial performance through increased market share. Case studies have also indicated a positive correlation between data on hospital income margins and patient experience measures.
From now on, the success, even the survival, of healthcare organisations will depend more and more on the quality of patient experience. Broad consumer trends and specific regulatory pressures are driving fundamental change.
Tune in to what the customer wants
Consumer expectations of good service have been raised across the board. The need to deliver an exceptional customer experience is already driving strategy and transforming organisations in many industries. Government agencies are also placing more importance on the quality of experience citizens have when they use public services and are looking to design and deliver services centred on citizen needs.
In healthcare, consumers are more informed than ever about their health and care options and, with that, increasingly empowered in their decision making. Digital platforms, in particular, are giving consumers more information, especially ratings and reviews of patient experience, about how health services are performing.8
Manage new requirements
Consumer expectation is not the only factor at play though. Increasingly, the standards and regulations under which health services operate require organisations to engage with consumers. For example Standard 2 of the National Safety and Quality Health Service Standards Partnering with Consumers, requires health services to create a consumer-centred health system that includes patients in decision-making, ensures that patients are partners in their care, and involves consumers in the design and development of healthcare.9
Clearly, patient experience is not just ‘nice to have’. While this is well known in academia and policy circles10, healthcare organisations have been slow to make it an important measure of their organisation’s performance and a driver of improvement. Why?
It is possible that the benefits are not widely known. Perhaps the most significant factor is that changing from a provider-centred approach to a truly patient-centred approach can be hard.
With good intentions, those who manage and deliver healthcare have tended to assume that they know what is best for patients.11 Patients have been seen as passively ‘receiving’ care, rather than being an active participant.12 13 Quality of service has been assessed by the quality of a doctor’s interactions with patients, without considering that the context in which that interaction occurs or how that matters to the patient experience.14
Clinicians will need to put aside their traditional assumption that they know what patients want and need. This challenge was recently recognised in the January 2017 OECD report on The Next Generation of Health Reforms, which urges investment “in measures that will help us assess whether our health system deliver what matters most to people”.15
Culture change is hard. Strong leadership and sustained commitment will be needed to reorient services to a patient-centred model where a positive experience is seen as an essential indicator of success tightly linked to safety and clinical effectiveness.
If we truly want to improve the lives and health of patients, then we must put patient experience at the heart of healthcare. The benefits are clearly there for both the patient and the organisation – we have no excuse. With so little known about what patients want and need however, we are still some way from reorienting healthcare to new measures of success. It is time we talked to patients themselves.
1Doyle, C., Lennox, L., and Bell, D. (2013), A systematic review of evidence on the links between patient experience and clinical safety and effectiveness, BMJ Open. 3(1).
2Ekman, I., Wolf, A., Olsson, L., Taft, C., Dudas, K., Schaufelberger, M., and Swedberg, K. (2012), Effective of person-centred care in patients with chronic heart failure: the PCC-HF study, European Heart Journal, 33, 11112-1119.
3Stacey, D.,Légaré, F., Col, N., Bennett, C, Barry, M et al. (2014), Decision aids for people facing health treatment or screening decisions. Cochrane Library. DOI: 10.1002/14651858.CD001431.pub4.
4DeWalt, D. Malone, R., Bryant, M. et al. (2006), A heart failure self-management program for patients of all literacy levels: a randomised controlled trial, BMC Health Services Research. 6:30.
5American College of Cardiology Foundation (2012), ACCF 2012 Health Policy Statement of Patient-Centred Care in Cardiovascular Medicine. A report of the America College of Cardiology Foundation Clinical Quality Committee. Journal of the American College of Cardiology. 59(23):2125-2143.
6Richards, M and Goldin, A. (2015), Patient-centered care and quality: activating the system, and the patient, seminars in Paediatric Surgery. 24(6): 319-322.
7Bertakis, K., and Azari, R., (2011). Journal of the American Board of Family Medicine. 24:229-239.
8Wynn, JD. (2016), The value of exceptional patient experience., N C Med J. 77(4). 290-292.
9Australian Commission on Safety and Quality in Health Care. Assessment to the NHQHS Standards. Accessed March 2017
10Millenson, M., DiGioia, A., Greenhouse, P and Swieskowski, D (2013), Turning Patient-Centredness from ideal to real, Journal of Ambulatory Care Management, vol 36, no 4 pp319-334
11Cornwell, J (2015), Reframing the work on patient experience improvement, Patient Experience Journal, vol 2, no 1 pp.
12Millenson, M., DiGioia, A., Greenhouse, P and Swieskowski, D (2013), Turning Patient – Centredness from ideal to real, Journal of Ambulatory Care Management, vol 36, no 4 pp319-334.
13Janamian, T., Crossland, L and Wells, L (2016) On the road to value co-creation in health care: the role of consumers in defining the destination, planning the journey and sharing the drive, Medical Journal of Australia, vol 204. No.7.
14Cornwell, J (2015), Reframing the work on patient experience improvement, Patient Experience Journal, vol 2, no 1 pp.
15OECD. Ministerial Statement: The next generation of health reforms, January 2017, accessed March 2017.
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