As much as I dislike being a patient, I have to admit it’s a good experience for a health care professional to go through. To be on the receiving end of the healthcare system not only helps me develop compassion for patients and families, but it also gives me a clearer vision of what we’re doing right and what we need to work on when delivering care. And it’s also given me some insight into patient satisfaction vs. patient-centered care.
A month or so ago I wrote a post on patient satisfaction scores and how health care providers are focusing on improving those scores, sometimes to the dismay of clinicians. I now have the opportunity to experience the health care system as a patient and be a satisfied or a dissatisfied consumer (or somewhere in between).
Recently, I paid visit to a dietitian and diabetes nurse educator because of a diagnosis of gestational diabetes. I was told to call the hospital’s central scheduling department to make the appointments. When I did, I was given two different dates two weeks apart, the first with the diabetes educator and the second two weeks later with the dietitian. I was given a long explanation about how the hospital was under construction and the bridge to the main hospital was closed, which is why I needed to enter through the medical office building entrance. It was also advised that I come 45 minutes early.
Then over the next few days I received follow-up calls from the scheduling department regarding the two appointments. When I returned the calls, a different employee took my call and wasn’t sure what the follow-up was regarding. I had assumed it was just to verify the times two weeks apart.
When I showed up for my appointment I followed the instructions then realized I was never given a suite number for the visit. I did my best to guess which one it was, but they were all closed. Why did I need to be there 45 minutes in advance? Perhaps I needed to stop in main hospital’s registration department first, after all they did mention something about the bridge being closed. So I got in my car and drove over to registration where I sat for 15 minutes before they called me over to discover that I had been in the right spot in the first place and I should go back. As I readied to get back into my car I asked what the suite number was. The registration employee had no idea and had to call the educator’s office to find out.
Once I settled in for my appointment, the educator asked about the instructions I was given and I told her I wasn’t given a suite number and was told to come 45 minutes early. She was none too pleased to hear that. Then she informed me that my appointment with the dietitian was immediately following my appointment with her. So that’s what the scheduling department was calling about! I told her that was great but I had no idea. She also told me that the employees in central scheduling could not see the same scheduling screen as the folks in the diabetes center and often did not know that earlier appointments were available.
Was this a satisfying experience? Not really. But the clinical care from the educator and dietitian was very good. They really listened when I explained how I felt about being there (annoyed at the diagnosis) and worked to try to come up with an eating and glucose testing schedule that fit my night shift job. After seeing them I knew what to do, when to do it, and who to call if something was off. With their focus on my needs, they were providing patient-centered care.
If asked if I was satisfied with my experience how would I respond? The scheduling process could have used some work but the clinical care was quite good.
This experience got me thinking about patient satisfaction and patient-centered care and how there is a distinct difference between the two. The writers of a July 2012 JAMA article Patient Satisfaction and Patient-Centered Care Necessary but Not Equal share my opinion.
Patient-centered care, as defined by the Institute of Medicine in its 2001 report Crossing the Quality Chasm, is defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions,” whereas the JAMA authors explain, patient satisfaction is based on consumer marketing and measures the quality of the service against the consumer’s expectations.
As pointed out in the 2011 article The Values and Value of Patient-Centered Care in the Annals of Family Medicine, what some hospitals have been calling patient-centered care is “superficial and unconvincing.” Things like greeters and hotel-like decor “might enhance the patient’s experience, they do not necessarily achieve the goals of patient-centered care.”
When looking at my experience, the scheduling department did not meet my expectations — to give the appropriate information like suite number and arrival time. Yes, I was not satisfied with the scheduling experience but not getting the correct information did not harm me in any way. However, if the diabetes center had not taken my unique situation into account and given me a health regime that fit my night shift schedule, then my health outcomes could have been compromised. Had I gotten the correct scheduling information but not appropriate clinical care, in theory I could have been happy but not as healthy.
In an opinion piece in Circulation: Cardiovascular Quality and Outcomes, the author writes that satisfied patients can still have poor clinical results, though more research on the correlation between patient-satisfaction, patient-centered care and patient outcomes needs to be done.
I agree and would also argue that when health care providers focus on patient-centered — because patients feel heard and valued with this type of care — high satisfaction scores will follow. Plus, there will be better patient outcomes when patients are participating in their care. If you had to pick one area to focus on, patient satisfaction vs. patient-centered care, I’d focus on patient-centered care.
Two resources to help providers achieve patient-centered care are The Journal of General Internal Medicine‘s A 2020 Vision of Patient-Centered Primary Care and Plantree’s Patient-Centered Care Improvement Guide. Both help providers assess their implementation of patient-centered care and give pointers on how to improve care delivery.
Perhaps it’s because I have always worked in the clinical setting that I believe good clinical care can trump, or at least balance, parts of an experience that are less satisfying. Healthy patients equal happy patients and I feel they, like me, would be more willing to compartmentalize different aspects of the care experience. Because they are treated like individuals and listened to by their clinicians, they’ll be less likely to give an overall poor satisfaction score if something, like scheduling, goes amiss. And let’s not forget that despite how health care has changed over the years, good health outcomes are really what it is all about.
Jennifer Thew, RN, MSJ
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