Working as a patient experience champion is a dream come true for me as both a nurse and a leader. Looking back, my desire to provide an exceptional experience started when I was a teen working in a long term care center as a certified nursing assistant; I just didn’t know that was what I was doing at the time. What I did understand was this: when I anticipated and met the patients’ needs, they were happier and my day seemed more meaningful. This provided a very simple measure of satisfaction at a time when patient satisfaction data was nonexistent. We all know healthcare providers who epitomize a high performing, caring individual who each of us hope to encounter when receiving care. Some of these individuals come by it naturally, while others have refined a skill set to achieve that level of caring and compassion. Regardless, we have all experienced excellent service in some form, whether in healthcare or another industry, and we know what it feels like to receive excellent service.
I “experienced” healthcare highs and lows through my own 6 month-event leading to a diagnosis of a chronic condition with unknown etiology and also through experiences of family members: two sisters diagnosed with breast cancer and a father going through open heart surgery. What became very clear to me, as my family and I moved through services in various healthcare organizations over a 15 year span, was that progress toward providing an exceptional experience every time occurred slower than one would expect, but when healthcare organizations got it right, phenomenal experience was the phrase that came to mind. As a patient experience leader, my observations over my career are much the same as those viewed through my eyes as a patient and family member. Yes, overall progress has been slow. However, as a healthcare leader, I understand the complexities that exist.
The progress, though slow to date, is currently showing promise in many respects. Conferences focusing solely on the patient experience are readily available, senior leaders are listing the patient experience as one of the top organizational priorities, employee evaluations often include patient satisfaction metrics, and data transparency is improving. There are many more areas of advancement in the patient experience realm and all of them demonstrate a heightened awareness of the integral part patient experience plays in the overall health of an organization through reimbursement, loyalty and outcomes. Furthermore, movement in organizations toward tackling the obstacles limiting exceptional experiences is gathering momentum, as evidenced by the addition of new patient experience leader roles at the senior leader level and additional dedicated employee and financial resources. One would expect a quicker pace in progress with these additional resources and increased knowledge gathered and shared within the industry.
At a recent conference, I heard numerous references to the human-centered experience versus the commonly used patient-centered experience terminology. I gave this phrase significant consideration over the following days. Using this phrase makes sense, as this language challenges us to remove the patient label from those we serve. This shift reminds us that we are interacting with another human being and not simply managing a patient or condition. Looking only at an individual as a patient prevents us from looking past the disease, condition, treatment, or service into the space that supports the entire human being. Improving the patient experience is a delicate balance between embracing standardization and data analysis while maintaining a laser focus on the individuality of every person receiving care or services.
To that extent, the body of knowledge for the patient experience is growing immeasurably. The following authors present information to further patient experience knowledge, encourage future research, and promote dialogue about challenges to meeting patient and family needs while also supporting those providing care. The topics include measurement concerns, nurse engagement, nursing home resident satisfaction, nursing professionalism, and internationally educated nurses’ contribution to the patient experience.
Berkowitz provides an overview of numerous research articles supporting the complex systems organizations are struggling to manage in relation to quality measures, patient experience, and patient satisfaction. In the article, “The Patient Experience and Patient Satisfaction: Measurement of a Complex Dynamic,” Berkowitz illuminates a multitude of factors patients use to develop their perception of quality of service and overall satisfaction. Consequently, measurement challenges exist given the exhaustive list of factors affecting perception of quality and service. The author provides conflicting views of the appropriateness of holding physicians accountable to patient satisfaction measures as well as the impact that nurse burnout, a positive work environment, and care coordination have on patient satisfaction.
Correlations between nurse engagement and safety, quality, and patient experience outcomes were noted and discussed in the article, “Nurse Engagement: What are the Contributing Factors for Success,” by Dempsey and Reilly. Nurses play a significant role in many patient care services; therefore, the manner in which nurses view their commitment to that role and the manner in which they perform duties within that role influence patient outcomes. The authors deliver compelling information about the importance of an engaged nursing workforce for an organization, including financial return on investment from the human resources perspective and the patient satisfaction perspective. Additional information on compassion fatigue and burnout, and prevention of these phenomena, conclude the article.
The experiences of 96 residents were studied by Tappen in the article, “They Know Me Here: Patients’ Perspectives on Their Nursing Home Experiences,” providing a rare look at potential predictors of satisfaction in the nursing home setting. In this study, residents were asked to provide comparisons for their stays in a hospital and the nursing home with clarifying comments about their preferred choice. Strong emotional responses were noted when discussing their experiences versus their conditions. Both positive and negative themes emerged for the hospital and the nursing home. A significant concern arose regarding understaffing and the value of the RN in the nursing home. The author continued to discuss recommendations for improving the experiences for the residents in the nursing home. The findings of this study align with previous research studies about the primary needs of the nursing home population.
Nursing professionalism encompasses many aspects, one being appearance. Geisinger Health System in Pennsylvania recognized a decline in the professional appearance of the nursing staff and raised concerns about how the decline might negatively influence the patient experience and patient perception of the quality of care. The authors, West and colleagues, chronicle the Geisinger journey to better understand the patient perception about the professional image of nurses in “Contributing to a Quality Patient Experience: Applying Evidence Based Practice to Support Changes in Nursing Dress Code Policies”. The journey begins with a thorough literature review and continues with an outline of the survey development and research process ultimately leading to an evidence-based dress code policy revision. The authors further discuss challenges faced throughout the project and next steps for Geisinger Health System as they continue to strive toward supporting an exceptional patient experience.
Recruiting nurses from other nations is a common practice today as a means to closing the nursing shortage gap. In the article, “Internationally Educated Nurses’ and Their Contribution to the Patient Experience,” Njie-Mokonya specifically addresses this practice for internationally educated nurses (IEN) in Canada. Furthermore, the author discusses the unique value IENs provide to the patient experience in a culturally diverse patient population. A key value contribution identified in the study was IENs’ fluency in other languages; thereby, assisting in better communicating the patient plan of care and decreasing anxiety for patients who speak a foreign language. Ultimately, IENs can assist in providing an improved patient experience through the provision of culturally competent nursing care.
These articles offer a wide perspective about the patient experience, a complex and sophisticated phenomenon of increasing importance to every nurse in practice. The journal editors invite you to share your response to this OJIN topic addressing the Patient Experience, either by writing a Letter to the Editor or by submitting a manuscript to further the discussion of this topic initiated by these introductory articles.
Julie A. Becker, DBA, MBA, RN
Julie Becker is the Chief Patient Experience Officer (CXO) for Lovelace Women’s Hospital in Albuquerque, New Mexico. Previously, she worked for Wheaton Franciscan Healthcare starting her career in 1999 as a bedside nurse. Over the next 15 years, she served in numerous leadership roles including Patient Care Manager, Director of Patient and Family Relations, and the first Vice President, Patient and Family Experience for the Wheaton system. In 2011, she received her MBA in Organizational Development and her Doctorate in Business Administration specializing in Leadership in 2013.