Academic journal article Online Journal of Issues in Nursing

The Patient Experience and Patient Satisfaction: Measurement of a Complex Dynamic

Academic journal article Online Journal of Issues in Nursing

The Patient Experience and Patient Satisfaction: Measurement of a Complex Dynamic

Article excerpt

Measurement and understanding of the patient, caregiver, and family experience of healthcare provides the opportunity for reflection and improvement of nursing care and patient outcomes. The concept of patient experience, however, is surprisingly complex. Were it not for the mandate to report on the metrics of the patient experience, we may have continued to value the concept but avoided the challenge of precision and definition around the term. Instead, as noted in a brief from the National Quality Forum, nursing leaders have put patient experience first on their list of organizational and patient care priorities (National Quality Forum, 2011).

Over time there has been a regulatory and clinical care response to the concept of patient satisfaction and patient experience. We often measure patient satisfaction but the satisfaction score is based on many factors that a patient experiences before, during, and after an episode of care, along with characteristics of the care environment.

Nurses, the primary caregivers in all health promoting environments, including hospitals, clinics, and community settings, have responded in various ways to regulatory and clinical mandates. The purpose of this article is to describe the concept of patient experience and its impact on patient satisfaction within the contextual framework of payment systems for quality and the challenges of measurement, such as lack of consistent terminology and multiple contributing factors. A brief review of selected literature can help readers to appreciate how these challenges may contribute to the complexity of measurement. Finally, several examples from clinical practice will consider regulation, organizational environments, and research that can offer clarity around important factors that impact a patient's experience and subsequent satisfaction with the provision of care.

Patient Experience and Payment Systems for Quality

A confluence of policy priorities, stimulated by the Affordable Care Act (ACA: Office of the Legislative Counsel. 2010) and the Centers of Medicare and Medicaid Services (CMS) Quality Strategy (2013). has brought a focus on the need to deliver care that provides a quality patient experience within healthcare systems. For example, the CMS Quality Strategy (2013) identified six priorities that include: making care safer; ensuring individuals and families are engaged as partners in their care; promoting effective communication and coordination of care; promoting prevention; working with communities to promote healthy living; and making quality care more affordable. To incentivize health systems to implement these goals, CMS created ways to reward innovation related to how these strategies are implemented across health systems. Each of the six priority areas within the CMS Quality Strategy (2013) is an opportunity to engage patients, caregivers, and families, thereby bringing the experience of care into the quality equation.

The Affordable Care Act (Office of the Legislative Counsel, 2010) called for provisions that would improve outcomes of healthcare through a series of requirements designed to assure quality reporting for such processes as effective case management, care coordination, chronic disease management, and others. Thus began a major focus on the development of measurement sets designed to collect and report on the quality of evidence-based clinical care within healthcare institutions. Not only would the system measure quality, it was designed to eventually reimburse services based on quality outcomes. The initial set of measures for the provision of care to Medicaid-eligible adults was issued in 2010 (Federal Register, 2010) and included a category of measures titled "Family Experiences of Care."

As the provisions of the ACA (Office of the Legislative Counsel. 2010) have become integrated into regulation within health system reform and into care environments themselves, more specific measures for the concept of patient experience have been developed. …

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