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Patient Experience Defined

Patient experience encompasses the range of interactions that patients have with the healthcare system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other healthcare facilities. As an integral component of healthcare quality, patient experience includes aspects of healthcare delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with clinicians and staff.

Understanding patient experience is a key step in moving toward patient-centered care. A common misconception is that patient experience and patient satisfaction are the same. They are, in fact, different. Patient satisfaction assesses patients’ expectations and whether those expectations were met. Patient experience considers whether—or how often—various aspects of care (such as clear communication with providers) occurred. 

By looking at the various aspects of patient experience, one can determine the extent to which patients receive care that is respectful of and responsive to individual patient preferences, needs, and values. Evaluating patient experience along with other components such as effectiveness and safety of care is essential to providing a complete picture of healthcare quality.

CAHPS Surveys Are Patient-Reported Experience Measures (PREMs)

There are many ways to gather information on patient experience, such as through not only CAHPS surveys, but also rapid-cycle surveys, focus groups, observation, journey mapping, and patient & family advisory councils. For their part, CAHPS surveys are critical tools for assessing the patient-centeredness of care and identifying areas for improvement. CAHPS surveys are among the most well-known PREMs, asking patients to report on aspects of their healthcare experiences that are important to them, and for which they are the best, and sometimes the only source of information. Because CAHPS surveys ask questions that have been tested using a consistent methodology, they are standardized, validated and reliable measures of patient experience. 

PREMs such as CAHPS surveys offer significant insight into patients’ perceptions of their healthcare experiences. Moreover, when used with patient-reported outcome measures (PROMs), they can provide a more complete picture about overall care quality.

Learn more about Patient-Reported Experience and Outcome Measures (PREMs and PROMs).

Learn more: How CAHPS Surveys Measure Patient Experience—An interview of Susan Edgman-Levitan, PA, Executive Director, John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital, and co-principal investigator of the Yale CAHPS team.

CAHPS Surveys Assess Important Aspects of Patient Safety

When patients share their experiences about their healthcare, they offer crucial insights about the safety of that care. Obtaining information from CAHPS surveys is an important way for healthcare organizations to hear from patients about patient safety and improve the safety of the care they provide. Lack of appropriate access to high quality care, good communication, cleanliness, care coordination, information during discharge, as well as lack of responsiveness to patient requests for help can lead to patient harm. 

In addition to CAHPS survey questions, narrative items allow patients to provide open-ended comments about their care experiences and are a valuable source of feedback to help improve patient safety and healthcare delivery. Examples of patient comments that identify quality and safety issues:

• Care Coordination: “The teams treating my child lacked communication amongst themselves and us, resulting in inconsistent approaches and inadequate information, and delay/improper treatment. Resident teams needed more senior supervision.” 
• Hospital Discharge: “Discharge instructions could have been clearer. I felt I needed to ask a lot of questions to get answers. Also, my son was discharged with a medication despite having an allergy [to that medication] documented in the medical record.”   

Relating Patient Experience to Other Quality and Patient Safety Measures 

A positive patient experience is an important goal in its own right. Moreover, substantial evidence points to a positive association between various components of patient experience, such as good communication between clinicians and patients, and several important processes and outcomes. These include lower utilization of unnecessary healthcare services; better patient adherence to medical advice; better process of care measures for acute myocardial infarction (AMI), congestive heart failure, pneumonia and surgery; lower inpatient mortality among acute myocardial infarction (AMI) patients; lower infection rates;¹ and better clinician and staff perceptions of patient safety culture.² 

Many factors other than patient experience can influence processes and outcomes. This is part of the reason why combining patient experience measures with other measures of quality is critical to creating an overall picture of performance. 

Learn more:

• CAHPS Surveys: Sorting Fact From Fiction—An interview of Rebecca Anhang-Price, Policy Researcher; Associate Director, Health Services Delivery Systems, RAND.
• —Audio interview of Susan Edgman-Levitan, executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital. Supplement to the N Engl J Med 2013; 368:201-203.
• Cleary PD. Evolving Concepts of Patient-Centered Care and the Assessment of Patient Care Experiences: Optimism and Opposition. Journal of Health Politics, Policy and Law 2016. 41(4):675–96.
• Shaller D. Patient-Centered Care: The Commonwealth Fund, October 2007.

^1. Anhang Price R, Elliott MN, Zaslavsky AM, et al. Examining the Role of Patient Experience Surveys in Measuring Health Care Quality. Medical Care Research and Review 2014 July. 71(5):522–54. 
^2. Sorra J, Khanna K, Dyer N, Mardon R, Famolaro T. Exploring relationships between patient safety culture and patients' assessments of hospital care. J Patient Saf 2012 Sep;8(3):131-9.