Doctors increasingly shut out of hospitals' patient experience efforts

As hospital and health systems examine how to improve the patient experience, one prominent constituency increasingly is not being considered to lead the effort: physicians.

Only 3% of executives in a May survey by the Beryl Institute, a patient experience advocacy organization in Bedford, Texas, said physicians or other clinicians held primary responsibility and accountability for addressing the patient experience. Even fewer, 1%, said chief medical officers were in charge, while 14% said chief nursing officers were. The most common form of patient experience leadership was committee, cited by 26% of executives, followed by a dedicated patient experience executive, cited by 22%.

The patient experience, a set of protocols designed to increase patient satisfaction and outcomes, continues to gain more traction as payment is increasingly tied to quality.

While patient satisfaction refers to what patients think about their treatment, the patient experience focuses on establishing protocols for care coordination, communication with caregivers and staff responsiveness.

Committee members or patient experience officers could be physicians. The study does not break down the level of physician participation in those roles. When hospitals began to launch patient experience efforts in the last few years, they tended to put doctors in leadership positions, said Jason Wolf, PhD, president of the Beryl Institute.

But that has changed, he said. Hospitals are determining that a medical degree wasn't a necessary prerequisite to study all the interactions that take place from patient check-in to discharge, and that doctors are willing to follow recommendations from a nonphysician experience officer.

“The prevailing wisdom has been in order to get [doctors] on board, [the chief experience officer] must be a physician,” Wolf said. “But physicians are intelligent people, and they will listen to others who aren't their peers in terms of health care and well-being.”

Some executives believe physicians aren't on board with patient experience efforts, according to the Beryl Institute study. The survey of 1,072 executives at 672 organizations found that 29% believed that lack of support from physicians was a major roadblock to improving the patient experience, up from 25% from a similar Beryl Institute report in 2011.

Any suspicion by doctors about patient experience efforts is not necessarily misplaced, said Reid B. Blackwelder, MD, a family physician in Kingsport, Tenn., and president-elect of the American Academy of Family Physicians.

“Patients shouldn't have an experience,” he said. “They have problems that need to be solved. This is not like Disney World. This is about safety and outcomes. The phrase is too slick and avoids what it's about, which is we take care of [patients] and minimize the risks.”

Team effort

The move away from physicians is driven by the idea that improving the patient experience is a team effort, Wolf said. It begins when patients check in, with physicians being only part of that, although they are key to the process, he added.

Dr. Blackwelder said he agrees that all team members should contribute to ensuring a positive outcome for patients. But he said the doctor is the most critical factor. He added that he doesn't believe hospitals and health systems need patient experience administrative positions.

However, hospitals are adding them. In 2011, only 14% of respondents said there was a dedicated patient experience officer, according to the Beryl Institute. That is in line with more hospital and health system executives saying they have a formal definition of the patient experience, up to 45% in 2013 from 27% in 2011, and more saying their hospital has a formal mandate for that effort, to 81% in 2013 from 69% in 2011. The most common problems patient experience leaders encounter are noise reduction, discharge processes, rounding, pain management and general communication issues.

Although doctors were cited as a roadblock, more hospital executives cited other reasons patient experience improvement efforts might be struggling (they could cite more than one problem). The most common issue, at 48%, was that patient experience leaders were “pulled in too many directions.” Forty-six percent said other organizational priorities were reducing the emphasis on patient experience. And 42% said a “general cultural resistance to doing things differently” was a barrier.