How Hospitals Are Trying to Improve the Patient Experience

During Covid-19, patient-experience ratings plunged amid staffing shortages, overcrowding and lockdown rules that barred families from the bedside. Now hospitals are adopting new strategies to help address complaints and service failures that can add up to a bad experience even when treatment is successful.

In addition to government-mandated post-discharge satisfaction questionnaires and other patient-experience surveys, hospitals are using new technology to identify issues in real time and fix them before patients go home unhappy. And they are drawing on expertise from the hospitality industry and other consumer companies for lessons on how to transform dissatisfied customers into loyal ones who will recommend the hospital to others.

“Consumer expectations are being set by industries outside healthcare, and the onus is on us to be better about meeting those expectations and finding where we can go above and beyond," says Heather Geisler, a former senior vice president of global brands for Hyatt Hotels who joined Detroit-based Henry Ford Health in 2020 as executive vice president and chief marketing and experience officer.

Hospitals have a strong financial and reputational incentive to improve the patient experience. The Centers for Medicare and Medicaid Services requires hospitals to administer standardized national surveys known as Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS. Results are posted on the agency’s Care Compare website, and Medicare rewards hospitals based on either how well they perform or how much they improve their performance.

Survey questions can’t show specific complaints, of course, but they often show up in comments patients include in their responses. Hospitals are now using machine-learning technology and artificial intelligence to analyze the narrative comments for patterns of failure—both in the surveys and in the hospital reviews patients post on social-media sites such as Yelp and Google.

Here are some of the top issues that hospitals are focusing on to improve patient-experience ratings—and the solutions they have found so far.

The food factor

Hospital food has long been the butt of many jokes, and it consistently shows up as a bad experience in satisfaction surveys.

“The conventional belief has always been that patients don’t go to hospitals because of the food, and we should just do what we have to do to feed them," says Northwell Health Senior Vice President and Chief Experience Officer Sven Gierlinger, who joined the 21-hospital system in 2014 with a résumé that includes eight years opening new hotels for the Ritz-Carlton hotel chain.

In Northwell’s patient surveys, some people downgraded what would have been a higher rating and stronger recommendation because of the food. “We could have super-caring nurses and competent doctors and excellent care, and then get dinged because of the food," Gierlinger says.

To counter those dings, more hospitals are hiring chefs, overhauling menus and steering away from overly processed foods like the standard lumpy mashed potatoes, gravy and mystery meat.

Northwell, for its part, has hired other professionals from the hotel and restaurant industries to run food services, including award-winning chef Bruno Tison, who had worked at the Plaza Hotel in New York and the Fairmont Sonoma Mission Inn and Spa in California. The menu was designed as “farm to hospital bed," refocused on fresh ingredients, hormone-free and antibiotic-free meats, line-caught fish and more plant-based menu items. The new approach also involved reducing salt and sugar, avoiding saturated fats, minimizing frozen and canned ingredients, and baking foods instead of frying them. During the pandemic, the only change was food delivered in disposable containers instead of China plates, Gierlinger says.

According to Gierlinger, Northwell’s quality-of-food national percentile rank jumped to the 84th percentile in this year’s first quarter from the ninth percentile in the third quarter of 2016. Costs increased by a maximum of only 2% each year.

At Henry Ford Hospital, nurses participate in taste tests of new menu items being prepared by hospital chefs, in a bid to make food a more positive part of the care experience. Nurses, who often are the ones to hear complaints or questions about the menu, “now can say these are some new things and they are great, I tasted them," says Geisler.

Keeping it clean

How patients feel about their environment figures prominently on satisfaction surveys, due in part to heightened concern over sanitary practices during Covid and fears of infectious-disease spread. “There is a fear factor with people’s concern about cleanliness, so when they see a bloodstain on the scrubs of a doctor or nurse taking care of them, it makes them feel unsafe," says Dr. Thomas H. Lee, chief medical officer at patient-experience survey and analytics firm Press Ganey and an internist and cardiologist at Brigham and Women’s Hospital in Boston.

UC Health’s University of Cincinnati Medical Center, a 726-bed hospital in Ohio, in late 2020 overhauled its approach to cleanliness, with a new “culture of clean" program that requires department leaders to go on patient rounds to observe cleanliness protocols—and ties a portion of their bonuses to cleanliness scores from patients.

Housekeeping managers use software to collect information from patients to make quick improvements to the cleaning service, such as immediately removing used linens left in patient rooms. The hospital also cut the ratio of patient rooms to housekeeping staff in half, with first-shift cleaners responsible for 14 rooms instead of 28, and added an evening turndown service. Its latest HCAHPS cleanliness scores are 69.5 out of a possible 100, up from 62.1 in the first quarter of 2020, says Rob Wiehe, executive vice president and chief operating officer for hospital operations.

R-e-s-p-e-c-t

Patient-satisfaction ratings are closely tied to issues such as how people feel they were treated by doctors and nurses. In an analysis of positive and negative insights from 175,334 patient comments collected at a major teaching hospital, Press Ganey found the most common positive theme across all comments was courtesy and respect. “If you don’t feel treated with courtesy and respect, you are never happy with care," says Lee.

At AdventHealth, a healthcare system with 51 hospitals in nine states, staffers attend Whole Care Experience training, learning how to engage with patients in difficult situations and convey courtesy, respect and empathy.

Staffers also go through simulations with actors posing as patients to help staff connect with patients, anticipate their needs and respond to concerns. Pam Guler, AdventHealth vice president and chief experience officer, says her team has learned lessons from Walt Disney World, where it provides healthcare services. The team has attended training sessions at the Florida theme park on service excellence and customer care, including how to anticipate needs and interact with families.

Skills practice labs for staffers include how to acknowledge and apologize for an issue, explain what they will do to correct the situation, and then act on it.

The communication barrier

Closely related to courtesy and respect are complaints about communication—whether doctors and nurses explained things in a way patients and families could understand, and explained the reason for new medicines and possible side effects.

Cleveland Clinic, with 18 U.S. hospitals including its main Ohio campus and two overseas, holds daily plan-of-care visits at the patient bedside including doctors, nurses and any other staff involved in care, asking first what matters most to the patient and family.

Dr. Leslie Jurecko, chief safety, quality and patient-experience officer, says the visits “are the most impactful thing we’ve done in terms of improving the patient experience." and Cleveland Clinic now surveys patients on whether the bedside visit took place and whether it helped them understand their plan of care.

Patients get explanatory cards about what to expect with the plan-of-care visit at the bedside, along with journals and notepads for patients to take notes or write questions for the team. Cleveland Clinic also uses volunteers, including former patients, to help educate patients about the visits.

Among those volunteers are Mike Nall, who has been hospitalized at Cleveland Clinic several times, and his wife, Vicki. They tell patients of his hospitalizations, including for a heart attack, empathize with their uncertainty, and suggest they might want to use their cellphone to include a family member in the visits if no one is there at the time.

“Nothing is worse as a patient lying in bed or a family member than not knowing what is going on," Vicki Nall says. “When you can ask a doctor questions and the team gives you a feeling of empowerment, you can be your own advocate.

During the early stages of the pandemic, when plan-of-care visits had to be suspended due to supply issues with personal protective equipment, the visits were taking place only 48% of the time. That rose to 71% in 2021, and its most recent full month of data shows the visits taking place 86% of the time.

“When patients tell us on the survey their plan-of-care visit was helpful to them, they’re also more likely to give us top ratings for teamwork and communication with doctors and nurses, and they are more likely to recommend our care to others," says Jurecko.

Prepping for home care

Patient satisfaction is also closely tied to how well patients understand their care when they leave the hospital. Research has found that patients and their caregivers often feel ill-prepared to provide follow-up care at home, and that patients who don’t have enough information about their discharge plans are less likely to be satisfied with their care and comply with their instructions. They are also more likely to return to the emergency room.

“Patients need to know who to call, what to watch for, when to take their medications, and when people feel like they have a handle on that, it ultimately makes them feel safe and secure," says Susan Grant, executive vice president, chief experience officer and chief nurse executive at Wellstar Health System, which has nine hospitals in Georgia.

In May 2022, Wellstar started a virtual discharge process to improve the experience of patients, drawing on the success of virtual family visits during the pandemic. Once a patient is identified for discharge, a clinician rolls a cart with a video monitor into the patient’s room, connecting to a special discharge nurse who goes over the patient’s follow-up plan, care at home and medications. Family members can be linked into the video meeting if they aren’t in the room, and there is time for them to ask questions; the sessions take on average about 22 minutes.

In a pilot at its Wellstar Paulding Medical Center, 89% of patients reported favorable experiences with the virtual discharge process, according to Assistant Vice President of Patient Experience Dana Caviness, “most often stating they appreciated having all their questions answered and a clear understanding of how to manage their health."

Laura Landro, a former Wall Street Journal assistant managing editor, is the author of “Survivor: Taking Control of Your Fight Against Cancer." She can be reached at reports@wsj.com.