4 Tips for Deciding Your Patient Experience Survey Themes

How do you decide what to ask in your Patient Experience survey, when it could be anything and everything?

Here are a few things to keep in mind:

  1. Your patients have physical, emotional and personal needs and often rely on support from caregivers. Capture enough of your patients’ need areas and don’t forget to measure caregiver thoughts.
  2. Your purpose or how you’re going to use your measurement outcomes. Ensure that you are able to relate outcomes to your KPIs.
  3. If you’re thinking about benchmarking, keep your questions aligned with best practice and make sure your sample is representative of the patient demographics that come through your door.
  4. If you want richer insights into patient experience or stories to alert or encourage staff, then identify what patients feel are the most important aspects in their experience of your healthcare setting, and seek specific information around that.

We looked at outcomes from a 2009 research report by The Kings Fund around patient ratings of aspects of inpatient care, and, a recent 2015 report by Deloitte that looked at the patient experience link to profitability. Here are our observations:


The Picker Institute (Europe) also identified that, how nurses and doctors interact with patients was a key determinant of overall satisfaction with care; and in particular, how coordinated their efforts were and whether they treated patients with dignity and respect.

Here are *14 key patient experience themes that healthcare settings use in their surveys, in a quest to measure the ‘right’ things:

Communication with doctors and nurses Confidence and trust in health professionals
Compassion and empathy Involvement in treatment decisions
Responsiveness of hospital staff Coordination and Integration
Emotional support – relieving fear and anxiety Being treated with dignity and respect
Involvement of family and friends Pain management
Cleanliness Quietness
Discharge processes Post-discharge

So start here. Start right. And you’ll be well on your way to getting impactful outcomes.



*based on HCAHPS (US), Picker (Europe) and NHS (UK) domains

Core Domains for Measuring Inpatient Experience of Care 2009 – The Picker Institute Europe

Patient Engagement and Their experience: The Virtual Touchpoint, 2012 – Tower Group Whitepaper

The Value of Patient Experience 2016 – Deloitte Report

The Point of Care Measures of patients’ experience in hospital: purpose, methods and uses, The Kings Fund 2009

Six Stages of Measuring Your Patient Experience

In our mission to serve the lives of millions in healthcare, I am often asked to speak at conferences, share my ideas, interview hospital CEOs as well as connect and collaborate with healthcare experts and Patient Experience (PX) champions.

A key lesson I’ve learnt is the need for healthcare providers to understand how to measure their patients’ experiences, based on their stage of Patient Experience maturity.  Measurement is crucial – you can’t manage what you don’t measure.

We therefore developed our 6E framework, a step-by-step guide to understand and holistically improve patient experience. It touches first on Experience – measuring it and verifying it, through a range of research activities.

If you’re just starting out in PX, mapping the patient journey is your first step. Ensure you talk to clinicians, non-clinicians and patients to map the journey.  Consider using researchers posing as patients (like a mystery shopper) to understand key steps and challenges. Then develop a survey to measure current patient satisfaction for each stage of the patient journey you’ve mapped out.

If you have a patient satisfaction survey, but not getting information you need, review the patient journey (or ‘shadow’ a patient) and determine what factors influence satisfaction at each stage of that journey. You may need to tweak your questions, or consider the timing of the survey.

Dell Children’s Medical Centre found survey responses were neither timely nor representative. They shortened their survey and gathered information real-time (at the completion of patient consultation). Their response rate increased from 30% to 50%, they identified the need for a more child-friendly atmosphere and an information brochure for patients, and rectified a patient/staff safety issue. They formed a PX committee aimed at completing one new improvement project every month. (Beryl Institute)

If you’ve been surveying PX for a while and now require more context, consider holding small discussion groups of 6 to 8 consumers (focus groups) to get further insight into their sentiments, attitudes and perceptions.

If you feel you are getting the insights you need, consider asking the ‘quiet’ consumer (who may have low literacy, or are reluctant to share views in a survey) via small focus groups or one-on-one conversations, which are less intimidating.

If the challenge is linking PX outcomes to business outcomes, are you mapping and measuring the right element of the journey? For instance, a healthcare provider seeking to drive growth of their maternity services, will need to ensure they understand which elements of care during pregnancy, childbirth and follow up, have the strongest impact on new mother’s satisfaction level. (http://healthcare.mckinsey.com/measuring-patient-experience-lessons-other-industries)

If you’re looking to integrate continuous improvement into your PX management, consider use of PX technology providing real-time feedback, granular outcomes and data integration, to collate survey outcomes, for view and use by all staff in your setting. One of the technologies that does that well is called MES Experience.

Wherever you are in your PX development, we would love to hear your story, so drop us a line and you could be featured in our next blog.

A step-by-step guide to improving patient experience for PX champions

Are you interested to hear from patient experience champions on best practice strategies to improve the levels of patient satisfaction?

Improving Patient Experience and Choice held in Sydney on 10 – 11 October 2016, is a premier two-day forum bringing together key stakeholders from Government, Health Districts, Hospitals and Health Care Providers.

My company Energesse is happy to be the Knowledge Partner at this event. In line with this, will be chairing Day 1 of the conference and will also be leading the workshop:

The 6 E Framework

A step-by-step guide to improving patient experience for PX champions

This workshop presents the 6 E Framework, a step by step guide on how to holistically improve patient experience, adaptable for any healthcare setting. This workshop will provide you with tools and techniques that you can use immediately.

improve px

With the UK’s NHS Head of Experience of Care, David McNally, and other C-Suite Executives, Directors and Leaders in Patient Experience speaking at this event. This two-day forum is a timely event for you to develop strategies and share expertise on improving patient experience and choice in Australia.

Here’s a sneak peek at other program highlights

International keynote:

  • David McNally, Head of Experience of Care, NHS England

Patient-centered culture and care

  • Carrie Marr, Chief Executive, Clinical Excellence Commission
  • Robin Whyte, Chief Executive Officer, Eastern Melbourne PHN
  • Rene Pennock, Chief Executive Officer, South Western Sydney PHN

The final early-bird ends this month, 30th September 2016 (Friday).   You may also avail of group discounts, call 02 9368 3915.

Hope you will join me, David McNally, Jean-Frederic and other leading patient experience professionals from Australia in October – for an unrivalled networking opportunity and unprecedented access to Australia’s leading patient experience champions.

If you wish to have a chat before the workshop, I’d be happy to get on a call. Drop me a note at avnesh@energesse.com or call 02 8091 0918.


‘E-Framing the Patient Journey’

Based on a True journey.

A friend, on holiday in Christchurch, broke her toe. Luckily, it was her fourth toe. Unluckily, her companions were one high-maintenance 4 year old and two suitcases. It was, bluntly, crap timing. Hobbling about, she headed to a clinic.

After a long wait, the nurse was brisk. Her toe was examined and it was explained to her that she would only get an x-ray if the doctor deemed it necessary. It was also explained that the reason for this is that the treatment would be the same whether or not the toe was fractured.

Waiting room number 2.

The doctor greeted her but faltered at her name. No, she didn’t have one of those long unpronounceable Indian names; it was just misspelled on the system.

The doctor laughed and shook his head, apologizing for his frontline team.  ‘Sorry. Kiwis can’t spell. My wife is a Kiwi, she’s terrible at it.’

‘I know!’ my friend agreed, quipping, ‘Spelling is the only time I feel like I don’t fit in as a Kiwi!’ Laughter and chatter ensued.

He got down to business, examined her toe, and ordered an x-ray. He reiterated what the nurse said about the treatment being the same either way.

Waiting room number 3.

It took 3 tries before the radiographer could locate the injury, and identified as being on the distal end (top part) of the fourth toe.

Waiting room number 4.

Fracture confirmed, the doctor asked about her activities over the next few days, whether she wanted her toe braced or strapped up for more comfort, and offered her crutches. Instructed to raise her feet while sitting and take painkillers when necessary, she thanked the doctor and left the clinic.

Let’s look at this patient journey through the lens of our 6E Framework:

This was a simple journey, yet one that could be measured.

There were parts of the Experience that were long and potentially frustrating (waiting times) and parts that had alignment and clarity e.g. the initial nurse assessment, the first consultation and differential diagnosis by the doctor, the confirmatory radiological investigation and then the final diagnosis and management plan by the doctor.

There would have been Emotions associated with waiting times and administrative mistakes (data entry errors), but there was humour and there was reassurance. The doctor displayed Energy in his engagement – he conveyed empathy with the patient, and communicated the treatment plan well, he knew his purpose and seemed personally satisfied with his work.

There was sufficient time spent in Execution (radiographer’s persistence with protocol and multi-disciplinary assessment (alignment of nurse’s communication with the doctor’s treatment).

My friend walked away from the clinic, satisfied. She felt like an individual. She connected, in a human way, with the doctor. She could see the team (nurse, doctor, radiographer) all working toward her diagnosis. As a result of their excellence, she wasn’t very frustrated with the four (!) waiting times, her misspelled name nor the pain she came in with.

In this case, as in many others, Excellence was defined by the patient, not simply by the providers.

In fact, I don’t think she cared to remember any lack in the clinic’s systems.

To her, the patient experience trumped the patient process. Herein lies the potential for Evolution in the patient journey.

To find out more about the 6 E framework for improving the Patient Experience, feel free to drop me a line.


It’s Not What You Think About Them. It’s How They Feel About You.

Walk into a healthcare boardroom and you’ll find C-suite managers poring over hard data reports, analytics that tell them that, mostly, all patients are happy with them, all KPIs have been achieved. Shimmy up to the nurse manager on duty, and you’ll find out that she’s weary but yay, three patients have been discharged (including the one with the demanding hubby), so it’s all good. Take the lift down to reception, and they’ll tell you different tales of woe and wonder. Why don’t these stories always align? After all, there is a myriad of measurement taking place – statistical data, patient surveys, focus groups, patient emails, improved processes and tools….

Creating a true, holistic picture of the patient experience is challenging. The disparate pieces of research that take place in a healthcare setting don’t always fit together or come together. Staff are listening to differing views, reading contradictory reports and acting on different outcomes and priorities. Indeed, in a 2015 patient experience survey of 1561 respondents from healthcare settings in over 21 countries, less than half had actually formally defined patient experience for their organisation (Beryl Institute).

Our 6E Framework aims to improve patient experience by offering healthcare settings a step-by-step guide on how to produce this true holistic picture. It not only gets you thinking about mapping the patient journey and uniting the disparate pieces of data that is collected throughout your setting on this ‘journey’ (EXPERIENCE), but it ensures the encapsulation of ‘patient stories’ and patient feelings (EMOTIONS) to build one clear purpose for all staff to follow (ENERGY) in improving the patient journey. It helps you develop an accurate strategic plan and implement solutions (EXECUTION) and ensures you measure and repeat your successes (EXCELLENCE). Ultimately, the framework develops your organisational capability in patient experience (EVOLUTION).

The Hertfordshire Partnership University NHS Foundation Trust and Leeds Community Healthcare NHS Trust are examples of healthcare organisations that benefited from sound advice with improving their patient experience:

  • Response rates quadrupled, covering more age, gender and ethnicity groups.
  • Solid mapping and measurement of patient journey elements allowed for immediate implementable strategies – many as simple as the need to disseminate more information or provide further explanation to patients – to address concerns and issues.
  • When the patient experience measurement was repeated within the same year, the level of patient satisfaction had significantly increased – doubled and tripled in some cases!
  • In the Hertfordshire case, in some wards, 100% respondents felt listened to (up from 54%).

Patient Journeys. Emotions. A Team Living Its Purpose.

For some, these are soft, soppy, intangible metrics to measure. But for those in the industry of caring, there’s no denying its culture-changing results at the front-line.

The Process Manager, Efficiency Manager or the PX Champion – Which Type Are You?

A lady walks into a hospital. She winces, rubbing her arm then kneading it gently. She approaches reception. She sighs and scribbles what she needs to on a form and is then motioned into the waiting room. She scurries up when she hears her name and disappears into a consultation room. Two days later, she walks out to a waiting car outside the hospital. She’s not rubbing her arm anymore.

If you ask a hospital manager what they think about the above scenario, and their focus is process rather than patient experience, they would probably measure success as a patient’s condition resolved, her details recorded on the right forms and the availability of a hospital bed (length of stay) as a result of that problem resolution.

Turn now to the healthcare center whose focus is patient management and efficiency; they would ensure that the effectiveness of every step of the healthcare process – from the patient arriving at reception to patient discharge – is measured and efficient from a time and activity perspective.

Now question the healthcare center whose focus is the patient journey. They would do all of the above, and more. They’ll wager their time to understand and measure the ‘winces’, the ‘sighs’, the ‘scurry’, the manner in which the patient ‘walks out to the waiting car outside of the hospital.’ They ensure the right questions are asked of the right people at the right time. They would also very likely follow-up with her after discharge to ensure her safety and service satisfaction. For these healthcare centers – the Patient Experience (PX) champions – the patient is at the very center of the care they receive.

The focus would be:

  1. Did the patient require help filling out the form (was there a physical pain or language barrier) VS. did the patient fill in the form we need them to fill in?
  2. Did the patient understand what the doctor was saying VS. did the doctor explain everything to the patient?
  3. Did the patient experience compassion and empathy during treatment VS. were staff able to treat the patient in a professional and timely manner?
  4. Were the family members reassured about the patient’s situation VS. were the family members informed about the patient’s situation?
  5. Is the patient able to perform well at work and at home in the days and weeks after discharge VS. was the patient followed-up with the day after discharge?

Taking a holistic view, the PX champions would also ask staff, if they were making a difference, if they felt resourced, supported, celebrated and if they felt like they had meaning in their work i.e. ‘living their purpose’ ?

Understanding the various elements that comprise the patient’s journey and then measuring each element of that journey, is what separates the wheat from the chaff, the top performing healthcare centers from the average ones.

Many are now riding the wave of PX trends. A 2013 survey of management committees in more than 1000 hospitals conducted by Catalyst Healthcare Research and the Beryl Institute, found that 70% of respondents ranked ‘patient experience and satisfaction’ as one of their top three priorities over the next few years – it exceeded cost management, capital improvements, HR and healthcare processes. The survey also found that more and more healthcare centers were delegating this very important area to dedicated experience leaders.

What kind of healthcare leader would be more meaningful to you?

Election Policies Need to Put Patients First

The Australian Federal Elections are drawing near. The Conservatives and the Labour Party are once again pitching their wares – fighting it out on who has the best health policy. Amongst the spouted sales spiel and all its nation-centric statistical data, the patient’s (what the policies are/should be ultimately all about) voice is lost.

A recently released book on ‘Patient-Provider Communication’ (Blackstone, Beukelman and Yorkston, April 2015), noted ‘that patients, health care providers, policy makers, and researchers live in nearly parallel universes with differing incentives, access to data and information, accountability expectations, and time frames for action’. What this alludes to is the potential for differing visions in patient healthcare, experiences and communications – resulting in a potentially disparate state of affairs.

What if patient experiences were given a larger focus in the formation of national health policies? How much more refined would policies be? Undoubtedly, communication between patients and their clinicians/hospital management will have more prominence in local and national policies. And from high-level policy to on-the-ground realities, issues like how to better communicate with the patient over things like a treatment or healthcare plan would get the attention it so rightfully deserves.

In my recent trip to the Beryl Institute Conference in Dallas, I had the good fortune of meeting with Dr. Tom Scaletta and Julie Danker – who lead patient experience initiatives at the Edward-Elmhurst Hospital – and found out how they manage patient communications. Regarded as one of the leaders in this space with their G.R.E.A.T. coaching techniques, they imparted practical insight into communication and engagement techniques that can help patients and clinicians.

Here are some key takeaways from them:

  • Contact patients the day after ED discharge – it keeps them safe and satisfied
  • Engage patients digitally – it reduces cost and increases reach
  • Automate work processes – it allows charge nurses and case managers to efficiently intervene at the right points in the workflow process
  • Build in an automated response mechanism/module into your systems – it allows for the acknowledgement of compliments and resolution of complaints by ED leaders
  • Measure, measure, measure – use statistically-valid metrics and patient comments to drive provider performance. We can always keep improving.

If you want to know more, watch the video below from our Patient Experience Channel (or check out www.eehealth.org/great)