Last month, leaders at the Boston- and Chicago-based Press Ganey Forsta shared results of a nationwide survey of health system leaders entitled “The State of HX Healthcare: Insights and Stories from the Data.” The report was prepared by Neil Buhlman, chief administrative officer and head of strategy at the firm.
Press Ganey’s senior executives report that, since February 2023, they’re observing a steady rise in patient experience scores– nearly reaching pre-pandemic levels at the end of 2023. This includes the likelihood to recommend a hospital, plus multiple key indicators such as doctors/nurses treating you with courtesy and respect, and discussing new medicines and possible side effects etc.
Looking at the elements behind patient experience ratings, Press Ganey’s leaders report that their survey of employees and physicians has found that employee and physician engagement in their jobs and organizations has been rising, after falling broadly over the past several years. On the employee side, on a scale of 1 to 5, engagement has moved from 4.14 in 201 to 4.12, 41.0, 4.09, 4.02, 4.02, and finally at the beginning of this year, 4.04 again. On the physician side, the annual numbers were 4.06, 4.04, 4.85, 4.11, 4.01, 3.98, and 4.00.
On the employee side, there has been a persistently large gap between the least and most engaged employees in patient care organizations, from a spread of 3.86 to 4.35 in 2018 to an even larger gap in 2024: 3.70 versus 4.37.
The good news: in measures of “activation,” gains have been made in the following areas: “see patient as an individual person” (+0.1); “care for all patients equally” (+0.2); “work is meaningful (+0.3); and “work makes a difference” (+0.3). In measures of “decompression,” the gains have been even stronger: “enjoy person time without focus on work” (+0.5), “disconnect from communications during free time (0.6), “rarely lose sleep over work” (0.7), and “able to free mind when away from work” (+0.8).
Average national safety culture scores gauged by employees have also improved nearly across the board: “safety culture overall” has rebounded back to 4.01 after dipping two years ago to 3.96; “prevention and reporting has risen to 4.37 after dipping from 1.4 in 2018 to 4.11 in 2021; “resources and teamwork” has rebounded back to 3.74 after dipping in 2021 to 3.76; though “pride and reputation remains a bit lower than in 2018, at 4.13 versus 4.21.
Many subthemes also emerged in the report: one example is around “strong leader-employee relationships,” which were associated with lower staff turnover. Where the “leader index” was rated as “high,” the average turnover rate was 16 percent; where it was rated as “moderate,” the turnover rate was 20 percent; and where it was rated as “low,” the turnover rate was 23 percent.
Shortly after the survey results were made public, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Deirdre Mylod, executive director at the Institute for Innovation and senior vice president of research and analytics at Press Ganey Forsta. Below are excerpts from that interview.
What is the timeframe in terms of when the survey responses were gathered?
Most organizations are surveying continuously. This reported reflected data over the last four or five years—continuous data. We usually process about 1.5 million inpatient surveys and 5 million medical practice surveys per year.
And why are patient experience scores improving?
Typically, we see patient experience scores getting a little bit better every year. What we saw when the COVID-19 pandemic hit, we saw an unexpected spike in people becoming more appreciate of their healthcare. I think there was fear and worry and also appreciation for what providers do. Then scores went down through 2020, 2021, and 2022; and now in 2023, they’re coming back up. And that initial spike of appreciation gave way to the realization that for the first time ever, it might not be safe to enter a patient care organization because of infection issues. And hospitals were using travel nurses significantly, and there were some dynamics there. And we saw a rise in instability among patients, we saw some violent crime; we had a rough few years.
But now, the environment is less tense, and even violent crime is going down. And most organizations no longer have mask mandates. And I’m very pro-mask, but mask mandates just set up a potentially antagonistic climate. And most hospitals have really enhanced their focus on patient safety and quality and employee wellness. And organizations have gone back to basics, but with a really strong human connection. So that’s a lot, but we think that’s what’s behind this rebound of patients have better experiences.
Is the fact that hospitals are pursuing patient engagement and patient experience consciously, making a difference?
Yes, I think so, and keep in mind that the first chief patient experience officer was appointed more than ten years ago. And even if there isn’t someone with the chief patient experience officer title, that idea is coming into the equation. And people are coming in from patient safety, from quality, from nursing, and so on. What matters is that they’re being integrated with other silos, including the chief diversity officer, for example. And they learn how to create a high-reliability culture. And organizations that leverage that are really advancing the patient experience. So it’s less about whether the person came from a patient safety or nursing or marketing background, but whether they’re integrating the concepts of high reliability and wellness into the patient experience.
Where are hospitals making mistakes, and where are they making gains, in this area?
I think one mistake—twenty years ago, we talked about patient experience as patient satisfaction. And that was before To Err Is Human. And it’s still a mistake to focus on superficial happiness; and twenty years ago, you would hear, how do we delight patients, and how do we create a “wow” experience? Patients don’t want that. The organizations that are doing well—the survey questions ask, do you get the information you needed, were you respected, did you have a good discharge experience. That’s not, did you like it? It’s what kind of experience did you have? Are we reliably delivering safe care, high-quality care, and compassionate care? If you go talk to staff and say, we want to make patients happier, that’s not inherently motivating; creating a safe, high-quality experience is.
Surveys 30 years ago were so focused on hospitality issues. Has that changed over time?
Twenty-five years ago, there were three or four questions about your food, and five questions about your room; but there were a lot of questions about the nurses and doctors, etc., even then. But people tended to focus on hospitality issues, the icing on the cake. And hospitality still has a role, but in service to reducing patient suffering, not as a substitute for high-quality care. Hospitality has a role, but it should no longer be a distraction to delivering high-quality, safe, compassionate care.
The old-fashioned brand loyalty is not going to help hospitals much any longer. Are hospital executives aware of that?
Hospital executives understand that they have to earn and re-earn loyalty with every interaction; it’s not just a carryover from last year. They know that they have to keep delivering on their brand promise. And we think of two frames. One has to do with teamwork among clinicians, etc., and something having to do with clinicians listening to you. You deliver on what matters most, to optimize trust. Nd then we have to create ease and reduce friction: don’t make people wait, don’t make it hard to schedule online, etc. Delivering on what matters most to create trust—that’s what delivers loyalty; but you’ve got to keep doing it. And they’re being much more flexible about how they use technology to help them to deliver on trust and ease.
The digital front door concept is animating a lot of work around patient and family satisfaction now. Is that concept influencing how everything is put together? One thing that our reporting is validating is that health system leaders are realizing how challenging it is to organize everything “behind” that front door.
I love that you pointed out the door is not the whole thing. The door is just the door. In terms of getting people to the front door, a lot of how we support organizations—people want to know where to go. They look at ratings. So we help people look at their data. And they publicize their own data. And so they’ll have hundreds of responses on one particular physician, not just a couple of comments. And they’ll try to achieve consistency of data presented on the web. And that consumerism data is usually incorporated into a find-a-doctor website, how to schedule, etc. But it starts with consumers having a need and searching. So how do you make it easy for them to find information? To choose you? To schedule? Once they’re there, though—we have a partnership with Epic, and we’ve created together with them a predictive rounding tool. A leader rounding in the inpatient setting. This tool looks at administrative data and your identity information and clinical information, and whether you’ve completed surveys in the past—to find out which patients are at risk for not having their needs met. So this tool proactively identifies patients at risk for not having their needs met. For example, Northwell has a predictive AI tool for predicting who doesn’t need their vitals taken during the night—so those patients can sleep.
We’re headed towards a much more holistic view of the patient, right?
Yes. We know who’s coming into our house.
How will this landscape change in the next few years?
What won’t change is that patients come into healthcare at their most vulnerable moment, and fearful over what’s happening to them, and they need safe, high-reliable care. That won’t change. What will accelerate is how technology and AI will make it easier for staff to deliver care and to deliver good experiences for patients, to create ease and deliver on the things that matter most to patients.
Is there any explicit advice that you’d like to share? What should senior leaders at patient care organizations be doing?
Start by leveraging high-reliability skills: the things you leverage for the culture of safety are really good for everything. And listen to your frontline workers; that’s how organizations survived COVID. And those two things will allow the patient experience to be better. And then your staff know they’re part of that solution.
