Physicians supporting a good patient experience of care

The Beryl Institute (2016a) defines patient experience as “the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care.”

Patient experience is an integral part of providing patient-centred care.  Physicians can support a good patient care experience from the time a patient picks up the phone to arrange an appointment through to the various interactions at the clinic and encounters with care providers, up to and including follow-up care.

The burden of illness

The burden of illness could vary from very simple and mild to very serious and emotionally traumatic. This also applies to illness types and unique patient characteristics. The illness experience could bring about emotional experiences such as shock, anger, anxiety, depression, and frustration. The onset of an acute illness may disrupt patients’ daily routines. Work may be affected. Depending on the patient’s stage of life, illness could affect their ability to care for their family, disrupt occupation or school attendance, limit social interaction, and alter plans and aspirations. Some diseases and conditions are an easy source of shame and stigma. It takes courage to present to the laboratory with a requisition for some blood tests.

In addition to these personal experiences, patients do not exist alone or in a void; they are part of social systems that include family, workplace, and community. The illness experience also affects the usual dynamic of this social setting and may create a ripple effect on family members, colleagues and others.  In addition to this, the negative economic implications of the illness could be temporary or permanent, opening up room for some socioeconomic difficulties. Where the patient is the breadwinner for the family, the illness experience may include fear of loss of productivity and the inability to provide for the family members.

To attend to the illness and carry along with the illness experience, our patients seek medical care to obtain answers regarding the disease and resolve essential aspects of the illness experience. A patient wants to know the diagnosis; they want to experience resolution of their ill health and need to be met with an understanding and empathic heart.  Patients have expectations that the health care provider should meet; they want to be listened to, have their fears allayed, and explore their hopes to improve their functionality and find ways to maintain the balance within their social milieu.

Poor patient experience of care worsens the illness experience. It heightens the burden of the illness experience and makes things worse for the patients. A patient who experiences poor care during access to the physician or health care facilities is more likely to complain to the College. It is often rewarding to patients to experience such excellent care and attention that they feel relieved with the experience afterwards, irrespective of the severity of their burden of illness.

Some best practices in patient-centred care

Physicians can support a good care experience at the entrance to care by reducing wait times and offering opportunities for same-day appointments. Patients will be relieved to access care sooner rather than later in our family physician and specialist offices, emergency rooms, and operating theatre for surgery. This will improve the timeliness of care and ease the anxiety that comes with the burden of illness.

Physician offices and hospitals should create a good, clean, esthetically pleasing, and friendly environment to welcome patients. Well-designed office space and hospital environment that produces a “wow” from patients will improve their perception of accessing reasonable, quality care. Such an excellent and welcoming environment should be supported with comfortable seats, charging ports, and electronic devices such as television or computers, which could deliver educational information while the patient is waiting.

There are great opportunities in current-day practice to utilize technology and artificial intelligence to support an outstanding care experience for patients. Physicians and physician leaders should explore current options and use state-of-the-art tools and facilities to make receiving care through our offices and hospitals easy, comfortable, and memorable. Physicians should pay attention to patient flow within facilities and ensure minimal time is expended during the visit by using appropriate human engineering and systems to manage the time spent at the physician’s office. Creating good access to care and reducing wait times within the office or hospital space will improve the experience of care received by patients.

Patients come into the visit with specific fears and expectations. During patient encounters, a physician should always use the patient-centred approach to understand the patient’s fears and expectations for a visit, allay their concerns, and, when possible, meet their expectations or communicate if those expectations cannot be met. Rushing through the visit and not listening to patient or family concerns degrades their experience and may lead to a negative outcome. Good eye contact, offering support, listening to patient concerns, and negotiating a common ground with their agenda all serve to improve the care experience. Simple things like providing a warm blanket, a snack vending machine close by, culturally appropriate eye contact and touch, comfortable hospital beds, and bathing and toilet facilities may look insignificant but improve the care experience.

Patients also receive care from other providers such as nurses, pharmacists, physiotherapists, and, in the case of Indigenous patients, may also receive care from a traditional healer. Physicians should coordinate care and ensure effective communication between providers of care. If one care provider is saying one thing and the physician is saying another, this will create anxiety for the patient and deteriorate the care experience. Patient confidence in the care provided and an improved care experience is more likely where there is well-coordinated care, good communication, and collaboration between providers.

The burden of proof

Studies have associated good patient experiences with better clinical outcomes and safety. In a systematic review of evidence
 by Cathal Doyle, Laura Lennox, and Derek Bell on the links between patient experience and clinical safety and effectiveness, it was discovered that patient experience is positively associated with clinical efficacy and patient safety and supports the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. The study finding supports the argument that the three dimensions of quality should be looked at as a group and not in isolation.

In addition to this, better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization.[1]  A study reviewing what patient complaints say about their experience reveals that patient complaints showed that communication and relationships are more valuable for the patient experience than care quality and patient safety.

Forty-one percent of complaints related to patient-provider relationships. Eighteen percent related to humanness and caring, 15 percent involved communication, and five percent related to patient-staff dialogue.  “These attributes are a reminder that patients need comprehensive and correct information and expect it to be delivered with care, respect, and sensitivity,” the researchers reported. “The records we reviewed confirmed that even one negative, unkind, or disrespectful encounter can fundamentally alter a patient's perception of care.”[2]

Another study on Using Patient Complaints to improve Patient Experience also confirmed that communication and other patient-centred care principles often fall short of the needs of both patients and their families. The study found that nearly 80% of complaints were focused on patient-provider communication, including those with doctors, nurses, administrators, and any other clinical or non-clinical staff. Specific complaints data shared by the published research indicates that the nearly 80% of complaints centred on patient-provider communication deficiencies:[3]