Susan E. Mazer, Ph.D. Blog

Thoughts and ideas on healthcare

Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.

Perception: What Influences the Patient’s Perception of Their Experiences?

August 1, 2022

Many studies have attempted to answer this question. The common generalizable factors influencing a patient’s perception of their experiences are age, acuity, culture, socioeconomic status, and cognitive capacity. These factors create demographics that currently inform hospital policies and practices.

For the past decade, The Beryl Institute has led a push for each healthcare organization to define the “patient experience”, also known as PX, to reflect their respective organizational cultures. Beryl defines the PX as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” The key action words in the definition above are, influence the patient perceptions.” 

Without question, whatever happened in the past that dominated their healthcare experience, good or bad, comes up for the patient every time they enter a clinic or hospital. The fear of pain or a negative health outcome is ever-present. For example, every cancer patient dreads those regular tests, whether quarterly or annually, because they have already lived through the worst possible fear: a cancer-positive test outcome.

In a 1992 article for the Journal of Health Care Marketing (JHCM, Vol. 12, No. 3 (1992), pp. 64), they asked “What are the effects of previous hospital experience on satisfaction with current hospital experience?” The author found that “all previous hospital experiences had a significant influence on perceived quality and satisfaction with the current experience.” This is even more relevant for those returning to the same hospital.

The article distinguishes between the patient’s affective or emotional response to what happened and their cognitive or knowledge-based evaluation of a provider’s performance. In other words, there is what we know, and then there is how we feel about it.

Patient Expectations & Time

Expectations are not necessarily based on reality. Nor are they easily modified. “Reasonable Expectations,” however, come from individual experiences and insights informed and tempered by reconsideration of what happened. Over time, some events that were incredibly annoying at the time may become less relevant while other details are recalled and intensify in the remembering, retelling, and reliving. Nevertheless, expectations come to life in real-time, despite being based on past experiences.

What We Know

Our current way of understanding the patient experience is mainly using surveys that come “after the fact.” In-the-moment evaluations are often reactive. In the hours (days, years) that follow, circumstances change, and similarly, the meaning attributed to the patient’s experience will follow.

Informing patients about what they can realistically expect from those caring for them helps ease the pressure on the bedside caregivers. Setting realistic expectations for the patient also helps create trust and confidence between caregiver and receiver of care. This is NOT about a diagnosis. Rather, this is about the human caring factors: comfort, compassion, reliability, and trust.

Assessing and modifying individual patient expectations to keep them positive, but in line with what is possible, is a significant step in positively impacting and managing the patient’s perceptions.

In addition to patient expectations, the study found that “behavior intentions” were equally important to defining patient perceptions.

Behavioral Intentions & The Patient Experience

“Behavior Intentions” are defined as “motivational factors that influence a given behavior.” Patients perceive the caregiver’s intention and attitude as “on purpose.” Nothing is thought of as off-handed or accidental. Rather, the trust placed in the clinical staff is based on the assumption that everything matters.

The following questions can be asked to the patient when taking their medical history. The questions are focused on the patient, the circumstances, and the kind of medical intervention that is to occur or may be needed.

  1. What has been your experience in the past? (If the patient has not had a prior experience themselves, then ask about the experiences that they have heard about that would cause concern)
  2. What do you most fear going into this treatment/procedure/test?
  3. What helps to make you more comfortable when you are in circumstances that are inherently uncomfortable or painful?

“We provide you with the care that you deserve and that will move you onto a path of recovery. That is why we are asking these questions. Is there anything else you can share that might help us optimize your experience?”

If we do this, we can better anticipate and manage patients’ fears and anxieties. Knowing more about their personal needs and concerns becomes the first step toward patients and families being able to openly express themselves to those caring for them. Asking in advance begins the patient journey with a demonstration of concern for each patient. Once the conversation starts, much will be revealed by the patient either directly or indirectly.

Paying attention to what is said, how it is said, and what is unsaid can offer insights as to how the experience of the patient can be optimized.

The real turnaround is taking steps to ensure a positive experience in advance, rather than after the fact. This becomes clear evidence of caring that goes beyond medical protocols and pharmaceuticals. The patient experience should be one of being cared for and cared about; the question always is how to demonstrate caring in tangible, memorable ways.

John, J. (1992) Patient Satisfaction: The Impact of Past Experience. Journal of Health Care Marketing, 12, 56-64.

For more on this subject, you can read Susan’s blog, From Post-Traumatic Stress Syndrome to Post-Traumatic Hospital Syndrome.