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Prioritize operational standards for patient experience success

July 31st, 2013

by Doug Della Pietra

Does your organization have a prioritized operational framework for the patient experience that would effectively guide the beliefs, behavior and ultimate decision of the emergency department doctor in the following example and true story?

An elderly woman presents with stroke-like symptoms. After negative test results and failing to satisfy the criteria for admission, an ED doctor in Columbia, S.C., planned to send her home but admits her when the woman's family insists.

Why? As the Forbes article "Why Rating Your Doctor Is Bad For Your Health" from earlier this year explains: "'Her family refused, and they told me so ... Do I call security and escort them out? I was more concerned with them giving me a bad patient-satisfaction survey score than her going home and having a stroke,' which he considered highly unlikely."


The author underscores the physician's primary dilemma: "Between 5 percent and 7 percent of his compensation--some $10,000--is dependent on high Press Ganey scores."

Why Patient Experience Operating Standards Are Important

Dr. James Merlino, head of the Office of Patient Experience at the Cleveland Clinic, explains prioritizing patient experience operating standards is important "because you don't want to get into a situation where you are pushing people to improve the patient experience and they push back saying, 'So you want me to pay more attention to making patients happy than my quality (of care).'"

He also emphasizes that patient experience is "not about making patients happy over quality. It's about safe care first, high quality care, and then satisfaction and experience. We want people to understand how it's prioritized."1

Examples of Prioritized Operational Frameworks

I disagree with the conclusion that the Forbes' article title suggests, namely, that "rating your doctor is bad for your health." Rating physicians, hospitals, medical practices, surgical centers, etc. is not the fundamental issue; competing and incorrectly prioritized operational standards are bad for the health of our patients. To guide caregivers at the Cleveland Clinic and Disney's cast members, each organization developed prioritized operational frameworks.

Operating Standards for Patient (Guest) Experience

Cleveland Clinic Disney
Priority 1: Safety Priority 1: Safety
Priority 2: Quality Priority 2: Courtesy
Priority 3: Experience & Satisfaction Priority 3: Show
Priority 4: Value & Efficiency Priority 4: Efficiency

Interestingly, even Disney's operational framework1 would have provided the ED doctor in the earlier example with a prioritized set of standards congruous with both good medicine and the explicit (Hippocratic Oath) or implicit promise of every healthcare worker to "do no harm" and "improve people's health."

Establishing a prioritized operational framework for patient experience is not only crucial for the overall experience of our patients but equally important for the peace of mind and confidence of all caregivers who face dozens and even hundreds of decisions every day. (See Tom Dahlborg's post, "Healing the healer in healthcare.")

If you know of other healthcare organizations that have a prioritized operational framework for patient experience, please share and comment below. Thank you.

1 Hirsch, Lonnie. "At Cleveland Clinic, Patient Experience is Not Just About Patient Satisfaction. Healthcare Success Strategies." May 3, 2013. Last accessed on June 10, 2013.

2 For a good explanation of what each of Disney's operating standards involves, see Kinni, Theodore B. Be Our Guest: Perfecting the Art of Customer Service. New York: Disney Editions, 2011. Print, 48-51.

Doug Della Pietra is the director of Customer Services and Volunteers for Rochester General Hospital in New York, where he directs an intentionally-designed patient- and family-centered volunteer program, oversees the front-line valet and guest services teams, and leads the service excellence element of the Patient Experience Initiative while co-chairing the hospital's Patient Experience Team. Follow Doug @DougDellaPietra on Twitter.


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