Insights on the Future Priorities of Patient Experience Research as Care Experience Research

Abstract

Patient experience must innovate and demonstrate impact alongside evolving healthcare systems, technology, and patient populations to meet demands and deliver excellent, high value care. Patient experience focuses largely on experience and satisfaction metrics from unique encounters, while burnout and turnover of healthcare team members persist, and the technology industry aims to disrupt healthcare delivery. Academic medical centers are well positioned to lead the way by conducting user and academic research to develop, test, and disseminate findings from successful interventions which are cocreated with patients and care teams. This article outlines three insight areas with opportunites for innovation toward this aim: focus on care experience in parallel of patient experience, integrate human-centered design as technology solutions are developed from the inside out, and measure and evaluate all interventions aimed at enhancing the care experience.

Three to Five Key Points

• Patient experience focuses heavily on aggregated patient data and composite metrics, while care team burnout and turnover persists. The focus should also include care experience, encompassing the team and focusing on care outcomes.

• As technology rapidly advances, health systems should cocreate and implement technological solutions using human-centered design for solutions that are developed to empathetically meet care needs.

• Care experience innovation and improvement efforts must demonstrate impact by measuring and evaluating all interventions’ impact on experience and clinical outcomes.

• Academic medical centers are well positioned to lead the way in care experience innovation and research to generate knowledge to be used in community and rural settings.

Introduction

As the healthcare landscape rapidly changes, the patient experience remains central to providing high value care, as exemplified in the value based care equation (Value = (Quality + Patient Experience)/Cost). Patient experience is consistently associated with patient adherence, patient engagement in preventive care, clinical outcomes, and resource use such as reduced length of stay in the inpatient setting and increased appropriate use of primary care visits. ¹ Delivering excellent patient experience is challenging amid evolving patient populations and the healthcare landscape, particularly with rapid technological advancements, and rising rates of provider burnout. For example, populations are aging such that the World Health Organization estimates that the proportion of people over 60 will double by 2050. ² This population aging, in turn, results in a greater number of older patients who need complex and more health care, and who prefer clinical interactions with more emotional displays and that are not rushed. ³

We argue that academic and user research must be a priority to innovate the optimal care experience, defined as that which includes patients, loved ones, and clinical care teams, and centers care outcomes to advance care goals, alongside the evolving landscape. It is particularly incumbent on academic medical centers (AMCs) to conduct rigorous research to develop generalizable, externally valid interventions and solutions to be used in patient experience at large. The aim of the research to be conducted in the field ought to be to (1) reduce suffering for patients, their caregivers, and the healthcare professionals delivering care, and (2) to improve health outcomes. The following offers three actionable insights within which research is needed, and practical recommendations associated with each insight, as summarized in Table 1.

Table 1.

Actionable Insights and Practical Recommendations in Care Experience Research.

Actionable insights	Practical recommendations
Patient experience focuses heavily on patient data and metrics, while care team burnout and turnover persists	Broaden to a care experience focus, including PROMs as tools to enhance relationship-centeredness, alongside PREMs Increasing relationship-centeredness of encounters with patients and among care teams Socialize this focus early in clinician training including UME and GME Consider spaces between visits via care coordination and complex management especially for underserved populations Develop partnerships with community organizations for continuous care Increase opportunities to involve patients and caregivers as partners
Technological advances are occurring faster than ever and there is a proliferation of digital solutions aiming to disrupt the industry	Employ human-centered design and empathetic approaches Solutions should come from within healthcare in partnership with companies (inside out instead of outside in) Implement with relationship-centered discussions of new technology with patients
Patient experience must demonstrate impact via evaluation of all care experience interventions aimed at enhancing the care experience	All interventions must include evaluation plans Evaluation of programs should increase in rigor Both successes and failures should be documented and disseminated Link care experience to clinical outcomes Link care experience to cost and value Link care experience to the goals and needs of patients and their caregivers (PROMs) AMCs are well positioned to lead the way in innovation and research

Abbreviations: PROM, patients and their caregiver; PREM, patient reported experience measure; UME, undergraduate medical education; GME, graduate medical education; AMC, academic medical center.

Actionable Insights

Insight 1: Patient Experience Focuses Heavily on Patient Experience Data and Metrics, While Care Team Burnout and Turnover Persists

Even with increased focus on social determinants of health, systems collect a large quantity of data focusing on patient reported experience measures (PREMs). Quantitative PREMs and satisfaction data (ie, Consumer Assessment of Healthcare Providers and Systems [CAHPS], likelihood to recommend scores, etc ⁴ ) position the patient as an individual entity, with each individual encounter with the system as the focus of the patient experience. This practice homogenizes patients by reducing their experiences to a forced-choice, aggregated score or composite metric. Systems also do not often receive input from family members or caregivers. Meanwhile, at least 45% of physicians are experiencing burnout in 2024, with administrative barriers to providing clinical care to patients (eg, entering data into the electronic medical record [EMR]) as the main contributor.^5,6 Taken together, a focus on aggregated patient data is contributing to both homogenization of patients, and to burnout of their care teams. In addition, care teams are tasked with implementing new technologies at rapid rates.

Insight 2: Technological Advances are Occurring Faster Than Ever, and There is a Proliferation of Digital Solutions Aiming to Disrupt the Healthcare Industry

Beginning with the wide adoption of the EMR in the early 2000s, technological advancements in healthcare have proliferated. The rapid advancement of artificial intelligence (AI) is particularly shaping the patient–clinician relationship and delivery of care. Crossover between healthcare and technology industries is increasing and technology companies are entering into the healthcare delivery space (ie, Amazon One Medical), aiming to disrupt. With new technologies growing in scope and number, patient experience is receiving additional focus.

Insight 3: Patient Experience Must Demonstrate Impact

Healthcare professionals in patient experience continually focus on demonstrating improvement in scores. However, achieving small improvement in healthcare metrics is exceptionally challenging, particularly when scores are already high, thereby facing a ceiling effect. ⁷ In addition, a common misconception about patient experience is that it is synonymous with patient satisfaction. ⁸ Unfortunately, satisfaction can be viewed as a positive enhancement, rather than a necessary cornerstone of value in health care. This is particularly under scrutiny as the healthcare industry faces rising costs. ⁹

Practical Recommendations

Recommendations for Insight 1: Broaden to Focus on the Care Experience in Addition to the Patient Experience

A focus on satisfaction and PREMs alone does not align with the reality that care decisions and care delivery are also experienced by patients’ loved ones, and their clinical care teams. This focus also omits patient reported outcome measures (PROMs) as a tool for determining patient-centered care pathways and value. We recommend systems broaden to include care experience by employing relationship-centered measures that align with the needs and wants of patients, families, and care providers. Measures must account for the humanity, expertise, and individuality of each patient, loved one, and clinician as they have care encounters with one another. Relationship-centered care encourages connection, cocreation, and collaboration to meet patient needs while also encouraging professional fulfillment of providers via four principles: recognition of personhood and roles of interactants, importance of emotions, reciprocal influence of patients and care teams, and that formation of relationships requires investment. ¹⁰ Research is needed to develop and test interventions with clinicians and patients which increase relationship-centeredness in health encounters, probing the association between relationship-centeredness and PROMs, clinical outcomes, and care coordination. This focus should begin in undergraduate and graduate medical education to ensure clinicians commit to relationship-centeredness as they train. For example, recent research has demonstrated that attendings using a relationship-centered coaching approach to conduct observations of medical residents while communicating with patients improve resident communication confidence and feedback culture. ¹¹

In addition, the care experience focus must go beyond each individual encounter with the system and consider the space between encounters. Researchers should consider how to partner with community organizations for continuous care, and how to create interventions which support follow-up care. Examples of initiatives include postdischarge phone calls and appointment scheduling after emergency department visits to avoid preventable hospital readmissions. Researchers should also position individual patients at the center of healthcare decision-making via PROMs. This requires more structured ways to include patients in intervention design and organizational decision-making. Patient and Family Advisory Committees (PFACs) are an excellent starting place, yet we must conduct research by engaging with those whom the interventions aim to serve, particularly those patients who have historically experienced health disparities. This engagement should exist in implementation of technological solutions as well.

Recommendations for Insight 2: Integrate Human Factors as Technology Solutions are Developed From the Inside Out

Technological solutions have potential to diminish physician burnout and increase care efficiencies. For example, researchers at Google found that diagnostic accuracy and patient experience were better for a healthcare chatbot called AIME compared to a primary care physician via a double-blind, randomized crossover study. ¹² However, any technological solutions implemented in healthcare should have human-centered design to cocreate empathetic solutions that meet the unique needs of the organization, care teams, and patients. AMCs, in particular, should partner with technology companies to cocreate these solutions. For example, a large AMC recently implemented ambient AI scribes which resulted in significant reduction in physician EMR documentation time, a primary contributor to provider burnout. ¹³ Less documentation time may enhance care experience in many ways, including enhancing the relationship-centeredness of encounters as physicians may focus time on the human interaction with the patient.

Recommendations for Insight 3: Measure and Evaluate All Care Experience Interventions Aimed at Enhancing the Care Experience

As systems implement solutions, technological or otherwise, they must evaluate interventions to demonstrate enhanced value and relationship centeredness. All interventions should include an evaluation plan, and AMCs with research capabilities should conduct robust research studies to create generalizable knowledge to be used in community and rural healthcare settings. This requires dissemination of findings from interventions that are developed and tested. Additionally, care experience metrics should be tied to clinical, PROMs and cost outcomes to demonstrate increase in value of care. Process improvements and outcomes evaluation should be conducted with rigorous continuous quality improvement, and with the patient, caregiver, and clinician's goals at the center.

Conclusion

The ultimate aim of care experience is to reduce suffering of patients, loved ones, and their clinical care teams and to improve clinical outcomes. A strength of care experience as a field is the deep commitment that professionals hold to patients and care teams. The field has begun conducting innovative user and academic research to develop interventions and improve outcomes. Yet, more work is needed, particularly in the areas outlined above to ensure that measurements and interventions are aligned with what patients, caregivers, and clinical teams want. AMCs are well positioned to lead the change by way of leveraging their academic missions, partnerships with physicians and patients, and the numerous encounters throughout their systems. AMCs should engage in rigorous, continuous innovation and quality improvement to develop generalizable knowledge to be used at community and rural health systems. In parallel, health systems must maintain excellence in the basics of providing high value care.