Shaun Frost: Why Hospital Patients’ Expectations Should Dictate Their Care

By Shaun Frost, MD, SFHM

Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.

Barriers to Understanding Patient Expectations

Time availability. Busy clinicians might not have adequate time to discuss expectations with their patients.
Illness acuity. Emergent and urgent illnesses require immediate decision-making that might impede full exploration of patient preferences.
Healthcare literacy. Healthcare is complex, and patients frequently do not understand the complexities. Furthermore, patients might not know how to articulate their expectations (and thus require physician assistance to do so).
Patient empowerment. Patients might not believe it is acceptable to ask their care providers to consider their preferences and goals.
Culture of paternalism. Although some patients prefer their physicians to unilaterally make healthcare decisions, many want a voice in decision-making. Care providers need to respect this and resist the temptation to routinely assume a paternalistic role in decision-making.
Insufficient documentation. Patient care preferences are infrequently documented in a portable fashion that is readily transmissible between care providers.

It is difficult to disagree that patients and their families deserve to be satisfied with the care they receive, and furthermore that a satisfying care experience is the foundation upon which the ability to heal is based. Mention the subject of patient satisfaction, however, to care providers, and prepare for many to respond negatively. For most, this frustration likely stems from the challenges associated with satisfaction measurement, and the application of this measurement to provider performance reporting and reimbursement. Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.

In some respects, healthcare’s preoccupation with satisfaction measurements seems analogous to administering a final examination before teaching the course material. If so, at this juncture, it would be prudent to back up and examine the curriculum required to master the subject matter necessary to perform well on the test. To this end, it is necessary to:

Identify the contributors to a satisfying patient experience, and Focus specifically on understanding patient expectations.

Expectation Examination

An essential reading on the subject of patient experience and satisfaction is a July/August 2005 article in The Hospitalist titled “Patient Satisfaction: the Hospitalist’s Role,” in which Patrick J. Torcson, MD, MMM, FACP, SFHM, introduces “The First Law of Service.”¹ According to this law, satisfaction can be mathematically defined as equal to patients’ perceptions of the care they received minus their expectations for that care (satisfaction=perception–expectation). Accordingly, if perception meets or exceeds expectation, an associated degree of satisfaction will be generated.

Both perceptions and expectations can be affected to create satisfaction. Remodeling a hospital lobby is an example of an effort to primarily influence patient perception. When considering efforts to influence patient expectations, it is useful to think of universal versus individual patient requirements, needs, desires, values, and goals. Examples of universal patient expectations (meaning expectations held by all or a majority of patients) would include receiving warm meals at scheduled times, having call lights answered in a timely manner, understanding the side effects of medications, and receiving instructions at the time of discharge. Examples of individual patient expectations (meaning expectations that are personally held by individual patients because of reasons unique to individual circumstances not common to everyone) would be need for low-cost medications due to economic hardship, prioritization of functional improvement versus pain elimination, and tolerance of treatment-related side effects.

It might be fair to say that in its pursuit to create satisfying patient experiences, our healthcare system has focused more on influencing perception and universal patient expectations than it has on addressing unique, personally held patient interests. In the future, we should attend more diligently to individual expectations. By doing so, patients will be better engaged, providers will be better informed, and satisfaction will follow.