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Patient Satisfaction/Experience

Patient satisfaction is a key determinant of quality of care and an important component of pay-for-performance metrics. Under the Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Value-Based Purchasing (HIVBP) program, Medicare reimbursements are linked to patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys completed by patients. Click to expand


Patient experience takes a broader perspective than patient satisfaction. The Beryl Institute is "a global community of practice and premier thought leaders on improving the patient experience in healthcare". They define the patient experience as "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care." The Beryl Institute website includes a broad array of resources including:

  • Publications
  • Case Studies
  • Research Grants
  • Conferences and other events



Patient Satisfaction/Experience: HCAHPS

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the basis of the HIVBP program incentives. The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. Three broad goals have shaped the HCAHPS survey. Click to expand

  • First, the survey is designed to produce comparable data on the patient's perspective on care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers.
  • Second, public reporting of the survey results is designed to create incentives for hospitals to improve their quality of care.
  • Third, public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of hospital care provided in return for the public investment.


The HCAHPS survey contains 21 patient perspectives on care and patient rating items that encompass nine key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment and transition of care.


Patient Satisfaction/Experience: Survey Vendors

There are vendors who have developed patient satisfaction surveys and associated services for hospitals seeking to improve their performance. In 2012, Modern Healthcare magazine identified the 21 largest patient satisfaction vendors. Click to expand

The Largest Patient-Satisfaction Measurement Firms include:

  1. National Research Corporation (
  2. Press Ganey Associates (
  3. HealthStream (
  4. Professional Research Consultants (
  5. Strategic Healthcare Programs (
  6. Deyta (
  7. DSS Research (
  8. National Business Research Institute (
  9. Sullivan Luallin (
  10. Jackson Group (
  11. Arbor Associates (
  12. J.L. Morgan & Associates (
  13. Surgical Outcomes Information Exchange (
  14. Rural Comprehensive Care Network (
  15. Beacon Technologies (
  16. Novaetus (
  17. Research & Marketing Strategies (
  18. TRC (
  19. WB&A Market Research (
  20. Center for Health Services and Outcomes Research (
  21. IntelliQ Health (


Click here to purchase the full article.

Also in 2012, the Society of Hospital Medicine’s (SHM’s) Practice Management Committee asked several of these vendors to complete a questionnaire that addressed: What Hospitalists Should Know About Their Patient Satisfaction Survey Vendor?

The questionnaire included questions related to:

  • Survey instrument: content, development, customization options
  • Survey methodology: sampling, distribution methods, physician attribution
  • Reporting: formats, options, benchmarking
  • Support: resources, links to other data sources, additional services
  • Organization: contacts, approach to customer service, conferences


The vendor responses are available by contacting the vendor directly. SHM did not publish the vendors’ responses as they included proprietary information. The following vendors completed the questionnaires: Avatar, HealthStream, NRC/Picker, PRCand Press Ganey.


Patient Satisfaction/Experience: Research in the Journal of Hospital Medicine

Patient Satisfaction/Experience – Interventions

Patient Satisfaction/Experience – Cleveland Clinic Patient Experience Summit

The Cleveland Clinic is one of the acknowledged leaders with regard to the patient experience, holding a Patient Experience Summit annually. The 2014 Summit was held May 18-21, 2014. Click to expand

The Summit included:

  • A two-track Pre-Course day
  • Speakers with a wide range of perspectives: CEOs, academics, vendors, authors, policymakers, payers, pharmaceutical companies and others
  • A number of hospital case studies including: Intermountain Healthcare, University of Arkansas, University of New Mexico Health System, Hennepin County Medical Center, Greenwich Hospital, University of Wisconsin, UCLA Health, Brigham & Women’s Hospital, NY Presbyterian, ThedaCare, UC San Francisco, Griffin Hospital, Morristown Medical Center and Cone Health


A copy of the proceedings with PDFs for many of the presentations can be found here.


Patient Satisfaction/Experience – Other Case Studies

  • Cleveland Clinic – Patient First Culture Click to expand
    Each employee and clinician goes through three hours of Patient Experience training, which includes learning how to interact with patients and how to apologize when something goes wrong.


  • Emory University - The Accountable Care Unit Click to expand
    Four Elements:
    1. Unit-based physician/nurse teams
    2. Structured Interdisciplinary Bedside Rounds (SIBR)
    3. Unit-level performance reports
    4. Unit-level physician-nurse (dyad) partners


  • Intermountain Healthcare Click to expand
    went through a process of defining Patient Experience which led to the establishment of a Patient/Family Advisory Council and a CMS-funded "shared decision-making" pilot for five conditions.


  • Mayo Clinic -- SPARC (See, Plan, Act, Refine, Communicate) Click to expand
    Looks to employ the "scientific method" to identify better ways of delivering care. For example, industrial engineers observe physicians and patients interacting, and then develop ways to improve not just efficiency, but the overall patient experience.


  • Susquehanna Health Click to expand
    is a health system in Williamsport, Pennsylvania. After trying several interventions to improve HCAHPS scores, the Hospital Medicine Group (HMG) experimented with a "sit down and round" project where hospitalists and nurses sit down at patient’s bedside and address a series of specific questions with the patient. The project started as a pilot in October 2013 resulting in three successful months of improved HCAHPS scores on that floor. Consequently, it was rolled out to the entire hospital in January 2014.


  • ThedaCare – Collaborative Care Click to expand
    In 2007, ThedaCare (Wisconsin) "was determined to burn down the old hospital model … in order to engage all staff directly with patients." The new care model included a new architectural design and a team (MD, RN, Pharmacist) that works with the patient and family to develop and execute a care plan. Patients move through a series of "tollgates" spelled out in the plan. Daily huddles review issues with patients and work flow. When errors occur, the team studies the process for improvements.


  • Triad Hospitalist Group Click to expand
    is a program of approximately 45-50 physicians at Cone Health in Greensboro, North Carolina. In 2010, they initiated a system-wide cultural transformation with a focus on patient-centered care. Hospitalists were a major focus of the initiative. A Service Excellence Committee was chartered, patient experience data was shared with physicians and a hospitalist training program was launched. The training program included small groups discussing "difficult conversations" with patients and a simulations used to improve skills. Following the training, there was physician-specific performance reporting and follow-up with individual hospitalists. The initiative led to substantial improvement in patient satisfaction scores. For more information, contact the group’s administrator, Robert Hickling (


  • University of California, San Francisco Click to expand
    The UCSF quality team developed a checklist to improve physician communication with patients, then taught it to the attending hospitalist faculty. The project began with a list of 29 best practices for patient-physician interaction, as identified in medical literature. Hospitalists then voted for the elements they felt were most important and most easily measured, resulting in a Top-10 list.


  • Virtua Healthcare Click to expand
    This hospital launched its STAR initiative in 2000 focusing on the following five points:
    1. Best People
    2. Caring Culture
    3. Excellent Service
    4. Highest Clinical Quality and Safety
    5. Resource Stewardship