Focus on What Matters in Patient Surveys: The Person, Not the Score

April 1, 2021
April 1, 2021

By Mary Koloroutis, MSN, RN, Consultant at Creative Healthcare Management

There has never been a time in our history with greater focus or energy on how patients are experiencing their care. In a recent Beryl Institute study, 70% of CEOs identified the patient experience as being among their top three priorities for organizational excellence and success.

In order to improve patient satisfaction, health care organizations have invested significant energy and resources into teaching healthcare workers the fundamentals of good customer service, including such behaviors as:

  • Introducing themselves
  • Letting patients know their role
  • Informing people about what to expect
  • Asking patients if there is anything more they can do for them before they leave
  • Following up when they say they will

Clearly, these are all important actions, but I propose that these behaviors do not represent a big differentiator for patients and families. Just as people anticipate that they will receive high quality clinical care when they enter a hospital or clinic, people also expect hospitable and civil behaviors to be present. Both clinical quality and hospitable interactions are baseline expectations. Patients are likely only surprised (and distressed) when these aspects of care are absent.

Too Much Focus on Scores

Not surprisingly, even with customer service initiatives being implemented across the country, the latest Beryl study shows that CEOs are less satisfied this year than last year with their progress in measures of patient satisfaction. Further, clinicians are feeling “metric and monitoring fatigue” as they are trying to meet the measures of customer service initiatives and often end up frustrated at the results. Perhaps part of the problem is that in an effort to improve the patient experience, there has been an inordinate amount of attention focused on improving patient satisfaction scores rather than a focus on truly understanding the person and his or her response to illness and trauma.

See People as People, not Numbers

When we focus on the score, the person becomes objectified, literally the “vehicle” to a positive score or the “obstacle” to not obtaining a positive score. When people become vehicles and obstacles, we’re no longer seeing them as people.

Theologian and philosopher Martin Buber wrote about “I-It” and “I-Thou” encounters, asserting that the I-Thou relationship was one of mutuality, reciprocity, and shared humanity, whereas the I-It relationship was marred by separation, detachment, and objectification of the other (Buber, M., I and thou. New York: Scribner’s (1958)). This implies that if we’re seeing our patients as the vehicle to getting better patient satisfaction scores, we’re inadvertently coating our encounters with them in a thin (or not so thin) layer of separation, detachment, and objectification. Our ability to let down our own self-interest and truly focus on their interests and well-being is compromised. Clinicians speak to me about “getting in trouble” if they forget to say what they have been taught to say—specific key phrases designed to influence scores. This should be a worry to us all, because it is in the clinician-patient relationship that authentic therapeutic encounters occur. It is through the clinician-patient relationship that healing is enhanced or diminished. There is no place in this relationship for “handling” the person in our care in order to have them respond in a certain way on a survey.

A Reminder to Put Care and Humanity First

This brings us to the seemingly illogical, but wholly accurate conclusion that focusing on patient satisfaction scores is an almost certain route to failure. If we want patients to know that we care about them as people… we really do have to care about them as people. If we’re looking for answers outside of this simple equation, we’re wasting our time and money.

Really focusing on the patient experience means focusing on patients as people. It means taking the time to connect in a way that leaves patients and their families with no doubt at all that we’ve got their backs. So what do we do? If our aim is to get patients to realize we’ve got their backs, we can add that to the scripting, “Is there anything else you need? I have the time. And remember, I’ve got your back!” But would it work? And more importantly, who do we become in that paradigm? It’s as if the scripting, in and of itself, puts another layer of separation and detachment between the caregiver and the patient.

The Importance of a Human Connection

Human connection is a knowledge-based discipline. It’s based on the science of human caring and the psychology of the human response to illness and suffering. We all know human connection when we see it. When clinicians are at their best, and when the nature of their relationship with the patient is supported, honored, and held in the dignity it deserves, authentic human connections happen. It is likely that these connections entail the practices and principles outlined in the book See Me as a Person: Creating Therapeutic Relationships with Patients and Their Families:

Attunement: Intentionally connecting with people exactly where they are and remembering that what might be routine for you is often life altering for the person receiving care.

Wondering: A practice of discovery grounded in curiosity and genuine interest in the other. Learning about the person is fundamental to the provision of safe, quality care.

Following: The practice of listening to, respecting, and acting on what we learn from our patients and families.

Holding: Creating a safe haven for healing in which people feel accepted and held with dignity and respect.

Patient satisfaction scores provide information we can and must use to continually improve our care. Trying to “care to the score” is futile and counterproductive. When we remember that the key to excellent patient satisfaction scores is excellent, person-centered care, we are on the right track. When we remember that we are more alike than not, and that our work in caring is to connect to our shared humanity, we are on the right track. When we the see our patients as person, we see them as the very reason we came to work on this day—we see them as our reason for being.

 * * * * *

As a co-creator, author, and editor of the Relationship-Based Care series of books and seminars, Mary helps health care organizations create a framework for delivering world-class care with strong underlying values and principles, and then works with them to implement that framework. Her most recent book, See Me as a Person: Creating Therapeutic Relationships with Patients and their Families, co-authored with Michael Trout, helps clinicians in all disciplines to connect authentically with the patients and families in their care no matter how chaotic their care environments may be. Contact Mary at