1. Bartol, Tom APRN

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On a recent trip to Walt Disney World, I was inspired by a staff member going out of his way to help make a dining experience special for me. I asked him a question, and he immediately worked to find a solution, going to the kitchen and obtaining something that would accommodate my needs. He did not tell me what he could not do, what was not available, or what was not his job-he did what he could to take care of me. Many of us have experienced places like Disney World, where the people and staff seem to make the visit special. At Disney, they call these "magical moments," actions that make the experience unique and memorable.

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The focus on the patient experience in healthcare has become in vogue, at least in theory. In 2007, the Institute for Healthcare Improvement (IHI) developed the Triple Aim framework, which includes three dimensions: Better care for individuals, better health for populations, and lower per capital cost.1 The Triple Aim dimension improving the patient experience has become a mantra of healthcare reformers. Yet, the focus on improving care in many cases is losing the "care."


Harvard professor Arthur Kleinman puts it this way: "Even questions of 'quality' in healthcare become distorted. What counts as 'evidence,' then, is an absence of presence."2 Electronic Health Records have contributed to the challenge, creating a multipage document useful for coding, audits, and verifiable measures of cognitive services; however, they have become too cumbersome to find what is meaningful to the needs, values, and goals of the patient. "The patient is more than the sum of a series of drop-down boxes."3 The Triple Aim and measures that have followed have put more emphasis on process and patient flow than on patient experience.


What matters most?

In a past column, I shared a tale of two patients with type 2 diabetes mellitus: one who met all of the quality measures (patient A), the other met few quality measures (patient B).4


At the time I asked, "Which patient is healthier?" The resounding response was patient B. Looking back at these patients, I now ask, "Which patient had better care or a better patient experience?" Meeting quality standards alone does not define patient experience.


Patient experience is the patient's perception of the interaction, the time spent together based on the values, goals, and desires for that visit. Meeting quality goals does not mean better care (or even caring in some cases). Someone recently pointed out to me that patient A was likely the one with a 10-minute visit and patient B the one with a 30-minute visit.


Enhancing the patient experience can improve the clinician's experience as well. Seeing that a patient is happy can make us happy. The clinician caring for patient B likely felt more satisfied with her job. I asked the Disney food service worker who made my experience special what motivated him to do what he did. He responded, "I love what I do, I love my job, I love to make a difference." The one who creates a magical moment often receives one as well.


Enhancing the patient experience is much more than sending out feedback surveys and then trying to address the issues identified. It is a proactive, conscious approach to make each visit feel unique and special for the patient. It redefines the measure of a successful day, the culture of our practice, from seeing a certain number of patients or achieving a percentage of quality measures to connecting with an individual to helping create positive life changes. This takes into account the needs, values, and choices of a patient, finding out not just "what is the matter," but finding out "what matters most."


Creating an experience

Some businesses outside of healthcare, such as Disney, Starbucks, and the Ritz-Carlton, have become experts in customer experience and can teach us a lot. These companies have made a conscious decision to develop a culture that goes beyond just selling a product or service to creating a unique and special customer experience.5-7 Ritz-Carlton's vision is to create an experience that "enlivens the senses, instills well-being, and fulfills even the unexpressed wishes and needs of our guests."7 A vision like this would transform the patient experience of his or her healthcare.


To begin to enhance the patient experience, picture yourself as a patient or "customer" at your own workplace. What do you feel as you walk in the door, check in, and are brought back to a room? What would you want to hear? What would you want to experience? How would you like to be greeted and treated? What would make you feel good and cared about, and what would make the visit special and unique for you. This simple exercise can help us empathize with our patients to help us better understand their experience and what we might do to create positive experiences for them.


As we change the way we think about healthcare from a task mentality to an experience mentality, we create something special for the patient. Instead of thinking about the patient as a sick person coming in for treatment, think of the person as someone who has needs, values, and feelings and wants to be healthy and to be heard. Rather than solving problems, we build relationships, acknowledge problems, and share information to help move forward with the patient. People long to be involved, to be connected, and to be part of their care. As Starbucks says it, "Customers aren't looking for best friends; they just want a positive connection, and they want their needs to matter."6


Changing the culture of healthcare

Creating a unique and caring experience means going beyond the check boxes, beyond the structure of templates. Find out about your patient, who this person is, what he or she has done, what matters to him or her, and what the patient's source of support is. Make a note of these things, children's names, a pet, a hobby, or an upcoming special event, and ask about it at a future visit. Interest in their lives beyond the clinical condition lets them know you care.


To enhance the patient experience, use a patient's name when you speak to him or her. Listen, really listen, put down the computer for a minute, make eye contact, and show your interest in that person. Acknowledge what the person says; hear and acknowledge what is said before writing it down before trying to solve it. Simply being heard and acknowledged, without judgment, without solutions, makes a moment special.


Make an extra phone call, contact a consultant, look up a phone number, or find a coupon online to help a patient get a better price on a medication. Share self-care ideas, getting beyond just the numbers and diagnostics. Share information so that the patient can make decisions, identifying the individual risks, strengths, and the potential benefits of interventions. These small steps, taking time to see the patient's unique needs, let the patient know that you care.


Enhancing patient experience means changing our culture of healthcare from one that measures numbers of patients seen and numbers of boxes checked to one that listens and creates a special experience for each patient. Many processes are set up so that clinicians can see patients more quickly. The real answer may be in seeing fewer patients and seeing them in more effective and caring ways. The result, as we do this, will be improved individual health, improved population health, and lower per capita cost: the Triple Aim! Maya Angelou summed it up well: "I have learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."




1. IHI Triple Aim Initiative. [Context Link]


2. Kleinman A. The art of medicine: caregiving as a moral experience. Lancet. 2012;380:1550-1551. [Context Link]


3. Martin SA, Sinsky CA. The map is not the territory: medical records and 21st century practice. Lancet. [Context Link]


4. Bartol T. Patient-centered medical homes or data-centered medical homes. Nurse Pract. 2014;39(2):8-9. [Context Link]


5. Snow D. Lessons from the Mouse: A Guide for Applying Disney World's Secrets of Success to Your Organization, Your Career, and Your Life. Orlando, FL: Snow and Associates; 2010. [Context Link]


6. Michelle JA. The Starbucks Experience: 5 Principles for Turning Ordinary into Extraordinary. New York: McGraw-Hill; 2007. [Context Link]


7. Michelli JA. The New Gold Standard: 5 Leadership Principles for Creating a Legendary Customer Experience Courtesy of the Ritz-Carlton Hotel Company. New York: McGraw-Hill; 2008. [Context Link]