What Patient-Experience Data Reveal about Trust.

This essay analyzes two types of patient-experience data to broaden and deepen understanding of trust in health care. Analysis of patients' open-ended comments shows a close connection between patients' feelings of trust and their intent to recommend providers and provider organizations-a global measure to evaluate patients' perceptions of care experiences. Patients' comments also reveal the bidirectional building of trust between the patient and the caregiver. Trust gets built when patients perceive their caregivers to trust their knowledge of their bodies as well as when caregivers demonstrate caring behaviors that earn the patients' trust. Patients' ratings of a closed-ended survey item on "confidence in provider" create the greatest differentiation for the global measure of patient experience-whether patients did or did not recommend a practice or provider. The essay also discusses related findings on pre-visit friction and the use of humor by the caregiver to expand understanding of trust.

Physician Burnout, Resilience, and Patient Experience in a Community Practice: Correlations and the Central Role of Activation.

Clinician burnout and patient experience are important issues that are often considered separately. New measures of resilience may influence both. We explored relationships among clinician resilience, burnout, and patient experience. Analysis included 490 physicians who completed surveys measuring burnout and resilience (decompression and activation) and had at least 30 patient experience surveys available for analysis. Burnout was measured with 2 items from the Maslach Burnout Inventory (MBI) which were part of the organization's ongoing measurement of clinician experience. Resilience was measured with 8 items from 2 Press Ganey validated subscales related to clinicians' ability to decompress from work and their experience of feeling of activation and connection to purpose while at work. Clinicians reporting more frequent symptoms of burnout based on the MBI items reported less ability to decompress (r for individual measures ranged from -.183 to -.475, P < .01) and less feeling of activation (r for individual measures ranged from -.116 to -.401, P < .01). Individual elements of decompression and activation were significantly associated with patient experience. In terms of activation, feeling that one's work makes a difference (r ranged from .121 to .159, P < .05) and believing one's work to be meaningful (r ranged from .102 to .135, P < .05) were positively associated with patient experience with their care provider. However, elements of decompression such as being able to free one's mind from work (r ranged from -.092 to -.119, P < .05) and being able to disconnect from work communications such as e-mails (r ranged from -.094 to -.130, P < .05) were negatively associated with patient experience with their care providers. Patient and provider experience are intertwined in that clinician resilience is associated with both burnout and patient experience, but individual mechanisms of resilience may be beneficial for the clinician but not for the patient.

Hospital-level correlation between clinical and service quality performance for heart failure treatment.

A national cross-sectional study correlates the satisfaction ratings of heart failure patients (diagnosis related group 127) and the Centers for Medicare & Medicaid Services' process-based quality measures for heart failure treatment for 32 hospitals during the first and second quarters of 2004. Two of the four measures of clinical quality showed statistically significant, moderately strong, positive correlations with a global measure of satisfaction and with, respectively, 5 and 7 subscales of the 10 subscales of satisfaction under examination (Pearson's r ranged between .40 and .67, 2-tailed; p < .05). Findings demonstrate that quality need not be a zero-sum issue, with clinical quality and service quality competing for resources and attention.

Satisfaction of families using end-of-life care: current successes and challenges in the hospice industry.

This study examined the satisfaction of family members with the end-of-life care their loved ones received. Data were collected from 1,839 individuals receiving care from 17 different care agencies nationwide. Although family satisfaction with hospice care was generally quite high. situational factors played a role. The timing of the referral was critical, with families rating services lower almost across the board when the referral to hospice was deemed "too late." Additionally, families expressed greater satisfaction when the patient's care was overseen by the hospice director, rather than a personal physician. Each of these findings has important implications for physicians, patients, and families as they begin to plan for end-of-life care.