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Value of patient experience:Hospitals with higher patientexperience scores havehigher clinical qualityExecutive summaryWith the market shift towards value-based and patientcentered models of care, improving patient experienceis an increasingly common focus for hospitals. Goodpatient experience is an intrinsically valuable goal, andpayers are increasingly emphasizing patient experienceas part of care quality.1 Patient experience scores—reflecting factors as diverse as a hospital floor’s noiselevel throughout the night and how well nurses anddoctors communicate with patients—have become keyhospital performance measures.In Deloitte's 2016 report The value of patient experience:Hospitals with better patient-reported experienceperform better financially, we found that higher patientexperience scores are associated with higher hospitalprofitability, and that this association is strongestfor aspects of patient experience most likely to beassociated with better clinical care (in particular,nurse staffing engagement).Since improving patient experience can likelyaddress attributes of care that promote and increasequality, 2,3 these results suggest that improvementsin patient experience scores might be associatedwith increased clinical quality. However, patientexpectations do not always map to clinical qualityindicators. Patients sometimes value amenities morethan clinical ability.4 As a result, improvements inpatient experience might not always be associatedwith improvements in clinical quality.5Although many consumers value both clinical qualityand care experience when choosing a hospital, thelink between patient experience and hospital qualityhas not been well studied.6 The literature on the topicis rather limited, and has largely focused on selectedclinical outcomes such as readmissions andmortality rates. 7 To gain greater insight into this topic,the Deloitte Center for Health Solutions conductedregression analyses to examine the associationbetween patient experience scores and a broadrange of hospital clinical quality measures (bothprocess of care [POC] measures as well as clinicaloutcomes). We controlled for numerous hospital andmarket characteristics that can also affect hospitalperformance, including hospital ownership, location,teaching status, payer and patient case mix. Ouranalyses point to two main findings:Hospitals with higher patientreported experience ratings havebetter process of care qualityscores. Hospitals receiving “excellent”(9 or 10 out of 10) patient experienceratings have better clinical qualityscores for all 18 process of care measures that weanalyzed compared to hospitals receiving “low” (0 to 6out of 10) ratings. For instance, a 10-percentage-pointhigher score in the number of respondents giving ahospital an “excellent” experience rating is associatedwith a 20-minute lower emergency department (ED) waittime relative to hospitals receiving a “low” rating.Hospitals with higher experienceratings have better scores forsome, but not all, clinical outcomes.Hospitals receiving “excellent” patientexperience ratings have lowerreadmission and mortality ratescompared to hospitals receiving “low” experience ratings.High-scoring hospitals, however, don’t always have lowerhospital-acquired infection (HAI) rates. Such resultssuggest that patients might find it difficult to infer qualityfor care outcomes that are less obvious, or that are

Value of patient experience: Hospitals with higher patient experience scores have higher clinical qualityinfrequently encountered, such as HAIs at surgical site. Italso could indicate that the variation in outcomes betweenhospitals is small because most hospitals have alreadymade considerable progress in reducing HAIs.We also performed additional analyses to studypotential factors that might underlie the associationbetween experience scores and hospital clinical quality.The results indicate that:Clinical quality measures thatare more visible to patients aremore strongly associated withpatient experience. Clinical qualitymeasures that are more visible andtangible for patients, such as ED waittimes and readmissions, are more closely associatedwith patient experience ratings.Communication with nurses andrelevant discharge informationenhance patient experience,and are strongly associatedwith clinical quality. Experiencescores pertaining to nursecommunication and discharge information have thestrongest association with the largest number ofclinical quality measures.Hospitals’ participation invalue-based care models,such as accountable careorganization (ACO) affiliationand bundled-paymentarrangements, may strengthenthe association between patient experience andhospital clinical quality. Our regression analysesdetermined that ACO affiliation and paymentincentives tied to quality—such as bundledpayments—might strengthen and reinforce theassociation between patient experience and clinicalcare quality domains such as ED and surgical care.2Hospital executives face multiple priorities andresource demands, and may question the businessvalue of analyzing and acting upon patient experiencedata. Along with our prior work on the associationbetween patient experience and hospital profitability,these new findings help strengthen the business casefor patient experience. Moreover, our findings pointto particular aspects of care that hospital leadersmight want to prioritize for investments in toolsand mechanisms that engage consumers and helpimprove patient experience.Hospitals with higher patientreported experience ratingshave better process of carequality scores. Further, hospitalswith higher experience ratingsalso have better scores for some,but not all, clinical outcomes.

Value of patient experience: Hospitals with higher patient experience scores have higher clinical qualityIntroductionWith the appearance of a market shift towards valuebased and patient-centered models of care, improvingpatient experience—along with efforts to improveclinical quality, and reduce the cost of care— is anincreasingly common tactic for hospitals. Althoughimproving patient experience can be valuable unto itselfand regarded as distinct from improving clinical quality,the two concepts are often interrelated. Payers, forinstance, increasingly emphasize patient experience as acore element of care quality.8 In tying hospital Medicarepayments to experience scores under the Value BasedPurchasing Program, for example, the Centers forMedicare and Medicaid Services (CMS) noted: “Deliveryof high-quality, patient-centered care requires usto carefully consider the patient’s experience in thehospital inpatient setting.” 9Although consumers often value both inpatient clinicalquality and the care experience when choosing ahospital, the link between these two factors has notbeen studied closely.10 Literature on the topic is ratherlimited, and has largely focused on clinical outcomessuch as readmissions and mortality rates.11In this study, we analyzed the association betweenpatient experience scores and a broad range of widelyused clinical quality measures (both outcome and POCmeasures) reported to CMS. We found that hospitalswith higher experience ratings generally have betterclinical quality scores, particularly for process of caremeasures. Combined with the results of our previousstudy, which documented the association betweenpatient experience and hospital profitability, these newfindings provide evidence to help make the businesscase for increased focus on patient experience. Thatcould help guide hospitals in prioritizing investmentsin tools and mechanisms that engage consumers andhelp improve patient experience.Hospitals with higher patientreported experience ratings havehigher POC quality scoresTo examine the relationship betweenpatient experience and hospital clinical quality, wecombined hospital-level patient experience ratings fromthe most widely used hospital experience survey—theHospital Consumer Assessment of Healthcare Providersand Systems (HCAHPS)—with clinical outcome and POCquality measures from CMS.12 In the HCAHPS survey, only ranges of scores arepublicly reported, so the main HCAHPS metricsthat we used in our analyses are the percentage ofrespondents giving a hospital a rating of 9 or 10 outof 10 (“excellent” rating), 7 or 8 out of 10 (“moderate”rating), or 0-6 out of 10 (“low” rating). See sidebar onthe following page or the appendix for details. For quality measures, we selected a broad range ofPOC and outcome measures based on conversationswith subject matter experts, data availability, andinclusion in key Medicare reimbursement programs,such as the Value-based Purchasing (VBP) andhospital star rating programs. See sidebar on thefollowing page or the appendix for details.“Delivery of high-quality, patientcentered care requires us tocarefully consider the patient’sexperience in the hospitalinpatient setting.”—Centers for Medicare and Medicaid Services (CMS)3