This publication will provide an overview of patient experience, how it is measured, and how to achieve it optimally within the healthcare setting. Sodexo’s definition of Patient Experience will also be explored.

1. Overview of Patient Experience:
Definitions and Measurement Tools
Darien T. Kadens, PhD, MBA, Director of Healthcare Research, Sodexo
Rachel Permuth, PhD, MSPH, National Research Director,
Innovations 2 Solutions, Sodexo
Taylor Lauricella, PhD Candidate, Industrial and
Organizational Psychology, Sodexo Research Fellow

2. 2
The information and concepts contained in this document are the proprietary property of Sodexo.
As such, they cannot be reproduced or utilized without permission.© 2015
In the healthcare system worldwide, there has been a shift from a traditional,
disease-centered approach toward a more contemporary, holistic patient-centered
care model. As more hospitals convert to this patient-centered model, the standard
for defining and measuring quality services has evolved to include a construct
known as “patient experience.” In fact, Patient Experience is now considered
one of the three pillars of quality in healthcare, along with clinical effectiveness
and patient safety.1
Despite its importance and widespread acceptance, Patient
Experience as a construct is not standardized, with many existing definitions and
measurement instruments. Therefore, this publication will provide an overview of
patient experience, how it is measured, and how to achieve it optimally within the
healthcare setting. Sodexo’s definition of Patient Experience will also be explored.
Defining Patient-Centered Care
In a traditional disease-centered approach, the provider makes
all decisions regarding the health of the patient, using empirical
evidence and data. This approach is usually reactive, occurring
in response to a patient developing an illness.2
In patient-
centered care, however, the provider actively works with
and engages the patient and his/her family to identify and
fulfill the full spectrum of patient needs.3
This process is
accomplished through ongoing patient feedback, practice-based
learning and comprehensive care, which gives patients a smooth
transition as they progress through all aspects of care.4
According to researchers Morgan and Yoder, there are four
key attributes of patient-centered care: holistic care,
individualized care, respectful care and empowering care
(see Figure 1).5,6
Holistic care refers to valuing the whole patient
by meeting his/her physical and psychological needs, while also
recognizing his/her values and beliefs. Individualized care occurs
when healthcare providers take into account a patient’s unique
needs and preferences. Respectful care refers to recognizing the
patient as an active health consumer, providing a patient with
options and listening to the patient’s wishes. Empowering care
occurs when healthcare providers encourage autonomy and
facilitate patient participation in decision-making.5,6
Figure 1. Attributes of Patient-Centered Care
Empowering Care
Holistic Care
Respectful Care
Individualized
Care
Patient-
Centered
Care

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The information and concepts contained in this document are the proprietary property of Sodexo.
As such, they cannot be reproduced or utilized without permission.© 2015
There are a number of benefits of the patient-centered model
over a disease-based approach. One benefit is that patients
and families feel they have a voice throughout the healthcare
process. This helps to establish trust between the provider, the
patient and the family, and leads to higher levels of satisfaction
with healthcare services.6
In addition, research shows that a patient-centered model
results in better health outcomes than a disease-centered
model. For example, one study found that patients who
experienced more patient-centered care during their stay required
fewer visits to specialty care clinics, fewer hospitalizations, and
fewer laboratory and diagnostic tests after being released.7
Similarly, a recent meta-analysis of 29 studies found that
patient-centered care was related to increases in emotional
well-being, improvements in physical symptoms, engagement in
healthy behaviors, and a reduction in hospital visits.5
What Is Patient Experience?
The concept of Patient Experience has emerged as a result
of the shift toward a patient-centered care model. From a
business perspective, hospitals that focus on all aspects of the
patient’s experience are more likely to see improvements in their
patient satisfaction survey data and HCAHPS. Because HCAHPS
scores are publically available, hospitals scoring high on them
can attract more patients, providers and payers.8
In order to
realize these outcomes, however, it is essential that hospitals
understand what Patient Experience is, how to improve it, and
how to measure it.
Patient Experience is widely assessed among patient-centered
healthcare systems. However, although Patient Experience
has been extensively studied and measured, there is not one
standard definition. Rather, there are a number of definitions
and dimensions covered within this construct. The variation
among them is often based on the healthcare system and/or the
measurement tool used.
Jason A. Wolf, Ph.D., Executive Director of the Beryl Institute,
defines Patient Experience as “a patient’s cumulative
evaluation of the journey they have with [the healthcare
system], starting when they first need [you], and based on
their clinical and emotional interactions, which are shaped
by your people, processes and your physical setting.”9
Meanwhile, Dr. Suzanne Shale – Oxford University Fellow and
consultant in the fields of Patient Experience and healthcare
ethics – describes how Patient Experience refers to
“…reducing suffering and reducing anxiety [to the patient]
across the entire continuum of care, from first phone call
to discharge.”10
In research commissioned by the UK’s National Institute
for Health Research (NIHR), Doyle et al. hypothesized that
Patient Experience can be conceptualized through its various
dimensions, which differ across definitions. For example,
one perspective of patient experience defines it as the
combination of the relational and functional aspects
of care (see Figure 2). The relational aspect refers to the
interpersonal pieces. This includes emotional and psychological
support, as well as treating patients with compassion, dignity
and respect. Other interpersonal aspects involve enabling self-
care, giving families a voice in decision-making, and providing
the patient with clear, transparent information. Meanwhile,
functional aspects refer to the basic conditions of care. These
include effective and timely treatment, providing the patient with
a safe, comfortable and clean environment, and coordinating
smooth transitions and continuity between healthcare teams.11
Figure 2. Relational and Functional Aspects of Patient
Experience
Meanwhile, according to researchers Wolf et al., another way
to conceptualize patient experience is to understand
whether the psychological needs of the patient are being
met. The first psychological need is confidence; meaning,
whether the patient trusts the healthcare system. The second,
integrity, describes whether a patient is treated fairly. The third,
pride, alludes to whether the patient feels positively about their
interactions within the healthcare system. The last, passion,
describes whether the healthcare system has invested in the
patient and the patient will return to the same system in the
future, if needed. When all four needs are met, the ideal Patient
Experience has occurred.10,12
According to the Beryl Institute, Patient Experience is defined as
“…the sum of all interactions, shaped by an organization’s
culture that influence patient perceptions across the
continuum of care.” 9,13,14
Interactions refer to the interface
between the patient and the employees, policies, processes
and healthcare environment. The culture refers to the vision
and values of the organization. Perceptions include what is
understood and remembered by patients. Continuum of care
includes the delivery of care before, during and after the patient’s
stay.
Relational
Aspects
Compassion
Dignity
Respect
Self-care
Voice
Transparency
Functional
Aspects
Effective and Timely
Treatment
Safe Environment
Clean Environment
Comfort
Smooth Transitions

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The information and concepts contained in this document are the proprietary property of Sodexo.
As such, they cannot be reproduced or utilized without permission.© 2015
Sodexo’s definition of Patient Experience reflects this emphasis
on the continuum of care (see Figure 3). The Patient Experience
begins during pre-admission with tasks like scheduling necessary
tests and confirming the appointment, and continues post-
discharge with follow-up and a reminder for future appointments.
During the patient’s stay, however, treatment is only one aspect
of their care – they might also be assisted with things like pet
care, running errands, or arranging lodging and transportation
for visitors.
In fact, Sodexo recognizes that the ideal Patient Experience
is increasingly being defined by non-clinical elements,
such as convenience, customer service and staff attitude.
In fact, more than 80% of the time a patient spends in the
hospital is not related to direct care. Patients who report
any problem with their room or hospital staff rate their overall
experience 39% lower than patients with no problems. Therefore,
a more well-designed Patient Experience alone will not achieve
success. Creating a truly engaged workforce that remains
consistent over time is also critical to delivering lasting change.
Figure 3. Sodexo’s Definition of the Patient Experience
The Patient Experience

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The information and concepts contained in this document are the proprietary property of Sodexo.
As such, they cannot be reproduced or utilized without permission.© 2015
In sum, although there is no standard definition for Patient
Experience, there are several themes that are touched
upon across these various definitions. Patient Experience
encompasses a patient’s entire journey through the
healthcare system, with an emphasis on smooth transitions as
the patient progresses. The psychosocial needs of the patient
hold equal importance to the quality of the environment and
the quality of care. Most importantly, all definitions of Patient
Experience reflect a patient-centered care approach. Next,
we will examine the relationship between Patient Experience and
other constructs related to patient care.
How Does Patient Experience Differ
from Other Related Constructs?
Patient Experience vs. Patient Satisfaction
Patient Experience and patient satisfaction are often used
interchangeably – but many would argue that the two are
very different. A dominant perspective is that patient
satisfaction is a subset of Patient Experience (see Figure 4).
Patient satisfaction refers to a patient’s (positive) perceptions
of care. Patient Experience, on the other hand, encompasses
both having a happy patient and ensuring high-quality care
and service outcomes.13,15
Furthermore, Patient Experience
encompasses the dynamics of the relationship between a patient
and the healthcare worker. It also emphasizes engagement, both
of the patient and the employees; whereas patient satisfaction
covers the static perspective of the patient.16
Figure 4. Patient Satisfaction is a subset of Patient Experience
Patient Experience vs.
Patient Quality of Life
It is not always apparent how Patient Experience differs from
patient quality of life, as they both emphasize the lifestyle and
psychosocial needs of the patient. Patient quality of life,
however, typically refers to a specific subset of patients,
whereas patient experience is much broader. Specifically,
patient quality of life is typically used in context of patients
suffering from a major illness, patients who recently underwent
a surgical operation, and/or patients who are nearing the end
of their lives. The goal of patient quality of life is also very
specific: to relieve suffering.17
Patient Experience, on the other
hand, encompasses patients in varying stages of illness with an
emphasis both on psychosocial needs and providing the best
care possible.
Patient Experience
Detailed experience of
healthcare service
Patient engagement
Engagement of staff
Positive patient perceptions
Patient Satisfaction

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The information and concepts contained in this document are the proprietary property of Sodexo.
As such, they cannot be reproduced or utilized without permission.© 2015
Sodexo’s definition of patient quality of life, however, is more closely aligned with Patient Experience and quality of care. Sodexo’s Six
Dimensions of Quality of Life are described in Figure 5.
Figure 5. Sodexo’s Six Dimensions of Quality of Life
However, Quality of Life issues differ, depending on the
environment. When examining Quality of Life among patients,
the dimensions of most relevance would include:
Physical Environment: For example, appropriate
temperature, access to nature, and quality furniture in
patient rooms.
Social Interaction: This could include the provision
of comfortable visiting areas and facilitating positive
interactions between staff and patients.
Ease and Efficiency: For example, reducing wait times
or streamlining communication between healthcare staff
and patients.
Health and Well-Being: This could include the
provision of nutritious and healthy patient meals, and
advice on nutrition and lifestyle.
In recent research conducted by Sodexo’s Quality of Life
Institute, 90% of hospital leaders strongly agreed that they
place a high level of importance on improving quality of life in
their organization.18
This is explained in part by the nature of a
healthcare organization’s activities, which aim to directly improve
the Quality of Life of their end-user: the patient.
The survey also revealed that hospital leaders believe that the
concept of Quality of Life has shifted dramatically, and will
continue to undergo changes in the coming years. According to
one hospital director in France, “We must always reevaluate
Quality of Life for our patients. We don’t address this topic
as we did 20 years ago, and 20 years from now it will be
different again. Quality of Life is a topic that never stops
evolving.”
How Is Patient Experience
Measured?
There are a number of existing measures that can be used to
measure Patient Experience. One common measure is the
HCAHPS (Hospital Consumer Assessment of Healthcare
Providers and Systems) Survey. The HCAHPS was created in
order to have a standardized measure of Patient Experience that
can be used to make comparisons across various hospitals. The
survey contains 32 questions and covers eight key dimensions
(see Figure 6).1
In addition to effectively measuring Patient Experience in
these areas, the HCAHPS survey also accomplishes three other
important goals. First, it allows for objective and meaningful
comparisons across healthcare systems. Second, the survey
results are reported publicly, which incentivizes providing quality
healthcare. Third, the public reporting enhances accountability of
hospitals. In order for hospitals to use this survey and participate
in public reporting, they must meet a number of program
requirements, including HCAHPS training.1
Press Ganey is the largest HCAHPS administrator in
the U.S.19
However, the company believes that to advance
the Patient Experience, providers must obtain a more in-
depth understanding of patient needs and address targeted
opportunities within patient populations. With that in mind,
Press Ganey works with providers across the care continuum
to collect feedback through census-based survey instruments
containing additional questions around perception of care.
The robust data sets and shortened improvement cycles allow
organizations to act more rapidly on patient insights, and have
opportunities to validate, monitor, course-correct and enhance
initiatives.
As a result of extensive research and analysis, combined with nearly 50 years of experience,
Sodexo has identified 6 dimensions essential to Quality of Life.
Social Interaction – Factors
that strengthen bonds among
individuals and facilitate
access to activities or events.
Personal Growth –
Everything that allows an
individual to learn and make
progress.
Ease and Efficiency – Ability
to devote your full attention
to the task at hand and carry
it out with ease, efficiency and
minimal interruption.
Recognition – Factors that
contribute to an individual
feeling truly valued and
appreciated.
Physical Environment –
Factors that contribute to a
person’s comfort and sense of
well-being.
Health and Well-Being –
Promoting a healthy lifestyle
through a well-balanced diet
and physical activity.

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The information and concepts contained in this document are the proprietary property of Sodexo.
As such, they cannot be reproduced or utilized without permission.© 2015
Another instrument used to study patient experience is the Picker Patient Experience Questionnaire-15 (PPE-15). The
PPE-15 is a 15-item measure that was validated using data collected from patients in the United Kingdom, Germany, Sweden,
Switzerland and the United States. Eight dimensions are covered within this instrument (see Figure 6). The PPE-15 is highly reliable
and is often used in research settings.20
Figure 6. Comparison of HCAHPS and the PPE-15
Achieving Optimal
Patient Experience
Regardless of the definition or instrument utilized, achieving
optimal Patient Experience is of the utmost importance for
healthcare systems. There are a number of strategies an
organization can employ to optimize Patient Experience (see
Figure 7). According to Planetree, the first step is fostering a
strong culture of patient-centered care. In the most extreme
scenario, this process may involve a cultural transformation
of the healthcare organization, which can be achieved
through organizational assessments, strategic planning, and
implementation of new systems, processes and policies. It is also
important to engage current employees and develop an effective
leadership team. This step reinforces the patient-centered culture
among staff and creates a supportive, positive work environment
for employees. The next step is to promote patient activation,
which occurs when patients are given access to resources and
information that enable them to participate in their care process.
Lastly, it is critical to measure the performance of the healthcare
system through assessments.21
Receiving feedback from
patients is an invaluable tool that allows healthcare providers
to understand which areas they are excelling in and which areas
need future improvement.
Figure 7. The Planetree Approach
Sodexo’s Recommendations
for Future Operationalization
of Patient Experience
Planetree’s recommendations above capture four essential steps
required to achieve optimal Patient Experience. However, Sodexo
recognizes that the ideal Patient Experience is increasingly being
defined by non-clinical elements through employees at all levels
of the organization. As previously mentioned, more than 80%
of the time a patient spends in the hospital is not related to
direct care.
With this in mind, it is imperative that training be provided
not only for physicians and nurses, but also for frontline
workers, including environmental services staff and food
service workers. This training should educate employees on
specific, expected behaviors, and should be experiential so that
employees can better understand how patients feel and practice
behaviors that contribute to an improved Patient Experience.
Sodexo’s healthcare employees take part in empathy awareness
training and receive extensive CARES behavioral training –
focusing on Compassion, Accountability, Respect, Enthusiasm
and Service.
Furthermore, communication about the role frontline
workers play in creating the optimal patient experience
should occur at all levels of the organization, with specific
emphasis on the outcomes that can be achieved for patients
(higher satisfaction and better health outcomes), employees
(greater job satisfaction and engagement), and the organization
(greater market share).
In sum, a more well-designed Patient Experience alone will not
achieve success. Creating a truly engaged workforce is also
critical to delivering lasting change.
Dimensions of HCAHPS Dimensions of the PPE-15
Communication with
Nurses
Communication with
Doctors
Responsiveness of
Hospital Staff
Pain Management
Communication About
Medicines
Hospital Cleanliness
and Quietness
Discharge Information
Overall Rating of
Hospital
Information and
Education
Physical Comfort
Emotional Support
Respect for Patient
Preferences
Coordination of Care
Involvement of Family
and Friends
Continuity and
Transition
Continuity and
Transition
P Patient Activation
P Performance Improvement
P Leadership Development
P Staff Engagement
4 Steps to Optimize Patient Experience

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The information and concepts contained in this document are the proprietary property of Sodexo.
As such, they cannot be reproduced or utilized without permission.© 2015
References
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one
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devkaran.pdf?sfvrsn=0
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[18] Sodexo Institute for Quality of Life. (2015). How Leaders
Value Quality of Life in Their Organization: the first international
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a4f69838#/a4f69838/1
[19] Press Ganey. (2015). Patient Experience Solutions. Retrieved
from http://www.pressganey.com/solutions/patient-experience
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[21] Planetree. (2014). Approach. Retrieved from http://
planetree.org/approach/