With this issue of the journal, we will embark on a new and important series on the human experience in health care. The human experience in health framework is an important advance in our thinking about the elements of the health care system that shape interactions for patients, families, communities, and care providers. This series will be led by our nursing colleagues at Press Ganey, a health care performance improvement organization best known for its pioneering work in measuring patient experiences and using that data to assist organizations in improving experience performance, reducing patient suffering, measuring nurse-sensitive outcomes, and improving the overall quality of health care.
Most nurses are familiar with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which is the first national, standardized, publicly reported survey of patients' perspectives on hospital care. Starting in 2012, the Affordable Care Act included patient experience survey scores as part of its Hospital Value-Based Purchasing program. Many of the questions on the HCAHPS survey are linked to or influenced by the delivery of nursing care. These surveys assess interactions with physicians and nurses, personnel responsiveness, the cleanliness of the hospital environment, and other aspects of hospital care.
Press Ganey's own research, as reported by Dempsey and colleagues (Journal of Nursing Administration, 2014), has demonstrated that, among the current 29 HCAHPS survey questions, better performance is largely influenced by positive responses to questions that are influenced by nurse communication. This has led to familiar communication strategies such as nurse scripting, nurse leader rounding, and service recovery. Unfortunately, the oft singular focus on improving the inpatient stay has led to a misstep in addressing what really matters to patients: what happens before they enter the health care system, and what happens once they return to their homes and communities.
A deeper understanding of health care work concedes that patient experience encompasses not just the clinical and interpersonal aspects of care, but the administrative, operational, cultural, and structural characteristics of the entire care delivery system. Consider the role that unconscious provider bias, patient distrust, misinformation, or inequitable access to care might play in the overall patient experience. To this end, the patient experience has been reconceptualized as the human experience. So, what is the human experience in health care?
According to Wolf and colleagues (Patient Experience Journal, 2021), "The human experience in healthcare integrates the sum of all interactions, every encounter among patients, families and care partners and the healthcare workforce. It is driven by the culture of healthcare organizations and systems that work tirelessly to support a healthcare ecosystem that operates within the breadth of the care continuum into the communities they serve and the ever-changing environmental landscapes in which they are situated. The human experience in healthcare ultimately is the fruit born from the core of patient experience itself."
There is a lot to unpack in this formal definition. Stated another way, the work in advancing the human experience forces nurses to build upon and think beyond the patient experience; it is no less important but considers how the patient's experience might be influenced by such issues as climate extremes, neighborhood safety, living in a food desert, interacting with a beleaguered workforce, or being denied access to care because of insurance-all very real and important issues that influence how we care for individuals and their families within their communities.
In this issue, we welcome Jeff Doucette, chief nursing officer at Press Ganey, to introduce The Human Experience in Health Care series. Backed by an unwavering commitment to improving the human experience, national datasets, and access to a team of thought leaders in nursing, Doucette and the Press Ganey team will articulate the critical role the nurse plays in human-centered care. These discussions will not only improve systems for our patients but will also engage the nursing workforce in designing a health care system that is safe and equitable across the continuum of care.