Join | Print Page | Contact Us | Your Cart | Sign In | Register
Guest Blog
Blog Home All Blogs
Search all posts for:   


View all (66) posts »

Understanding the Gap Between Patient Expectations and Reality

Posted By Barbara Lewis, Friday, June 21, 2013

Some events change our lives. They may be small actions that have a substantial impact or they may be traumatic events that forever alter our life. For me that event began to unfold when my younger sister, Joan, called me from the Intensive Care Unit where she had been hospitalized for an unknown infection. She expected to be released within a few days. Nonetheless, as soon as I hung up the phone, I booked a flight across the country to be with her. I spent 15 to 18 hours a day in her room recording and monitoring medications, test results and procedures. During the next few days as she improved, I put on my marketing hat and observed the hospital environment with both awe and surprise. After spending nearly three decades in marketing, much of that around customer or client satisfaction, I was fascinated with how the hospital functioned.

I decided to jot down my observations, which I planned to discuss with the head of the ICU on the day of my sister’s release. Unfortunately, Joan took a turn for the worse and died at the end of the second week. When I returned home, I found my notes. As a looked over the pages, deciding what to do, I thought that the head of the ICU might like to know my thoughts. I set to work on a document I called Joan’s Family Bill of Rights. I marveled at a group of unbelievable people who have dedicated their lives to healing the sick and comforting the dying. Yet, as a family member I felt invisible most of the time – a nuisance in the hospital room, who asked too many questions.

I emailed the document to the head of the ICU, who sent it to the head of the hospital and he, in turn, emailed it to the heads of the health care system. They contacted me to talk and within three months flew me to their facilities to make three presentations, which they videotaped for their training program.  I didn’t feel invisible any longer. Here was a health system that truly listened.

What surprised me was the number of people after each presentation who told me their stories. I realized that my experience was not unique and that patients and family members everywhere shared my own narrative. Joan’s Family Bill of Rights wasn’t just my story; it was universal. As the document was passed around in meetings and on the internet, an increasing number of nurses contacted me.

I asked myself, "How can I help?” I spent over a year researching my observations, such as compassion fatigue, situational awareness and the relationship between quiet and healing. I found that the Healthcare Consumer Awareness Hospital Process and Systems (HCAHPS) surveys were tracking patient satisfaction in hospitals across the country. I was surprised to learn that money was tied to the scores, which reflected certain patterns. For example, the well educated and younger generally score the survey lower, while the poor and less educated score the survey higher. I studied the questions and devised scenarios of high scoring or low scoring.

In my opinion, the discharged patients score the HCAHPS surveys based on the difference between expectation and reality. Patients come into hospitals with certain expectations. Every person has different expectations; however, in many cases those expectations can be generalized. For example, the more educated probably want more information about their condition. (HCAPHPS survey question: Patients Who Reported that Their Doctors {or Nurses} Always Communicated Well.) The gap between the expectation and the reality is where the survey scores reside.

There are at least five HCAHPS survey questions that are directly related to the patient’s journey through the hospital system. Low HCAHPS scores not only affect Medicare payment, but insurance reimbursements; future patients, who opt for other facilities; and donor defections, as well.


As businesses have been doing for years, it’s time hospitals understand the patients’ expectations, manage those expectations and shut the gap between the hope that patients have when they come into the hospital and the realization they are stuck with when they leave. Closing that gap means redesigning systems and altering behaviors.  It’s time to exceed patients’ expectations, which will not only boost HCAHPS scores, but have a substantial impact downstream as well.


Barbara Lewis has been a marketing consultant for over two decades. She began her career as a journalist writing for national publications from The Wall Street Journal to Ladies Home Journal. She has an MBA from the UCLA Anderson School of Management where she currently lectures. You can reach her at: 

Tags:  Expectations  HCAHPS  ICU  Patient Experience  reality  survey 

Share |
Permalink | Comments (0)

Stay Connected

Sign up for our informative series of monthly e-newsletters from The Beryl Institute.

The Beryl Institute
1560 E. Southlake Blvd, Ste 231
Southlake, Texas 76092