We hear it all the time: evidence-based practice. But can you use research and evidence to help build, grow, and/or improve your business? The answer is most certainly, “yes”. Recently published research explores factors that influence patient experience & satisfaction with physical therapy services. In this article, we’ll take a dive into some of this research and pull out some nuggets that will hopefully help you improve patient experience and engagement in your clinic or rehab center.
Research About Patient Experience & Satisfaction
Recent events and changes in the healthcare industry, specifically in the United States, has led many organizations to wonder how to measure the quality of healthcare services. For a long time, objective —or standardized— data and outcomes were used to measure “quality” in healthcare. However, over the past few years, researchers started to take a look at more qualitative data, centering around patients’ satisfaction with the services they receive. It makes sense if you think about it: how can you rate the quality of a service by the numbers alone? Healthcare centers on the patient. That means that the patients should have a say about whether a service is good or bad. Large healthcare companies and Universities began researching just that subject.
The Research: Main Takeaways
So what does the research say about patient satisfaction with rehab or therapy services? Well, a systematic review published in 2011 showed that there were two main factors that determined a patient’s satisfaction with musculoskeletal outpatient rehab services. These two factors include the interpersonal attributes of the therapist/clinician and the process of care .
One interesting finding was that treatment outcomes were infrequently or inconsistently associated with patient satisfaction . Do you know what that means? It means that your patients care less about the outcome of treatment than they do about the process involved in receiving care and the interpersonal skills of their clinician. If the clinician is personable, makes the patient feel comfortable, and builds a strong, trusting therapeutic relationship with the patient, that clinician will receive a higher satisfaction rating than a clinician who may be technically the better of the two. What often separates clinicians who’s patients leave high satisfaction rating from those who’s patients leave poor ratings has little to do with technical skill or knowledge. It has more to do with the human connection that the patient experiences, or doesn’t experience, in the clinic.
Now this isn’t to suggest that you can be a mediocre clinician and hope to succeed in the long run. This is healthcare, after all, and there is an expectation that patients will benefit from treatment or services. All the interpersonal skills in the world won’t help you out if your patients feel the treatment they receive is sub-par. But this research does suggest that, given two clinicians that are at least competent in their field, the clinician with better interpersonal skills and a great process in place will tend to have higher patient satisfaction ratings.
Interesting Findings From the Research
This particular systematic review broke the quantitative data down into 3 sub-groups: Degree of Patient Satisfaction, Patient Characteristics, & Aspects of treatment associated with satisfaction . One interesting finding about the degree of patient satisfaction was that, on average, patients generally reported satisfaction with outpatient therapy between 68-91% of the time . Now these findings include patients and clinics across Europe, so there may be some variation in other areas like the US, Canada, and other parts of the world.
Another interesting finding revolves around the status or level of injury. According to research, patients tend to report higher satisfaction with outpatient therapy services if they are seen or treated for acute musculoskeletal conditions rather than those experiencing chronic pain . This means that those of us treating patients in chronic pain will need to step up our own game, both in the process of care delivery as well as our own interpersonal skills and interactions. In fact, the research also shows that patient experiencing chronic pain place greater importance on the process or organization of care. Those patient experiencing acute injuries or conditions placed greater weight on the clinician’s interpersonal skills . Understanding the results of this research helps us organize and structure our clinics to better meet the needs and expectations of patients depending on where they are in their recovery process and what they consider most important.
Process & Organization of Care
Let’s take a look at how the process or organization of care impacts patient satisfaction according to the research. The research outlines factors involved in the process of care as timeliness of treatment, efficiency of treatment, frequency, follow-up, individualized programming, and patient involvement in decision making . For example, patients with chronic low back pain considered individualized treatment planning and the ability to contribute to treatment decisions of great importance. This research gives us a road map to an outstanding patient experience. By ensuring that our patients receive timely and efficient treatment that is individualized, with their own input, we can leave patients feeling satisfied, engaged, and truly cared for.
Organization of care also plays a role in the overall patient satisfaction of treatment. For example, access to services, convenient clinic hours, location, parking, and approachable and available staff all impact patient satisfaction scores . It should seem pretty obvious, but poor levels of cleanliness or clutter also negatively impact a patient’s reported level of satisfaction following treatment.
Treatment Outcomes & Expectations
Contrary to what many may think, clinical outcomes do not always correlate with patient-reported satisfaction levels. For example, according to some published research on the subject, high satisfaction was sometimes —but not always— related to pain reduction . This may be due to the fact that some patients felt that self-management strategies they learned while in treatment were more important than reduction in pain. If they were able to manage the pain themselves, they still considered that a “win” so-to-speak.
Also, improving a patient’s strength and mobility can have a great impact on their quality of life, even if there is only minimal improvement in symptoms such as pain. This should give us hope that we can still have a positive impact on patients, even if they end up needing to go through with surgery after treatment, or if they are still experiencing pain or some limitations. Especially if we are implementing a biopsychosocial treatment strategy, we may be able to positively affect a patient’s quality of life —leading to higher treatment satisfaction— even if the underlying symptoms are minimally changed. This means that even patients experiencing chronic pain can experience improvements and feel satisfied with the treatment they receive in out clinics.
Part of what we can do as clinicians to improve a patient’s satisfaction and engagement with our services is to help frame or manage expectations at the beginning. The research shows that a patient’s expectations of the therapy encounter influences their evaluation of —and satisfaction with— the care they receive . For example, patients with acute conditions tend to have lower expectations and higher satisfaction rates than those experiencing chronic conditions.
Knowing this, we as clinicians would do well to begin managing a patient’s expectations at the outset of treatment. This may include providing additional education around the treatment program, recovery rates, what to expect, etc. If a patient knows what to expect going into treatment, they’ll be less likely to be surprised at the end (who knows, maybe they’ll even be pleasantly surprised by the gains they weren’t expecting!).
Human Connection & the Role of The Clinician
Another interesting finding from the research is that patients reported higher levels of satisfaction when they were treated by the same clinician over the course of treatment . This follows some of the research around patient-therapist interactions, which we’ll look at in detail below. It also seems pretty intuitive.
Ultimately, all of healthcare is about one thing: humans helping humans. It is a personal service involving a human experience. Patients want that experience. They want to feel that their clinician understands their situation, knows how to help, and truly cares about them. Consistency helps foster this relationship. It’s hard for patients to feel that human connection when they are treated like numbers on a schedule, being seen by whatever clinician is available at that time. The best clinicians —those that are sought out by patients— are those who are able to make that human connection felt. Let’s take a look at how the patient-therapist interaction can affect patient satisfaction and engagement.
It goes without saying that —at the very least— patients expect to be treated by clinicians who are professional, competent, friendly, and caring. Research also shows that patients place a great deal of weight on the clinician’s ability o communicate effectively; from explaining a diagnosis to educating the patient of self-management strategies . In fact, this research concludes that high-quality patient-therapist interactions are more important to patients than convenient clinic locations, parking, organization of care, and even in some cases the treatment outcomes . Given that information, we clinicians and clinic owners should be trying to do anything we can to improve the interactions patients have with our staff and clinicians.
So how do we improve patient-therapist interactions? Well, the research highlights a few areas that include: 1) a clinician’s interpersonal and communication skills, 2) a clinicians practical or technical skills, and 3) individualized treatment planning and organization of care . We’ve spent a good deal of time discussing that last point above, so we’ll focus on the clinician’s skills.
Interpersonal & Communication Skills of the Clinician
Research shows that a clinician’s active listening, empathy, friendliness, encouragement, confidence, and nonverbal communication all impact a patient’s satisfaction and engagement with treatment . These skills play a large role, not only in developing trust or rapport with patients, but they also impact the organization of care. Take active listening as an example. When a clinician takes the time to actively listen to and understand a patient’s unique situation it does 2 things: 1) it allows a bond to develop between clinician and patient, leaving the patient feeling valued and truly cared for, and 2) it helps inform the therapist and gives them the information necessary to tailor the treatment plan to be individualized for that patient.
Think about it: patients want to have their story heard. They want their therapist or clinician to understand where they are coming from, what they’ve experienced, and how they feel about it. When a clinician takes the time to actively listen to the patient’s story, show empathy, provide encouragement that things will get better, and then confidently explain to the patient the treatment approach, that patient walks away from that encounter thinking “Wow! That therapist understands me and what I’m going through and they actually care about helping me get better.” Those moments create those experiences that truly leave a positive impact in our patients’ lives.
Practical & Technical Skills
Another area the research shows has an impact on patient experience is the practical or technical skills of the clinician . Tying in with the previous example of communication skills, patients tend to feel that a clinician that is able to provide simple and clear explanations has stronger skills or training. That makes sense, if you think about it. People that truly understand a subject (or diagnosis) are able to provide simple, clear education or explanations.
On top of being able to explain things clearly, patients also believed it is vital that their clinician posses excellent technical skills and abilities . Whether this involves manual therapy techniques, application of modalities, or exercise prescription, clinicians must show their patients that they have mastered those skills. This is likely due to the fact that patients simply tend to put more trust in clinicians who they feel are expert practitioners. This reason alone should make all of us who work as clinicians strive for constant improvement and development. After all, the whole reason patients come to our clinics is to receive the expert care we are able to provide. It doesn’t matter how efficient the care is delivered or organized, or how the parking is at your clinic. If you are simply adequate as a clinician, you will struggle to deliver an amazing patient experience.
Many factors influence patient experiences in our clinics or organizations. Recently published research indicates that the process of care and the interpersonal attributes of the clinician play the biggest role in determining a patient’s satisfaction with rehabilitation/therapy care. Ultimately, patients want to experience a human connection during their course of treatment. Practical skills of the clinician do play a role in the overall satisfaction patients report. However, what is arguably just as important is how that clinic, clinician, or organization makes that patient feel.
Do our clinics run patients through the rehab mill? Do we make patients feel like numbers on an assembly line, offering cookie-cutter treatment programming? Or, do we strive to learn each patient’s unique story —where they are on their role to recovery— to understand how their particular limitation impacts their daily life? The clinics and clinicians that are able to do that will deliver an experience unlike any other in today’s healthcare landscape. Their patients will feel cared fore. Their clinicians will feel the pride, impact, and fulfillment of doing truly meaningful work. And they will rise above the throng of mediocre clinics offering one-size-fits-most therapy treatment programming.
Have you tried to make any changes to improve their overall experience in your clinic? Have you tried to incorporate research and evidence into those changes? Share any additional resources that you found helpful in the comments below!
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 Hush, J. M., Cameron, K., & Mackey, M. (2011). Patient Satisfaction With Musculoskeletal Physical Therapy Care: A Systematic Review. Physical Therapy, 91(1), 25-36. doi:10.2522/ptj.20100061
 O’Keefe, M., Cullinane, P., Hurley, J., Leahy, I., & Bunzli, S. (2016). What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis. Physical Therapy, 12(04), 163-165. doi:10.1055/s-0035-1567123