Patients Are Giving High Marks to U.S. Health Care Providers During the Crisis

Patients Are Giving High Marks to U.S. Health Care Providers During the Crisis

by Patrick T. Ryan and Thomas H. Lee - May 26, 2020

When people feel vulnerable, they focus on what matters most. That’s why in the hours after JFK was shot or the terrorism attacks of 9/11, people huddled in their homes with their families. And that’s why, as the Covid-19 pandemic has unfolded, people have been rediscovering that the essence of health care is not miracle drugs, but the humanity and commitment of caregivers. As we’ll describe, this shows up dramatically in large surveys we’ve done on patients’ experience of their care. The impact of this new awareness could persist far beyond the end of the pandemic if providers seize the moment.

The pandemic has shown a spotlight on the bravery and compassion of caregivers on the front lines, and the public is responding. They are hearing stories about clinicians working relentless shifts and putting their desperately ill patients first, even at a risk to their own lives. They’re hearing about the hospital personnel lined up in lobbies, laughing and cheering through their masks for patients going home. And people around the world are honoring caregivers from their doors and windows, clapping, ringing bells, and banging pots to celebrate their work, courage, and sacrifice. They’re making more material gestures of solidarity too, sewing masks in their homes to send to caregivers, and donating generously to organizations that provide the front lines with personal protective equipment.

When 2020 began, none of these scenes were imaginable, but they are transforming how people think about health care. Before, their focus was mainly on costs and shortcomings of the “system.” Covid-19 has helped patients and providers themselves remember that health care is more than just another business sector. And data demonstrate that this trend is growing stronger every week across the country - especially in the nation’s hot spots.

In our ongoing consumer research of patients’ experience over the last decade we’ve seen their  overall ratings of their care go up at a rate of about 1% per year. But we saw a much bigger increase - 1.6% - in just one month (February to March 2020), based upon surveys from 238,601 patients hospitalized across the U.S. The increases were even larger in subsets from the two hottest hotspots at the time, Washington state (4.3%) and New York (13.2%).

At Press Ganey, we have never seen changes like this in a month. In our data, New Yorkers have been perpetually among the most critical in their ratings of care (that is, the least likely to give high ratings). But, during the most harrowing moments of the Covid-19 crisis, their appreciation stands out. This is the survey version of their banging on pots every night. In our data, they are banging louder and louder. For example, ratings of the skill of physicians rose 2.4% nationally, 2.8% in Washington and 10.4% in New York.  Ratings of nursing rose 2.4%, 2.5%, and 10.4%, respectively. Pain control ratings improved 2.9%, 5.4%, and 12.5%.

We saw the same trends across measures of human interactions between patients and their caregivers in the general categories of courtesy, keeping patients informed, personalizing care, responsiveness, and empathy. Nationally, ratings for most of these measures improved by 0.5% to 2% in that month.  In Washington, the increases were 2 to 3 times as great, and in New York, 4 to 5 times as great.

We also found fascinating consumer trends when we used artificial intelligence and natural language processing to analyze more than 7 million Covid-related comments in patient surveys from February 1 to April 4. There was a surge in dissatisfaction early in the crisis with the process of care (i.e. testing and treatment) as distinct from how caregivers themselves were perceived.  But those negative comments trailed off beginning in late March and as the crisis intensified, the frequency of positive comments about caregivers has gone steadily up.

The picture painted by these data is bracing for health care in every way. The challenges of this pandemic are overwhelming, but, for caregivers, being overwhelmed is not an option. Nationally, and especially in the hot spots, they are rising to the occasion with remarkable reliability - and not just on the technical aspects of care. Of course, caregivers worry about the availability of intensive care beds and personal protective equipment. But those worries have not distracted them from doing what they can to ease suffering, give hope, show empathy, and comfort patients, their families, and each other.

With strong leadership, health care can seize this moment in which caregivers are so proud and patients and the public are so grateful. What has raised public esteem for health care in recent weeks is more than creativity in increasing ICU capacity. The softer side of medicine really does matter, and everyone has rediscovered this during this period of vulnerability. The strategic move for health care providers is to now prioritize the values that have won the respect of society through the pandemic, and organize around meeting patients’ needs effectively, efficiently, and compassionately. That prioritization can create a virtuous cycle in which care improves and caregivers on the front line are buoyed by appreciation for their work, the way the public thanks soldiers for their service.

Even in New York.  In fact, especially in New York.

Patrick T. Ryan is CEO of Press Ganey.

Thomas H. Lee, MD, is the chief medical officer of Press Ganey. He is a practicing internist and a professor (part time) of medicine at Harvard Medical School and a professor of health policy and management at the Harvard T.H. Chan School of Public Health.