For many years health systems fielded surveys to determine whether their patients were satisfied with all aspects of the care they were receiving in their communities.  Organizations invested a great deal of money and resources to identify and improve areas that patients reported dissatisfaction with.  Patient satisfaction had become a buzz word in the industry.

With the adoption of the Affordable Care Act (ACA) in 2010, patient experience began to take center stage as the Agency for Healthcare Research and Quality (AHRQ) developed and implemented the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program.  The program and its family of surveys is designed to advance our scientific understanding of patient experience with health care.

Patient experience and patient satisfaction are now healthcare terms that are often used interchangeably.  Patient satisfaction and patient experience are different.  While the differences may be subtle, they are important to understand as we strive to deliver patient-centered care.


The Agency for Healthcare Research and Quality (AHRQ) defines patient experience as, “the range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities. As an integral component of health care quality, patient experience includes several aspects of health care delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with health care providers.”

The Beryl Institute, a healthcare organization dedicated to improving the patient experience, states that patient experience is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”

CAHPS surveys are a measure of patient experience, according to AHRQ. These surveys are an objective measure of care quality, as perceived by patients, that are designed to help health care organizations use data to identify strengths and weaknesses, determine where they need to improve, and track quality improvement progress over time.

CAHPS surveys ask questions like the following:

  • Provider explained things in a way that was easy to understand
  • Provider spent enough time with patient
  • Patient got appointment for care as soon as needed
  • Provider listened carefully to patient

Patients respond by utilizing a response scale of Always, Usually, Sometimes or Never to report on their experience as objectively as possible.  To assess patient experience, one must find out from patients whether something that should happen in a health care setting (such as clear communication with a provider) actually happened or how often it happened.

Overall performance on a CAHPS survey is calculated as a “Top Box” score.  This is defined as the percent of questions that received the best possible or most desired response, which is typically “Always”.

“CAHPS surveys do not ask patients how satisfied they were with their care; rather, they ask patients to report on the aspects of their experiences that are important to them and for which they are the best, and sometimes the only source of information,” the agency wrote on its website.

“Because the surveys ask well-tested questions using a consistent methodology across a large sample of respondents, they generate standardized and validated measures of patient experience that providers, consumers, and others can rely on,” AHRQ continued.


AHRQ describes patient satisfaction as understanding “whether a patient’s expectations about a health encounter were met. Two people who receive the exact same care, but who have different expectations for how that care is supposed to be delivered, can give different satisfaction ratings because of their different expectations.”

In other words, patient satisfaction is a subjective healthcare measure. Two patients can receive the exact same care but have different satisfaction levels because they had different expectations, AHRQ said.

Some examples of patient satisfaction survey questions include:

  • Rate the personal manner of your provider
  • Rate your ability to get an appointment when you wanted one
  • Rate the friendliness and helpfulness of the staff
  • Rate your overall satisfaction with your visit

Satisfaction surveys will typically utilize a Likert response scale with “5” being the best and “1” being the worst (i.e. Excellent, Very Good, Good, Fair or Poor).  10-point and 4-point Likert scales are also sometimes used.  Overall satisfaction is usually calculated by averaging the numeric value of the Likert scale across responses, for example 4.65 out of 5.00.

In the era of the CAHPS survey, patient satisfaction surveys have been deemed subjective.  Two patients that wait 25 minutes to start their appointment may score their Wait Time very differently based on their personal experiences and expectations.  It is fair to acknowledge that subjectivity exists in CAHPS surveys as well, for example, how patients perceive the difference between the “Usually” and “Sometimes” response options.

Subjective feedback can be a valuable tool when organizations seek to understand what is most important to their patients across varied socio-economic and geographic variables.  This data can be difficult to glean from the more objective CAHPS type surveys.


As the ACA has matured, the Centers for Medicare & Medicaid Services (CMS) has made patient experience a core component when determining reimbursement levels, STAR ratings, Quality Bonuses and public reporting.  It is clear that CAHPS surveys have taken center stage.  CAHPS surveys have become critical tools for healthcare professionals interested in assessing the patient-centeredness of the care they deliver, identifying areas for improvement determining whether objective quality measures have been met.

AHRQ states, “A positive patient experience is an important goal in its own right. Moreover, substantial evidence points to a positive association between various aspects of patient experience, such as good communication between providers and patients, and several important health care processes and outcomes. These processes and outcomes include patient adherence to medical advice, better clinical outcomes, improved patient safety practices, and lower utilization of unnecessary health care services.”

Public reporting and STAR ratings provide patients more transparency and informed choices in their healthcare decisions, creating savvy healthcare consumers.  Healthcare organizations will benefit by recognizing the interdependence of customer service expectations (measured through patient satisfaction) and process excellence (measured through patient experience).   Increasing market share could depend on it.

Please contact Brad Pancratz at 719.226.9883 or if you are interested in learning how your organization can gather continuous, year-round survey feedback designed to improve your patient’s satisfaction with their office interactions as well as your annual CAHPS measurement.