Improving experience – decoupling a moving train?

I’m puzzled when people rate highly (very satisfied or satisfied) their experience in clinics and hospitals while still complaining about the experience. What is in the overall rating (would recommend)?  Is it a comparison with other experiences that weren’t as satisfactory, yet annoyances still occurred?  I have spoken with people and caregivers who say,

this experience was one of my best, but that’s not saying much.  None of them were very good. Or seeing the nurse practitioner was great, but it’s impossible to make an appointment that’s convenient to my life. One organization I’ve worked with asked people and caregivers what matter most to them in their experience. They said, we want to know when there are staff changes: they developed a good relationship with a clinician or a direct care staff person and that person leaves the practice. When a question about that was added to the questionnaire, the scores dropped.  Who knew they cared? Some organizations stop with high scores and don’t look further. It’s hard to keep up the routine of running the office or unit and still find time to listen in different ways (rounds, focus groups, referring concerns to someone with time to listen).  It’s also hard to have time as people and caregivers to find someone who will listen to your concerns. I have to get to work or school or I’m not really sure what’s bothering me about this experience but I’m unsettled.

As a healthcare leader I know I have to look at perceptions in many ways and combine what I learn about people’s experience.  I have to be willing to listen and be open to change. It’s best when people with lived experience (people and caregivers who use our services) sit at the table when we plan listening and actually listen. The conversation changes dramatically.  It’s also more fun. In many organizations, it’s the same people who collect, analyze, and use experience data from month to month, year to year. After a while, you can predict the conversation   New perspectives at the table changes the conversation and increases the likelihood of different outcomes. I also know that I’m not likely to hear from people who didn’t return because they were unhappy.  I could learn from them.

A problem with high scores (greater than 90%) is that Improving those scores requires doing something very different. It’s hard to do something very different.  It’s disruptive and risky – like decoupling a moving train. That takes bravery and