Healthcare organizations invest significant time and resources in improving patient experience. New initiatives, training programs and campaigns can create momentum. The harder challenge is building the infrastructure that makes improvement last.
Our experience across a five-hospital health system reinforced an important lesson: Sustainable patient experience improvement requires moving beyond individual initiatives and embedding the work into how the organization operates.
Beginning in 2022, we developed an operating model built around four interconnected elements: governance, actionable data, training and reinforcement, and accountability. Together, these elements establish expectations, identify opportunities, build capability and reinforce consistent execution.
1. Make patient experience a leadership discipline.
Patient experience cannot be something leaders discuss only when scores decline. It must be integrated into the routines and decisions that shape organizational performance.
We incorporated patient experience into regular leadership discussions alongside quality and safety. Executive, service-line and unit leaders review performance, identify opportunities and establish corrective actions.
This approach shifts patient experience from a periodic organizational priority to an ongoing leadership responsibility. It also reinforces that the experience patients have is not owned by one department. Every leader and every care team influences it.
2. Turn data into action.
Healthcare leaders have no shortage of data. The challenge is making those data meaningful to the people who can influence the outcomes.
We standardized the distribution of patient experience data across the system, creating a common source of truth. We also connected performance measures to observable behaviors, helping front-line teams understand how everyday interactions influence patients’ perceptions of care.
Rather than focusing exclusively on percentages, we translated performance gaps into the number of additional positive patient responses needed to reach the next level of performance. In some cases, the difference was just five to 10 additional top-box responses. Suddenly, the performance gap felt less abstract and more actionable.
This approach helped teams connect their daily work with measurable outcomes. Data became more than a report to review; it became a tool for prioritizing action.
3. Don’t stop at training.
More than 8,000 nurses, unit clerks and patient care associates systemwide participated in standardized training, including relationship-centered communication. This investment established a common foundation for how we want patients and families to experience care.
Training creates awareness. Reinforcement creates habits.
People need opportunities to practice, receive feedback and build new habits. Leaders reinforce expectations through structured observation, real-time coaching and daily huddles. A 12-month communication and behavior calendar provides another mechanism for keeping priorities visible throughout the year.
Standardized practices, including bedside shift handoff, call bell communication, discharge phone calls, quiet hours and structured bedside rounding, are reinforced through everyday workflows.
The lesson is simple: If a behavior is important enough to teach, it is important enough to observe, coach and reinforce.
4. Create accountability for execution.
Even well-designed strategies lose momentum when expectations are not consistently reinforced.
Leaders develop action plans tied to performance gaps, report on the implementation of key practices and review progress routinely. Standardized reporting across hospitals and ambulatory locations establishes common expectations, while patient experience metrics are incorporated into leadership evaluations.
Accountability must extend beyond the final score. A score tells us what patients experienced; examining the behaviors and practices behind it tells us where improvement is needed.
The goal is not simply to ask why performance fell short. It is to identify variation, establish ownership and ensure agreed-upon practices actually happen.
What the results showed
Since we began implementing the operating model in 2022, system-level likelihood-to-recommend performance increased from 85.2% to 86.89%. Ambulatory likelihood-to-recommend performance increased from 87.77% to 89.38%, while emergency department likelihood-to-recommend performance improved from 67.42% to 70.72%.
During this period, several hospitals also advanced in CMS star ratings, and four of our five hospitals achieved an “A” grade from The Leapfrog Group.
These measures provide different perspectives on performance, but together they underscore a larger point: Patient experience, quality, safety and operational performance are interconnected. These outcomes cannot be attributed to a single operating model, nor should they be. Our experience suggests that strengthening the infrastructure around patient experience can help make those connections visible and actionable.
The question healthcare leaders should ask
Perhaps the most important question for healthcare executives is not, “What patient experience initiative should we launch next?”
Instead, ask: “What infrastructure do we have in place to ensure the behaviors we already know matter happen consistently?”
Answering that question requires knowing who owns the outcome, what behaviors influence it, where variation exists, whether leaders consistently reinforce expectations and how accountability is built into daily work.
Sustainable patient experience improvement is not about finding the next program. It is about creating an operating system that supports consistency across the organization, even as priorities, staffing and operating conditions change.
When governance, actionable data, reinforcement and accountability work together, patient experience stops being another initiative.
It becomes how the organization operates.
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