When it comes to patient experience within the ED, perception is everything. It isn't always the actual quality of care patients receive that impacts patient satisfaction scores. Instead, it’s their perception of the care.

Your emergency department may be hitting it out of the park. Outcomes, patient safety, resource utilization, adherence to clinical guidelines, efficiency — the data show that your ED staff is meeting or exceeding its goals for quality clinical care. However, patient satisfaction scores don't always reflect that standard of excellence.

Whether you blame the instruments themselves — the variety of surveys, diverse methodologies, the randomness of samplings, and limited participants required for tabulation — there is no guarantee a more standardized approach would garner better results. In the end, it's the patient's perception of the care received, not the facts themselves that matter most.

Rather than make perception an enemy to be thwarted, turn it into an untapped tool to capitalize on your ED’s foundation of quality care. Here's how:

Tidy Up the Place

The adage "you never get a second chance to make a first impression" applies here. The good news: You can make a good first impression just by ensuring you keep the ED environment neat, clean, and tidy.

Take a look around your ED. Is the waiting area or patient rooms cluttered? Are they clean? Are the chairs old, frayed, or broken?

Have windows been washed and cleared of cobwebs? Is the bulletin board organized with up-to-date, relevant information or covered over with old posters and notices? Is the nurse's station messy and clamorous or orderly and quiet?

The fixes are easy enough: Brighten up dingy and dark areas with a fresh coat of paint and better lighting. Remove clutter and empty the trash. Keep bathrooms clean and well-stocked with soap and towels.

If the overall scene presents a professional appearance, you will positively influence the perceptions of patients and their families from the moment they enter your doors.

Pay Personal Attention

You never get a second chance to make a good second impression either.

Assuming you've taken the first step — providing a professional appearance — making a good second impression comes through paying personal attention. That means having appropriate staffing ratios for peak times and ensuring your ED runs at maximum efficiency at all times.

Plan for contingencies by having both full-time and part-time physicians available (and part-time NPs and PAs as well). As a rule, we recommend maintaining one to two part-time doctors credentialed for every full-time physician.

While increasing the provider-to-patient ratio certainly allows for more personalized care and attention, it’s also an expensive option that few EDs can readily afford.

For that reason, another far less costly option we recommend is the use of scribes. Pairing your physicians with scribes enables them to focus more on patient care and communication and less on administrative functions and documentation.

The improved interaction between physicians and their patients (and patients’ families) will translate into a significantly improved patient encounter.

Communicate Effectively

Communication can make or break a patient's experience. However, more communication doesn't necessarily equate to better communication. Rather, content and delivery influence patient perception far more than time alone.

Two tips for improving content and delivery are:

Get rid of "doctor speak" - Medical terminology, though second nature to physicians, is in direct opposition with the health literacy of the average patient. Doctors should, therefore, simplify their vocabulary and shorten sentence lengths to a level that an average sixth-to-eighth grade student could easily comprehend.

Show compassion and empathy – Content is one thing; delivery is another. To that end, doctors should clothe their content with compassion and empathy, qualities associated with better outcomes, greater patient safety, fewer malpractice claims, and a better patient experience.

Expressing these qualities, however, can prove challenging in a busy ED environment. So, just like doctors are trained to think analytically, they should also be trained to communicate with compassion and empathy.

Offer providers tools and techniques, such as video instruction, a medical director who leads by example, and hands-on training, to teach them how to communicate more effectively.

Ask for Feedback

Maximize the opportunity to shape patient perception by capping off every encounter with a visit from a patient advocate.

Akin to a relief pitcher who takes the mound to nab the final outs when his team is in the lead, a patient advocate acts as a closer in your ED.

Filled by a nurse, scribe, or well-trained volunteer, the role of this “designated patient satisfaction officer” is to make rounds every day, asking each patient questions related to his or her stay in the ED.

The questions should be designed to identify any concerns or needs the patient (or family) might have and to determine if any gaps in service, care, or understanding exist. As a practical matter, ask questions that reflect those found in the patient satisfaction survey your ED utilizes.

A few examples:

  • Do you have any questions about your stay/tests/diagnosis?
  • Do you understand what you need to do next?
  • Are you/were you comfortable during your stay?
  • Do you feel we did a good job managing your pain/responding to your needs?
  • Did the doctor(s) and nurse(s) who treated you identify themselves?

If the patient advocate detects a verifiable lack of service or comprehension, the ED staff now has the chance to remedy that before discharging the patient — an outcome that can lead to better patient satisfaction scores.


Many EDs excel in delivering quality care but fail to provide a patient-centered experience that earns satisfaction scores on par with their clinical performance.

By highlighting and enhancing key aspects of the patient experience — the appearance of the practice environment, communication style of providers, and the impression upon exit — your ED can make each encounter more consistently positive and ensure that patients recognize the high level of care they receive and reward you with higher satisfaction scores as a result.