Meet the hierarchy of patient needs to improve experience

Patient experience isn't only about attempting to wow and delight patients and their families.

In a recent phone conversation, a long-distance friend of mine--I'll call her "Debbie"--described her father's hospitalization. She explained that when her father was there, the hospital was overcrowded and had more admitted patients than beds. The result: Her father received his care in the hallway of one of the hospital's inpatient units.

Debbie noticed several aspects of the basic care experience missing in the hallway when compared to a patient room.


  • No television, phone or call button (although there was a bell)
  • Standard privacy screens too short to prevent an average-sized person from seeing over as they walked by
  • No chairs for the patient or family within the screened-off area
  • Delayed meals because Debbie's father's "space" didn't have a room number or similar designation

Of course, not all on the list are created equally; some constitute safety and quality issues.

Debbie's and her father's experience with "hallway medicine" raises important questions about patient experience strategies and priorities. For instance, are we going for the “wow” before meeting the basic needs of patients?

Like Maslow's Hierarchy of Needs, patients have a hierarchy of needs, too. In Colleen Sweeney's keynote presentation at The Beryl Institute's 2012 Patient Experience Conference, she outlined a few of the most basic and fundamental patient needs:

  • A bed
  • Rest
  • Cleanliness
  • Reassurance
  • Response to call lights
  • Family needs (among others)

In their recent Harvard Business Review article, Deirdre E. Mylod and Thomas H. Lee emphasize the importance of eliminating the "avoidable suffering that comes from dysfunction in healthcare delivery." In other words, such dysfunction occurs when evidence-based clinical care is inconsistent and unreliable, resulting in avoidable sufferingsuch as:

  • Fear or anxiety as a consequence of lack of coordination and teamwork, lack of respect shown to patient, and loss of trust in providers.
  • Unnecessary waits "for appointments, test results and explanations, and even for their caregivers to communicate with one another about their care."
  • Apparent lack of concern about safety.

With gaps in the first, second and third rung hierarchy of patient needs for Debbie, her father and her family, avoidable suffering occurred.

Debbie's eloquent explanation of what was most important to her and her father highlighted for me once again the power of the patient and family voice. Her passionate advocacy for her father reinforced the need to expand "patient experience" beyond its often narrow reference to service excellence and patient satisfaction to include other key priorities--patient safety, care quality, value and efficiency.

Mylod and Lee maintain "a comprehensive approach to measuring and reducing suffering is not just an ethical imperative." As hospitals strive to hardwire the basics, it makes "strategic sense" to identify, measure and reducing avoidable suffering for patients and their families.

How? Consider the following strategic pillars:

Patient experience isn't only about attempting to wow and delight patients and their families. It's about eliminating avoidable suffering by "providing reliable evidence-based clinical care"--the foundation for every patient's most basic hierarchy of needs.

Doug Della Pietra is the director of Customer Services and Volunteers for Rochester General Hospital in New York, where he directs an intentionally-designed patient- and family-centered volunteer program, oversees the front-line valet and guest services teams, and leads the service excellence element of the Patient Experience Initiative while co-chairing the hospital's Patient Experience Team. Follow Doug@DougDellaPietra on Twitter.