When patients describe a disappointing health care experience, we often assume the problem occurred in the examination room. Sometimes it did. But after years of caring for patients in urgent and emergency settings and helping lead a high-volume orthopedic urgent care practice, I have learned that many negative patient experiences begin long before the physician walks through the door.
A patient may arrive in pain and not know how long the visit will take. They may move from registration to an examination room to imaging without understanding what happens next. They may receive excellent medical care and still leave frustrated because nobody explained the process.
That distinction matters. If we treat every patient-experience problem as a physician communication problem, we risk trying to fix individuals when what often needs attention is the system surrounding them.
Patients experience a journey, not an encounter
Clinicians tend to think about visits in clinical segments: history, examination, imaging, diagnosis, treatment, and disposition. Patients experience something different. They experience the front desk, paperwork, waiting room, medical assistant, examination room, imaging department, clinician, discharge process, and follow-up instructions as one continuous encounter. A breakdown anywhere along that journey can influence how they perceive everything that follows.
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This is particularly apparent in urgent care. Patients often arrive unexpectedly, in pain, and looking for answers quickly. Meanwhile, the clinical team is balancing unpredictable patient volumes, procedures, imaging, acute injuries, and competing demands.
Small operational problems can quickly become patient-experience problems.
Waiting is not always the real problem
One of the most important lessons I have learned is that patients may tolerate waiting better than they tolerate uncertainty. There will always be days when a medical practice runs behind. An unexpectedly complex patient may require additional attention. Imaging may take longer than anticipated. An urgent case may appropriately move ahead of another patient.
We cannot eliminate every delay. But we can reduce the uncertainty surrounding it. A brief acknowledgment of a delay and an explanation of what happens next can change the experience.
Silence creates its own narrative. A patient sitting alone in an examination room may assume nobody knows they are there. Meanwhile, the clinical team may be reviewing imaging, consulting another clinician, or preparing the next step in care. The work is happening. The patient simply cannot see it.
Closing that information gap may be one of the simplest opportunities we have to improve the patient experience.
Before blaming the employee, examine the process
Health care has another tendency worth reconsidering. When something goes wrong, we often look first for the person responsible. Why didn’t someone communicate the delay? Why did the patient wait so long? Why wasn’t imaging completed sooner? Why did discharge take another 20 minutes?
Sometimes individual performance does need to be addressed. But when the same problem occurs repeatedly across different employees and different days, leaders should ask a different question: Is our system making it unnecessarily difficult for people to do their jobs well?
That question has changed how I approach operational problems as a physician leader. Perhaps responsibilities are unclear. Perhaps information is not reaching the right person. Perhaps two processes unnecessarily duplicate each other. Perhaps staffing does not match patient arrival patterns.
Patient feedback can therefore be more than a satisfaction metric. It can be operational intelligence.
Physicians need to participate in process improvement
Physicians sometimes view operational improvement as something that happens in administrative meetings. I think that is a missed opportunity.
Frontline clinicians see parts of the health care system that dashboards cannot fully capture. We know where patients repeatedly become confused. We see bottlenecks develop. We know which processes look efficient on paper but become cumbersome during a busy clinic.
At the same time, physicians see only one part of the system. Medical assistants, nurses, advanced practice providers, imaging staff, schedulers, front-desk teams, and operational leaders see problems that physicians may never notice. Meaningful improvement happens when those perspectives meet. My experience in physician leadership has increasingly convinced me that improving patient experience requires the same mindset we bring to clinical quality: identify the problem, understand the process, involve the people doing the work, make a change, and determine whether it actually helped.
The goal should not be a better score
Patient-experience scores matter. They can identify patterns and highlight areas that deserve attention. But chasing the number itself can become the wrong objective. A better question is: What is the score trying to tell us about the patient’s experience?
A poor communication score may reveal a communication problem. A poor waiting score may reveal a workflow or capacity problem. Repeated complaints about staff interactions may point toward unclear expectations, inadequate training, or processes that consistently place employees in difficult situations.
The number is the signal. The work begins when we determine what is producing it. That is why sustainable patient-experience improvement cannot belong to a single physician or department. It requires clinical care, operations, communication, leadership, and frontline staff to work toward the same objective.
Patient experience is an operational outcome
The longer I work in urgent and emergency care, the less I view patient experience as a separate category of health care. It is often the visible result of everything happening underneath.
When communication is clear, workflows make sense, teams understand their responsibilities, and patients know what to expect, the experience feels different. Not because someone instructed the staff to provide “five-star service.” Because the system is functioning better around the patient.
That may be the most important lesson physician leaders can take from patient-experience feedback: If we want patients to experience better care, we should not begin by asking how to improve the score. We should begin by asking how to improve the system that produced it.
Manoj Sreedharan is a board-certified family medicine physician and the medical director of Injury Express at OrthoIllinois in Rockford, Illinois. He is also an assistant professor at the University of Illinois College of Medicine Rockford and a practicing emergency medicine physician at MercyOne Clinton in Iowa.
His work focuses on health care quality improvement, patient safety, patient experience, clinical operations, and evidence-based medicine. He is actively involved in clinical research, including biologic therapies for rheumatologic conditions, and serves as a peer reviewer for medical journals. He is passionate about advancing health care through physician leadership, medical education, and continuous quality improvement.
His peer-reviewed work includes a study of blood pressure control among U.S. adults with hypertension stratified by glucagon-like peptide-1 (GLP-1) receptor agonist use, drawn from the National Health and Nutrition Examination Survey, 2017 to 2020. He shares updates on LinkedIn.
