4. Managing the Patient Experience case: Identify and describe performance improvement terms, concepts, tools, and methods from chapter 12 that are evident in this case. CASE: MANAGING THE PATIENT EXPERIENCE: FACING THE TENSIONBETWEEN QUALITY MEASURES AND PATIENT SATISFACTIONCenter (AMC), a large tertiary-care health system consisting of six hospitals with a total ofBryce Jackson has recently been appointed chief experience officer for Academic Medical1,500 inpatient beds and an annual average of 60,000 discharges. In this role, he will overseethe Department of Patient Experience, which has responsibility for patient satisfaction data,and employee engagement. Bryce will report directly to the chief quality and patient safetypatient family complaints/grievances, patient advocacy, volunteer services, information desks,officer, who is responsible for quality and performance improvement across the system.Bryce has a decade of experience working in various middle management roleswithin AMC's Department of Patient Experience. During this time, he has noted a growingtension between patient satisfaction and quality measures. At AMC, although all healthsystem leaders are tasked with improving satisfaction and quality measures, fragmentationand tension result from the involvement of different leaders tasked with improving specificmetrics. Bryce recently completed a master's in healthcare administration (MHA) programthrough a school of public health affiliated with AMC, and he found during his studiesthat he is not the only one to notice the growing tension.propor-Prominent health administrators and researchers have noted that the current structureof the Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing(HVBP) program has contributed to, and perpetuates, this tension. One specific issue is thatthe CMS HVBP program now reimburses for an ever-increasing number of metrics. The piecharts in exhibits 1 and 2 illustrate the changes in the HVBP program at AMC. The ption of the reimbursement pie that is derived from patient satisfaction scores (the HospitalConsumer Assessment of Healthcare Providers and Systems, or HCAHPS, survey) has remainedrelatively steady, but the other segments of this pie are continually shifting. In 2013, clinicalprocess measures filled out the rest of the pie, but for the coming fiscal year, outcomes andefficiency will be added, incorporating a variety of metrics related to quality and patient safety.Bryce feels that use of this reimbursement pie at AMC has resulted in fragmenta-tion of the concept of patient experience, as well as tension among organizational leaderschallenged with maximizing performance for the individual metrics in each leader's piece ofthe pie. Discussions with peers at other institutions have convinced Bryce that this problemis not isolated to AMC; in fact, these tensions are felt in health systems across the country.The competing priorities are most evident at the point of patient care, with thepatient often becoming the victim of the tension. For instance, steps taken to meet a goalin patient fall prevention a key quality and safety metric-may be in direct conflict with agoal of improving the patient's experience as reflected in patient satisfaction scores. Duringhis time in middle management, Bryce has been in several staff meetings where frontlinenursing staff have discussed this problem. Staff are concerned that use of bed alarms willlead to hospitalized patients feeling restrained, thereby worsening their experience of careand lowering the resulting patient satisfaction scores.

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Introduction
Performance improvement is a strategy of performance management that helps to…