Stop Trying to Change the Score. Change the System.

Let’s start here:
Patient experience scores matter.

They influence reimbursement. They affect public rankings. They shape funding conversations. Under CMS programs like HCAHPS, patient feedback directly impacts hospital payments and star ratings. That reality isn’t up for debate.

What is up for debate is how we respond to those scores.

Because somewhere along the way, we stopped treating patient experience as a reflection of system health and started treating it as something to manipulate.

And that’s where things stop adding up.

Listening to patients is not the problem. In fact, it’s essential. Patient voices illuminate gaps in communication, access, empathy, and process. But measuring patient satisfaction in an attempt to “move the score” often misses the deeper truth:

Patient experience is an outcome. It is not the root cause.

If a nurse is managing six patients when staffing supports four, the patient feels it.
If a physician is buried in documentation for hours after a shift, the patient feels it.
If teams are stretched thin, burned out, and emotionally exhausted, the patient absolutely feels it.

No amount of scripting or hospitality training fixes that.

Research continues to show the intensity of the strain on clinicians. The American Medical Association reports physician burnout rates have hovered around 50 percent nationally, with peaks during the pandemic exceeding 60 percent in some specialties (AMA, 2023). Nurses report similar or higher levels of emotional exhaustion. A study published in JAMA Network Open found that healthcare workers experienced significant symptoms of anxiety, depression, and post-traumatic stress during and after COVID-19 surges, with rates far exceeding those of the general population.

This is not a motivation problem. It is not a compassion problem.

People do not go into medicine for 10 to 15 years of training, incur staggering student debt, sacrifice personal time, and walk into high-stakes environments every day because they want mediocre outcomes. They enter medicine to heal. To help. To serve.

When patient scores dip, the reflex is often to analyze communication tactics, bedside manner, discharge instructions, or rounding frequency. But what if those scores are simply signaling system distress?

Revenue minus expenses equals profit. In healthcare, people are both the largest expense and the largest driver of revenue. When clinicians disengage, leave, reduce hours, or make preventable errors due to overload, the financial impact is enormous. Turnover costs for a single bedside nurse can range from $40,000 to $60,000. Replacing a physician can exceed $500,000 when recruitment, onboarding, and lost productivity are considered.

Patient satisfaction influences reimbursement. Clinician stability influences survival.

There’s a difference.

Don Berwick, former CMS Administrator, has said that listening is foundational to patient-centered care. That principle remains true. But patient-centered care cannot exist without clinician-supported systems.

“When leaders attempt to change patient scores directly, they are adjusting the thermometer instead of lowering the fever.” Amy Gurske

You cannot coach empathy into someone who has not slept.
You cannot script warmth into someone who is drowning in administrative burden.
You cannot incentivize joy where there is chronic overload.

Patient experience is downstream.

It reflects staffing ratios.
Workflow friction.
Psychological safety.
Leadership responsiveness.
The emotional health of teams.

If we want to improve patient scores, we must stop chasing them and start listening to the humans delivering care.

That means real-time insight into what clinicians are experiencing. Not annual engagement surveys. Not reactive town halls. Not post-event root cause analyses after something goes wrong. And not benchmarking. Bench against yourself.

It means understanding where inefficiencies live before they become errors.
It means surfacing operational barriers before they drive turnover.
It means measuring the health of the system at the source.

“When you listen upstream, outcomes shift downstream.” Amy Gurske

At sayhii, we believe patient experience should be honored, not engineered. Our focus is on helping healthcare leaders understand the daily lived reality of their teams. Real-time insight. Actionable themes. Early signals. Because when clinicians feel heard and supported, patients feel it.

Not because we coached them to smile differently.
But because the system actually works better.

If the goal is to move the score, start by strengthening the foundation.

Patient experience is the echo. Clinician experience is the voice.