How High‑Quality Healthcare Improves Patient Experience: Goals, Challenges, and Costs
High quality healthcare should be a non-negotiable
High quality: it should be the goal in everything we do and experience. It seems like a no-brainer, right?
You would think so, but that’s unfortunately not always the case. We’ve all experienced less than stellar quality in many aspects of life, but there’s perhaps no arena in which low quality is more detrimental—and more unacceptable—than in healthcare.
Picture any of these scenarios (or maybe you don’t have to because you’ve experienced them firsthand):
- You want to see a provider to address an urgent medical concern, but you can’t seem to get anyone on the phone to secure an appointment.
- You feel rushed or unheard by a doctor during a consultation. You don’t have any time to ask questions or, when you do, you feel brushed aside.
- You’re finding it so challenging to untangle the costs associated with a particular treatment or specialist visit that you completely give up and decide not to get the care at all…even if it means you have to suffer.
- Months after starting to receive (and pay for) treatment, you learn that you received an incorrect diagnosis and didn’t even need the treatment to begin with.
Clearly, these are all examples of bad patient experiences—but it doesn’t have to be that way. Let’s explore how high quality healthcare benefits patients.
What is quality in healthcare?
The Agency for Healthcare Research and Quality describes quality healthcare as safe, effective, patient-centered, timely, efficient, and equitable. Of course, this definition is very high-level, as there are many metrics that go into measuring each of those domains of quality.
At Carrum Health, we are committed to providing each and every one of our members with access to the highest quality healthcare. Leveraging our proprietary quality methodology, we rigorously and regularly examine more than 50 quality metrics at our center of excellence partners.
How healthcare professionals deliver high-quality care
Providers in Carrum Health’s centers of excellence network maintain high standards by continuously monitoring clinical outcomes and patient feedback. This patient-centered approach keeps individual needs front and center, leading to better engagement with and adherence to treatment plans, which ultimately improves health outcomes.
Quality challenges in healthcare
Even organizations committed to high quality face significant obstacles. Below is a summary of key challenges and how they can impact both patient experience and outcomes:
| Challenge | Impact on patient experience | Mitigation strategy |
| Access delays and long wait times | Patients feel anxious, underserved and may abandon care | Flexible scheduling, telehealth, and care navigators |
| Fragmented care / poor coordination | Duplicative tests, inconsistent messaging, patient frustration | Integrated care teams and shared data platforms |
| Lack of cost transparency | Surprise bills, reduced trust, delayed decisions | Clear cost estimates, patient portals, and financial counselling |
| Inconsistent provider competence | Misdiagnoses, higher readmissions, worse outcomes | Validated quality metrics and regular auditing |
| Equity gaps and social determinants of health | Some patients receive sub-par care due to barriers. (e.g., language, transportation, income, or lack of digital access) | Targeted outreach and equitable resource allocation |
Addressing these challenges is essential to move beyond abstract quality metrics and deliver truly patient‑centered care that is accessible, coordinated, and equitable for all.
Examples of patient experience goals
Patient experience goals typically focus on what patients say about their care: being able to get timely appointments, clear communication with doctors and nurses, responsive staff, understanding medicines and discharge instructions, a clean, quiet environment, and whether they would recommend the hospital. These goals are standardized in national surveys such as HCAHPS and CAHPS and map directly to measurable outcomes—shorter waits, better adherence, and fewer readmissions—so organizations can track and improve them over time.
According to the NIH, the industry definition of quality healthcare has evolved over time to focus on “strengthening the link of quality with prevention and health promotion.” As knowledge grows, the standard of care must grow along with it so patients always have access to the best healthcare.
How does high quality healthcare directly impact the patient experience?
Without a focus on quality at every level of the healthcare system, it’s impossible to improve the experience of patients—and their health will likely be negatively impacted, as well. Here are four ways that high quality healthcare can make a positive impact on everyone involved:
1. The patient is at the center
Patients suffer when providers do not address their specific, individual needs. High quality healthcare keeps patients—their unique health history, their feelings, their preferences, their fears, their desires, their concerns—absolutely central.
Although facing a medical challenge can be scary, a patient who feels like they’ve been made part of the diagnosis and treatment processes and taken seriously every step of the way will come out with a better impression of their providers—and, ideally, this will help them become stronger advocates for their health in the future. Plus, when care is more tailored to a patient and that patient feels involved, they are more likely to be engaged with their care, which will in turn positively impact health outcomes.
2. It leads to better clinical outcomes
Of course we want patients to feel better—more confident, positive, taken care of—while they navigate the medical system…but quality healthcare goes further than that. In fact, higher quality healthcare correlates directly with better clinical outcomes. Providers and facilities that maintain high standards and keep quality at the core of their work see fewer patients returning because of complications or misdiagnoses.
For example, when it comes to surgical care, the RAND Corporation found that, in addition to directing 30% of patients who were recommended surgery to less invasive care (e.g., physical therapy), Carrum Health also reduced readmissions by 80% compared to the national average.
Ultimately, good health outcomes should be the goal of everyone working in the healthcare industry. That means high quality healthcare should be, too.
3. It’s more cost-effective
Everyone benefits financially when providers make correct diagnoses and treatment recommendations the first time, saving money for their hospitals and physician groups, the patient’s employer, and the patient by eliminating needless procedures (e.g., surgery avoidance) and minimizing complications that necessitate additional measures or readmission. Per the NIH, the average cost of hospital readmission after a total knee replacement is nearly $39,000—and that’s just one example of the unnecessary spend that’s often incurred with lower quality healthcare.
Patients have a better impression of a healthcare system that respects their time and resources—one that doesn’t leave them with piles of inexplicable bills. As a result, this makes them more likely to consult their doctors with concerns, meaning providers can offer more effective, efficient care. Everyone really does win when care is made approachable and affordable.
4. It reduces the emotional burden
Now that you have a better sense of what quality healthcare actually looks like, you can better imagine what patients experience when they’re on the receiving end of the opposite. Low quality healthcare takes its toll.
By reducing stress and helplessness and forging trusting bonds between providers and their patients, quality healthcare allows patients to make the best of whatever medical challenges they’re going through.
Center of excellence solutions and quality
One way to maximize quality healthcare for your population is to partner with a centers of excellence (COE) program—specifically one that takes quality seriously. When evaluating programs, you might consider factors like appropriateness of care, readmission rates, price transparency, access to care, and communication with patients. When providers are held to a high standard of quality based on these and other metrics, patients emerge from a medical journey—regardless of its scale or specifics—feeling heard and respected… and often with better outcomes.
Carrum Health remains committed to advancing quality healthcare standards to create sustainable, positive patient experiences across the United States. Through data-driven strategies and provider partnerships, Carrum ensures members access the best possible care while addressing cost challenges facing healthcare systems today.
If nothing else, patients with access to quality healthcare will be able to secure appointments without making dozens of phone calls and spending hours on hold. And that, in itself, is an upgrade.
The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.
