What is the patient experience? Part 1

What are patient reported outcomes and why are they important in Facial Plastic Surgery?

The practice of medicine is still an art and a science - a mixture of objective evidence, our mentor’s philosophy, and personal experience.  Modern medicine, in part, is defined by the progress from anecdotal practice to outcomes-based medicine.  The study of outcomes began in the late 19th century, essentially upending the medical establishment. Ernest Codman was a surgeon at Massachusetts General Hospital in 1895 when he proposed the “end result system” based on tracking surgical outcomes.1,2  He was ostracized from the prestigious medical community for demanding transparency in outcomes and errors.1  Today he is considered a revolutionary. 

One hundred years since Codman’s work, medicine has realized that outcomes research is essential to move the practice of medicine away from empiricism, decrease errors3,4, and improve outcomes.  Throughout this evolution there is one common thread: outcomes continue to be largely interpreted by the physician.  In 1988, Paul Ellwood gave the Shattuck lecture when he advised that continuing to view medical outcomes as interpreted by the physician would no longer suffice.5 

Patient-Centered Care took center stage when the 2001 Institute of Medicine’s “quality chiasm” report named Patient-Centered Care as one of the six key elements for providing high-quality healthcare in the 21st century.6  Patient-Centered Care allows patient values to guide clinical decisions and re-defines the physician-patient relationship.6  The physician role transitions from one of authority to one of partnership, collaboration, and empathy.7  The patient role transitions to an active role in decision making.  For organizations that practice patient-centered care, studies have shown higher clinical quality and efficacy8, a safer patient environment9, and improved financial results.10   

The patient’s perception of care is described as the “patient experience”.11  The new gold standard for measuring the patient experience is patient-reported outcomes (PRO): any report of a patient’s condition that comes directly from the patient without interpretation by a clinician.12  Patient-reported outcomes research uses validated questionnaires that accurately and reliably measure patient satisfaction, social well-being, quality of life and psychosocial status.

In Facial Plastic Surgery, defining and measuring outcomes is challenging and complex.  Surgical outcomes have traditionally been subjective as the yardstick for beauty varies dramatically13.  Objective measurements do not strictly correlate to our perception of beauty especially as the ideals of beauty are constantly changing, evolving, and widening.14 

More recently, a focus on Patient-Centered Care has shifted Facial Plastic Surgery outcomes toward the patient experience.  The patient experience is affected by expectations, process of care, adverse outcomes, office environment, and a complex surgeon-patient relationship.  Similar to other Facial Plastic Surgery outcomes, the patient experience has been difficult to quantify and measure in a meaningful way.  The ability to do so, however, has never been more important than now.  To advance the field of Facial Plastic Surgery within the generation of Patient-Centered Care, a focus on sophisticated outcomes research using highly-validated patient-reported outcome questionnaires is imperative.

We want to hear from you! For questions and comments, please reach out to us on social (IG @archerfacialplastics, Twitter @ArcherMD, FB Kaete Archer, MD @archerfacialplastics) or email us at drarcher@archerfacialplastics.com!! 


  1. Hicks CW, Makary MA. A prophet to modern medicine: Ernest Amory Codman. BMJ. 2013;347:f7368.
  2. Codman EA. A study in hospital efficiency. Boston: Thomas Todd Co. Printers, 1916:11-63.
  3. Leape LL. Error in medicine. JAMA. 1993 Dec 21;272(23):1851-1857.
  4. Leape LL, Berwick DM, Bates DW. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA. 2002 Jul 24-31;288(4):501-507.
  5. Ellwood PM. Shattuck lecture – outcomes management: a technology of patient experience. N Engl J Med. 1988;318(23):1549-1556.
  6. Committee on Quality of Health Care in America. Institute of Medicine. Crossing the Quality Chiasm: A New Health System for the 21st Washington, DC: National Academy Press; 2001.
  7. Epstein RM, Street RL. The values and value of patient-centered care. Ann Fam Med 2011;9:100-103.
  8. Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The relationship between patients’ perception of care and measures of hospital quality and safety. Health Serv Res. 2010;45:1024-1040.
  9. Weingart SN, Junya Z, Chiappetta L et al. Hospitalized patients’ participation and its impact on quality of care and patient safety. Int J Qual Health Care. 2011 Jun;23(2):269-277.
  10. Centers for Medicare and Medicaid Services. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospital-Value-Based-Purchasing. 2011. Accessed June 25, 2015.
  11. Balik B, Conway J, Zipperer L, et al. Achieving an exceptional patient and family experience of inpatient hospital care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. Available on IHI.org.
  12. S. Food and Drug Administration. Patient Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. 2009.  Available at http://www.fda.gov/downloads/Drugs/GuidelineComplianceRegulatoryInformation/Guidances/ucm071975.pdf. Accessed March 23, 2015.
  13. Sturm-O’Brien AK, Brissett AE, Brissett AE. Ethnic trends in facial plastic surgery. Facial Plast Surg. 2010 May;26(2):69-74.Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesth Plast Surg. 2000;24:192-197.
  14. Farkas LG, Hreczko TA, Kolar JC, Munro IR. Vertical and horizontal proportions of the face in young adult North American Caucasians: Revision of neoclassical canons. Plast Reconstr Surg. 1985;75(3):328-337.
Kaete Archer, MD Facial Plastic Surgeon

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