Patient experience is often discussed as a matter of service, communication, or satisfaction. Those dimensions matter, but they do not capture the full operating reality.
For many patients, experience is shaped before a clinical encounter begins: whether they can secure an appointment, understand what paperwork is required, complete an authorization process, arrange transportation, or get a clear answer when something changes.
That makes patient experience an operations problem as much as a cultural one.
The Agency for Healthcare Research and Quality defines patient experience as the range of interactions patients have with the healthcare system. Its examples include getting timely appointments, accessing information, and communicating effectively with clinicians and staff. This is distinct from patient satisfaction, which reflects whether an experience met a patient’s expectations.
For health-system leaders, the distinction is important. Satisfaction is partly subjective. Many experience failures are observable operating events: a delayed appointment, an unresolved call, a form that must be submitted twice, or a patient who cannot tell what happens next.
New research makes the burden more visible
A study published in JAMA Health Forum on August 28, 2026, offers a useful view of this operational friction.
Researchers analyzed care-coordination notes from a community-based program serving Medicaid managed-care beneficiaries in Washington, Virginia, and Ohio from January 2023 through November 2025. Natural language processing classifiers were used to identify four types of documented administrative burden: scheduling difficulties, transportation problems, paperwork and documentation requirements, and prior authorization delays.
The study included 142,473 enrolled beneficiaries. Of those, 49,282, or 34.6%, completed at least one care-coordination encounter and formed the analytic group for the documented burden measures.
Within that engaged group:
- 25.3% had a documented paperwork or documentation burden.
- 16.2% had a documented scheduling burden.
- 9.8% had a documented prior-authorization burden.
- 6.1% had a documented transportation burden.
Across the cohort, the documented burdens corresponded to an estimated 18,822 hours of patient time.
These findings should not be treated as national prevalence estimates. The study examined one care-coordination program, four participating plans, and only burdens recorded in encounter notes. Patients who engaged with care coordinators were also older, more often female, and higher acuity than eligible beneficiaries who did not engage.
Even with those limitations, the research demonstrates something strategically important: administrative friction can be classified, measured, and translated into patient time.
Why traditional experience programs may miss the problem
Most health systems already measure patient experience in some form. Standardized surveys such as CAHPS remain essential because they offer validated, comparable patient-reported measures.
But retrospective surveys alone may not tell leaders where an experience problem entered the workflow or how quickly it can be corrected.
A low rating may reflect a scheduling delay, an unclear handoff, a repeated request for information, a call that did not resolve the patient’s need, or several small breakdowns across different teams. By the time that signal reaches a dashboard, the original operating context may be difficult to reconstruct.
A 2025 JAMA Health Forum viewpoint argued that patient-experience improvement should be integrated with clinical quality and safety rather than treated as a separate program. The authors also called for more timely and relevant feedback, broader use of feedback beyond traditional surveys, and careful application of technologies such as AI and digital platforms.
The operating implication is straightforward: health systems need both outcome measures and process signals.
Surveys can show how patients experienced care. Workflow data, patient interactions, and operational events can help explain why.
A more useful executive question
Instead of asking only, “How satisfied were patients?” leaders can ask:
How much work did the organization require the patient to do in order to receive care?
That question changes the improvement agenda.
It directs attention toward concrete sources of friction:
- Access effort: How many attempts does it take to schedule, confirm, change, or clarify an appointment?
- Information effort: Does the patient receive consistent answers across the website, portal, contact center, and clinic?
- Administrative effort: Are forms, documentation, referrals, and authorizations visible and coordinated across teams?
- Resolution effort: Does the first interaction move the patient forward, or create another call, message, transfer, or follow-up?
- Recovery effort: When an appointment changes or a workflow breaks, can the organization identify the issue early enough to intervene?
These are not merely experience metrics. They are indicators of operating design.
What healthcare leaders can do differently
Improving the patient experience in healthcare does not always require another survey or a large transformation program. It can begin with a more disciplined view of patient effort.
1. Define a small set of friction events
Start with events that can be observed consistently: repeat contacts, transfers, unresolved requests, abandoned interactions, late appointment changes, duplicate documentation, delayed referrals, or unclear next steps.
The goal is not to create a perfect enterprise taxonomy. It is to give operations, access, experience, and technology leaders a shared language for the problems patients encounter.
2. Connect experience data to workflows
A survey comment about difficulty getting care is more actionable when it can be connected to appointment availability, response time, contact history, or the workflow that failed.
This requires governance. Leaders should define which teams own each friction event, what constitutes resolution, and how information can be used appropriately without exposing sensitive patient data.
3. Analyze interactions without removing human judgment
AI can help classify large volumes of patient interactions, identify recurring themes, and surface patterns that manual review may miss. The 2026 Medicaid study itself illustrates how natural language processing can make administrative burden visible in existing notes.
But classification is not the same as resolution. Healthcare organizations still need people to interpret context, validate findings, manage exceptions, and decide where workflow redesign is appropriate.
4. Measure patient time alongside organizational time
Healthcare productivity programs often measure staff effort, handle time, or cost per transaction. Patient effort deserves similar attention.
A process that appears efficient internally may still transfer work to patients through repeated calls, unclear instructions, or fragmented follow-up. Measuring both sides of the interaction helps leaders avoid “improvements” that reduce internal effort while increasing patient burden.
5. Treat friction reduction as capacity work
Every avoidable repeat interaction consumes organizational capacity. Every unresolved access issue can generate another call, message, transfer, or escalation.
Reducing friction can therefore support two goals at once: a better patient experience and more workforce capacity for interactions that require judgment, empathy, or complex problem-solving.
The PEC360 perspective
PEC360’s operating view is that patient experience should be managed across the work required to access, navigate, and receive care, not only through a score collected after the encounter.
That means connecting signals from appointment workflows, patient conversations, contact-center operations, and staff follow-up. It also means using AI selectively to make recurring patterns visible, support routine coordination, and give people better context. It should not remove human involvement from situations that require it.
The most valuable experience insight may not be a new score. It may be a clearer understanding of where patients are spending unnecessary time and why the organization is asking them to spend it.
For healthcare executives, that is a measurable place to begin.
Sources
- Basu S, Baum A, Robinson K, Batniji R. “Administrative Burden Documented in Medicaid Care Coordination.” JAMA Health Forum. Published August 28, 2026. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2852961
- Agency for Healthcare Research and Quality. “What Is Patient Experience?” Content reviewed March 2025. https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html
- Evans R, Shaller D, Edgman-Levitan S, Nembhard IM. “Strengthening Patient Experience Measurement and Improvement.” JAMA Health Forum. Published May 30, 2025. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2834514