What Healthcare Professionals Think About Patient Experience

Patient experience, understood as how patients and their families perceive the care they receive, has gained prominence as a quality indicator in healthcare. However, while research often prioritizes the patient’s perspective, this study focused on the other side of the relationship: the professionals who provide that care. Doctors, nurses, technicians, and other healthcare workers were asked to assess how they perceive the development of actions aimed at improving the patient experience in their workplaces.

Data collection was conducted through a validated, anonymous, online questionnaire administered between January and February 2024. A total of 47,711 healthcare professionals from 69 private hospitals across four regions of the country participated. Of this total, 13% were doctors, 54% were in nursing, and the rest belonged to other categories of the multidisciplinary team, such as physical therapists, psychologists, pharmacists, support technicians, and administrative professionals.

The questionnaire addressed six major areas related to patient experience: leadership and governance, infrastructure and access, care team involvement, patient and family participation, evaluation policies, and clinical quality. Each dimension received an average score and was classified according to its stage of development within the hospitals. The scale used ranged from “just starting” to “in progress” or “consolidated.”

Results Indicate Moderate Progress, But a Still-Fragile Link

According to the results, all dimensions evaluated by the professionals were classified as “in progress,” meaning that hospitals have ongoing initiatives but still face difficulties in achieving consistent results. The exception was “team and professional engagement,” which scored lower than the other categories and was classified as “just starting.” This suggests that healthcare workers feel there is a lack of structured and effective actions to involve them in care improvements.

The responses also revealed important differences between professional groups. Although everyone evaluated the same aspects of the hospital system, doctors gave higher average scores than nursing professionals, indicating a more positive perception of the institutions’ efforts. The overall average for doctors was 147 points, while for nursing it was 138. This difference may reflect how different categories experience working conditions and whether they feel heard or valued in decision-making.

On the other hand, factors such as professional experience or time at the hospital did not significantly influence the evaluations. Professionals with less than a year of experience or training gave similar scores to those with more experience, suggesting that the perception of patient experience challenges is not limited to seniority but is instead tied to the organizational environment as a whole.

Practical Importance: Investing in Teams to Provide Better Patient Care

The main finding of the study is that promoting a good experience for patients must, by necessity, include promoting a good experience for healthcare professionals. This means it’s not just about training to improve communication with patients or renovating physical structures, but also about ensuring that workers have proper conditions, are heard, are recognized, and are included in institutional strategies.

The evidence indicates that engaged leadership and healthy work environments are directly related to a lower incidence of errors, better teamwork, and greater patient satisfaction. Valuing teams is not just a humanitarian measure, but an effective strategy for quality management.

Written by Maria Eduarda Ledo de Abreu.

The study highlights the staggering shortcomings of the current system, known as Disclosure UK, which is managed by the pharmaceutical industry’s membership body/trade body , the Association of the British Pharmaceutical Industry (ABPI). The report finds that Disclosure UK leaves critical gaps that obscure potential conflicts of interest and put patient care at risk.

Key findings:

1. Billions in Untraceable Research Payments

Between 2015 and 2022, drug companies reported £3.3 billion in research-related payments, representing 72% of all disclosed transactions. These payments are lumped together in aggregate without naming recipients, making it impossible to assess where the money goes or how it might influence patient care. Companies such as AstraZeneca (UK and Sweden owned with HQ in Cambridge, United Kingdom), Allergan (US owned), and Bristol Myers Squibb (US owned) classified over 90% of their total payments as research-related, raising concerns about how the definition of “research” may be used to limit transparency.

2. Non-Research Payments Lack Clarity
Non-research payments, including sponsorships and consultancy fees, amounted to £1.1 billion over the same period. While under the Code of Practice these payments are supposed to name recipients, companies’ practices vary widely. Some report nearly all recipients, while others, such as Allergan, disclose as little as 15%.

3. Significant Breaches by Major Companies
Several companies have been found to violate transparency requirements. Novo Nordisk, the Danish company that manufactures the weight-loss jabs Wegovy and Ozempic, failed to report approximately £7.8 million in payments to over 150 UK healthcare professionals and organisations, which constituted a major breach of the self-regulatory Code of Practice.

1. The Iceberg of Uncertainty: Unveiling the “Unknowns”
   The study introduces a novel framework for understanding the “unknowns” of payment disclosure, inspired by the “Rumsfeld Matrix,” which categorises gaps in knowledge about drug companies’ financial ties to the healthcare sector. Researchers identified four key layers of uncertainty in how payments are disclosed under Disclosure UK:
   • Known knowns: These are payments that are reported and can technically be identified, but it’s tricky to trace them. For instance, the way NHS trusts or organisations are named by drug companies can cause records to be incomplete or misleading.
   • Known unknowns: These payments are acknowledged in the system, but their details – which are key for tracing potential conflicts of interest – are hidden from the public. For example, research payments worth £3.3 billion are lumped together without specific details like the names of recipients, the amounts, or the purposes—often hiding behind claims of “commercial sensitivity.”
   • Unknown knowns: These payments exist but are reported incorrectly or wrongly assigned. This happens when there are inconsistent naming systems or duplicate entries. For example, more than 10% of payments to patient organisations between 2015 and 2018 were reported wrongly, making it nearly impossible to establish the extent and nature of their ties to drug companies.
   • Unknown unknowns:  These payments are never reported at all—either because companies aren’t required to disclose them (like Vertex Pharmaceuticals, which isn’t part of the ABPI Code) or because they ignore reporting rules. These cases involve companies like Novo Nordisk failing to disclose payments altogether, which the industry’s self-regulatory body viewed as indicative of failings in the company’s corporate culture, and not just technical processes for payment reporting (see the case reports here and here).

Dr Piotr Ozieranski, lead author from the University of Bath, warns:

“Our analysis reveals that the public sees only the tip of the iceberg when it comes to drug company payments to healthcare professionals and organizations. Without strong legislation, conflicts of interest will remain hidden, undermining healthcare integrity and potentially putting patients at risk.

Sunlight is the best disinfectant, which is why we’re calling for a UK version of the USA’s Sunshine Act to ensure transparency in pharmaceutical spending.”

Dr Emily Rickard, co author from the University of Bath added:

“Why is one of the world’s largest industries—directly impacting public health—allowed such lax transparency? If pharmaceutical companies are funnelling billions across the UK’s health ecosystem in the name of public interest, the public deserves to know where this money goes and how it affects patient care.

The UK government must prioritise patients’ health over pharmaceutical profits, ensuring economic incentives don’t compromise wellbeing. Robust legislation for pharmaceutical payment transparency is essential to protect patients from the harmful effects of unchecked commercial influence.”

The report calls for the UK government to move beyond Disclosure UK and introduce mandatory legislation, which can be modelled on the US Sunshine Act. Such laws would:

• Require all payments, including those for research, to disclose full recipient details and amounts.
• Mandate consistent reporting standards, including unique identifiers for payment recipients.
• Impose significant financial penalties for companies failing to comply with transparency rules.

The research authors believe the government’s recent consultation on payment transparency is a step in the right direction. However, the report cautions that simply expanding Disclosure UK won’t be enough. Only legislation backed by enforcement mechanisms can bring the clarity and accountability needed to protect public trust in healthcare.

Specific recommendations for improvement are detailed in a recent Policy Brief published by the Institute of Policy Research at the University of Bath in collaboration with UK-based patient advocates.

1. The full study, “The unknowns of drug company payment disclosure: Why the UK needs payment transparency legislation,” is available in BMJ Evidence-Based Medicine.
2. DOI: https://doi.org/10.1136/bmjebm-2024-113101
3. The research builds on the findings of the 2020 Independent Medicines and Medical Devices Safety Review, which called for greater transparency to address financial conflicts of interest in healthcare.
4. This research was funded by the Swedish Research Council

Nutritional researchers from Aston University, with colleagues from other universities and leading nutritional groups, worked with the Association of Nutrition (AfN) to help develop a curriculum that can be rolled out amongst all undergraduate medical school students with potential for modules to be taught to other healthcare professional courses.

The paper jointly published in the British Journal for Nutrition  and BMJ Nutrition, Prevention and Health examined the development of a new curriculum aimed at undergraduate medical students and made recommendations on its roll out nationally, with a view to it subsequently being implemented into other healthcare courses.

The AfN Undergraduate Curriculum in Nutrition for medical doctors has been designed to be presented to medical students as an integral part of their general undergraduate training, making it clear how nutrition interrelates with the study of other systems and contributes to an inclusive understanding of health and disease.

Dr Duane Mellor, clinical dietitian and senior lecturer at Aston Medical School at Aston University and co-author on the paper, said:

“At present, lifestyle related health problems from living with obesity, through to high blood pressure, type 2 diabetes, heart disease and several cancers can all be linked to diet across our communities. Whereas in hospitals around a third of patients coming in can be undernourished.

“Nutrition and food play a key role to both keeping us healthy and helping to manage disease, which is why it is imperative we educate our future doctors and other health professionals about the role of nutrition in patient care.”

The paper sets out not only the need for nutrition education and the gaps, but how it can be included as part of what is already a very busy and content heavy curriculum. It builds on areas of the curriculum where nutrition could even be used to help teach concepts such as epidemiology.

It highlights how historically medical education along with the education of many health professionals not specialising in nutrition often have only a few hours of teaching on the subject.

Dr Glenys Jones, deputy chief executive at the Association for Nutrition, who led the curriculum development project and is co-author on the recent paper, said:

“Nutrition is a key and modifiable determinant of health and wellbeing, therefore it is essential our future medical and healthcare professionals are equipped to be able to identify when nutrition could be involved in a patient’s condition in order for this to form part of their care.

“The curriculum is not designed to turn our doctors into nutritionists or dietitians, but to give them the knowledge and skills to be able to think about whether nutrition could be playing a role and having the confidence and knowledge of who, when and how to refer on to suitable nutrition professionals when this is needed.”

Aston University is a pioneer in the key area of nutrition education of the future healthcare workforce. As one of few UK universities with a dietitian or nutritionist as part of the teaching team within its medical school, these skills are now being developed to benefit the training of other health professionals.

Dr Mellor added: “As one of a few dietitians and nutritionists embedded into the teaching team at Aston Medical School, we have been able to integrate nutrition across our curriculum.

“It is great to be able to highlight how nutrition links to the basic science areas such as biochemistry through to how you can encourage a patient to think about changing their diet in clinical skills’.

Aston University has also started to explore with the Association for Nutrition the potential need for nutrition education in other professions. From this an outline of a core curriculum for nutrition for a range of health professionals is in development.

Dr Mellor also plans to work with colleagues to further develop nutrition teaching at Aston University, thus helping students across subjects such as optometry and pharmacy to gain a better understanding of nutrition and how it impacts on their areas of expertise.

For more information about Aston Medical School please visit our website.

The 9-month program uses a community-centered approach to teaching physician advocacy to medical students on both the Twin Cities and Duluth campuses. The fellowship is organized around skills training, personalized physician-mentor pairings and hands-on advocacy activities.

“Medical care only accounts for 10% to 20% of health outcomes. Social determinants of health, including socioeconomic and environmental factors, account for the other 80% to 90%. Healthcare professionals have a professional and moral obligation to step outside of our clinics and hospitals, elevate the voices of frontline communities and use our expertise and privilege to advocate for policies that promote public health,” said Laalitha Surapaneni, MD, MPH, an assistant professor of internal medicine at the University of Minnesota Medical School and a hospitalist with M Health Fairview.

The research found key components of the fellowship, including a flexible curricular structure with built-in adaptability and emphasis on long-term health advocacy engagement, are associated with student growth. It also found that community-centered models of advocacy training offer a compelling way to enable physician advocacy to center on community needs, elevate the voices of those impacted by inequities and foster innovative system change driven by community wisdom.

The study also found programs that approach physician advocacy training similar to traditional medical education risk adopting an “ivory tower” approach that replicates existing power hierarchies and inadvertently focuses on physician accomplishments instead of community needs.

Twin Cities Medical Society started the fellowship program in 2018 with 11 students and mentors. It has grown to include more than 80 student/mentor pairs. Medical students interested in joining a future cohort can fill out an online form. 

Funding for the fellowship program is provided by the Physicians Foundation.