The waiting room can seem a long way from the board room.

Improving the patient experience has long been a top aim of health systems. While quality scores have improved, satisfaction scores have lagged. Only about a third of hospitals received the very top satisfaction ratings, according to CMS. One cause: health care providers are not asking the right patients the right questions to elicit the actionable insights needed for sustainable, positive change.

How can that be? Health systems are drowning in quality and safety data. Since 2008, the Hospital Consumer Assessment of Healthcare Providers and Systems survey has provided standardized, national reporting of patients’ perspectives on hospital care to supplement what each system gathers on its own. But how do health systems use all this data?

The answer: inconsistently and incompletely, with a few exceptions. With so much pressure to manage to the bottom line, understandable focus on avoiding “never events”, persistent organizational silos, EHR implementation dis-ease, and inertia born of continuous change, only the most critical improvement opportunities become priorities. The softer drivers of satisfaction drop off or go to the bottom of the list.

For more than a decade, my wife’s rare, incurable cancer took us to academic and community medical systems in five states and abroad, where I came to admire deeply the heroics of the physicians and caregivers we met. In my eight years as CEO of a national medical association, I visited countless health systems, urban and rural, large and small, to meet with talented executives trying earnestly to improve the patient experience. My time as a philanthropic investor in expanding education and health care access and improving quality showed me the persistent challenges of managing chronic diseases in the community.

Through all of this, I’ve found an essential voice missing from the conversation about patient satisfaction: the avid consumers of health care. We may not want to be, but we are.

Decades ago, the struggling airlines turned to their most avid business customers for help. So should health systems check the pulses of their most frequent bedfellows for greater insight into what secures and sustains their satisfaction. Hint: It’s more than having this decade’s magazines in the waiting room and offering fancy amenities.

I know this is well trod ground, but here’s one avid consumer’s take on how to really move the needle on satisfaction.

Talk to the right patients.

Concerns about whether satisfaction should be the penultimate measure for something as technically complex as medical treatment are legitimate. But the half of us dealing with chronic illness and buying health services frequently (often out of our own pockets) know what will satisfy us, and we want our health care providers to know, too.

But you have to ask, and periodic input from surveys is insufficient. Identify and tap into those who have the most intimate understanding of your system and, ideally, also know other institutions. They can help recognize patterns, amplifying the most persistent concerns that might be overlooked and promoting solutions that might go untested.

Ask the right questions.

You clearly need to elicit insights into quality of care, perceived efficacy of treatment, preparedness and demeanor of staff, and adequacy of facilities. The continuing and often immersive nature of your frequent patients’ experience can provide a distinctive, holistic, and longitudinal point of view:

• What parts of the patient’s overall care plan have you executed very well/poorly?
• What have been the most consistent strengths and weaknesses in your performance over time?
• How would the patient describe the culture of the organization taking into account all aspects of the patient experience?
• Relative to other institutions, what differentiates/diminishes you the most?
• How has the patient experience influenced decisions to seek other services from your institution/recommend it to friends and family?
• How have the patient’s feelings toward you changed as familiarity with you has grown?
• What’s the story you’d tell about your experience? How was the plot shaped by intentions, obstacles, and resolutions?
• Do you motivate patients to give you straight feedback often and to communicate directly with senior management?
• Do you recognize that timely documentation and communication of positive and negative observations from this credible constituency provide a unique basis for continuous improvement efforts?  Do you trumpet this discipline across the institution?
• Are you motivating care team members to elicit and capture anecdotes when speaking with patients whom they serve frequently?
• Do you generate hypotheses about how to fix pervasive and persistent issues and test your hypotheses with the consumers who know your system best?
• Do you consistently acknowledge all who contribute insights, as well as those who fix problems?

We are living longer and want to live well. This means that most of us will spend more time in the health system, as consumers of life-saving and life-sustaining services. We will have more service choices and greater ability to vote with our feet. The insights of avid consumers can help lift everyone’s game.