Understanding patients' perception of the inpatient psychiatric milieu is key to constant improvement of patient experience. Many have addressed concrete factors. Recognizing that the patient phenomenology is a driving factor in questionnaire responses, Chris Major has constructed practicable measures to address subjective influences on these important HCAHPS measures:

Communication with doctors and nurses: How can a patient be heard more clearly, and most importantly, how can they feel like they have been heard?

Responsiveness of hospital staff: When staff respond to patients, how can patients most feel they have been attended to?

Pain management: How can patients feel their pain has been ameliorated in a way that most matters to them?

Communication about medicines: How can medication and treatment information be delivered to patients in a way that is memorable and makes sense in terms of emotional response to risks and potential benefits?

Discharge information: How can patients feel invested in thier discharge plan, and how can they envision their recovery in the form of a common sense, practicable plan of action?

Cleanliness of hospital environment: While in the hospital, a clean environment helps patients feel safe, calm and well cared for, and in the psychiatric milieu, patients must feel responsibility and empowerment to keep the shared space clean.

Quietness of the hospital unit: Especially at night, quiet is important. Sound is the second most important high-order stimulus after vision, and is most likely to interfere with sleep. For many, a noisy environment adverseley affects their mental state, no matter what time of day. Therefore, the nature, timing and duration of noise on the unit is important to the experience of patients.

Chris Major offers clinical experience, viewed through the lens of contemprary grounded theory, as a way to improve subjective patient experience. This knowledge, in turn, can be used to increase patient ratings on questionnaires such as HCAHPS.