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SEATTLE – (Dec. 26, 2013) — A Virginia Mason study aimed at better understanding what patients mean when they describe their health care experience has identified 35 positive, negative and neutral emotion words that have clear, consistent meanings for patients, families and health care professionals.

This word set is now the foundation of the experience-based design (EBD) questionnaire at Virginia Mason and could serve as a model for hospitals and health systems across the nation.

The study, titled “Experienced-based Design for Integrating the Patient Care Experience into Healthcare Improvement: Identifying a Set of Reliable Emotion Words,” is published in the December edition of Health Care: The Journal of Delivery Science and Innovation.

EBD is a method for accelerating the redesign of health care delivery and making it more patient-centered by incorporating patient and caregiver experience and emotion. For example, EBD identifies emotional touch points during the care journey and assesses the emotional content of each one. Virginia Mason researchers determined the EBD questionnaire should contain words with clear, consistent meanings for it to be most effective.

In the Virginia Mason study, 407 patients, family members, nurses and other health care professionals were given 67 expressions and directed to sort them into positive, negative and neutral categories. The final list of positive and negative words selected for the EBD questionnaire at Virginia Mason contains only expressions that received at least 80 percent agreement about their perceived meanings.

Positive emotion words are: Compassion, confident, empowered, enjoyment, enthusiastic, grateful, great, happy, hopeful, joyful, loyal, optimistic, peaceful, pleased, safe, satisfied, secure, sense of accomplishment, successful and valued.

Negative emotion words are: Afraid, angry, disrespected, disgusted, depressed, frustrated, guilty, hatred, hopeless, ignored, insecure, jealous, resentful and sad.

None of the suggested emotionally neutral words produced at least an 80 percent agreement about their meanings. Virginia Mason selected “okay” as the neutral word for its EBD questionnaire because the expression received the broadest agreement among study participants about its perceived meaning.

“Some emotion words in the English language really depend on the context and mean different things to different people,” said Jennifer Phillips, innovation director in the Virginia Mason Kaizen Promotion Office and co-author of the study. “Now we have a standard word set to use in the questionnaire tool, which gives us more confidence.”

About Virginia Mason
Virginia Mason, founded in 1920, is a nonprofit regional health care system in Seattle that serves the Pacific Northwest. Virginia Mason employs more than 5,600 people and includes a 336-bed acute-care hospital; a primary and specialty care group practice of more than 460 physicians; satellite locations throughout the Puget Sound area; and Bailey-Boushay House, the first skilled-nursing and outpatient chronic care management program in the U.S. designed and built specifically to meet the needs of people with HIV/AIDS. Benaroya Research Institute at Virginia Mason is internationally recognized for its breakthrough autoimmune disease research. Virginia Mason was the first health system to apply lean manufacturing principles to health care delivery to eliminate waste and improve quality and patient safety.

To learn more about Virginia Mason, please visit or follow @VirginiaMason on Twitter. To learn how Virginia Mason is transforming health care and to join the conversation, visit our blog at

Media Contact:
Gale Robinette
Virginia Mason Media Relations
(206) 341-1509

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