Patient-centred healthcare starts from a changed perspective [1, 2], which is to break away from traditional illness-oriented healthcare and to understand the patient as an individual with unique value. Patient-centred is generally defined as 'respecting the desires, needs, and preferences of patients in the decision-making process by building partnerships between care providers, patients, and patients' families and ensuring education and support that patients need to make decisions and participate in their own care' [3]. Patient-centred medication (regardless of whether or not it achieves the goals it aims to achieve, such as improving the quality of health care and improving health levels) itself is considered essentially the right thing to do. Patient-centred is considered to be a key component of quality of health care and an essential component of health care system performance assessment.

A patient experience assessment (PEA) is a survey that evaluates the degree of patient-centred care at a medical site, such as a patient satisfaction survey. In many countries, customer satisfaction surveys have been conducted to assess patient-centred healthcare. In January 2017, the Health Insurance Review & Assessment Service (HIRA) in Korea started a trial implementation of the assessment service and systems [4]. In July of the same year, the first PEA was conducted in earnest. The first PEA conducted by the HIRA was for patients who were discharged from the general hospital [5]. The questionnaire consisted of 24 questions in six areas, including nursing and medical practices, medication and treatment processes, the hospital environment, and patient rights. The survey was conducted by telephone. The assessment results correct the distribution in consideration of different patient configurations by hospital and yield comparable patient experience scores by hospital [6]. Therefore, the PEA, which identifies experiences during hospitalization, is reported to be more descriptive of differences in practice by hospital than the patient satisfaction survey, which examines the patient's expectation and satisfaction [7].

It is reported that positive patient experience is related to increased hospital profitability [8], which directly affects hospitals and shows higher nursing service satisfaction and hospital reuse than patients who receive Customer Experience Management (CEM) [9]. In the future, hospitals will be paid medical quality support costs from the government based on the results of the evaluation. Therefore, hospitals are making various efforts to provide patients' experiences more positively.

The experiences of healthcare providers during the early days of shifting from disease-centred to patient-centred healthcare have important implications for the Korean medical community. The PEA will induce a change in the medical culture [9], and it will be necessary to look at the experience of the process as well as its consequences [10]. Quality improvement (QI) specialist is a mainstream nurse dedicated to quality management in hospitals, who proposes a service delivery system to efficiently provide interdependent medical field work, and plays a role in communication for cross-professional cooperation and coordination [11]. A holistic understanding of QI specialist's experience in patient experience surveys is thought to contribute to the development of the theory of cooperation and coordination in nursing practice.

The FGI study has advantages [12], such as, it helps attain an understanding about complicated PEA situations and identify major theme or variables affecting PEA in the hospitals. This study attempted to explore and to provide an explanation for the experiences of the quality improvement activities regarding PEA. These efforts will demonstrate the difference between patient satisfaction surveys and patient experience surveys in the practice of the medical field, and how changes are occurring in the attitudes and perceptions of health professionals after applying the PEA that were observed. This study will provide an opportunity to discuss the direction for a more valuable PEA.

The results drawn from this study encompassed three areas. First, QI specialists in charge of PEA recognised patient-centredness as a critical area in medical institutions via this PEA. Second, they pointed out that the current evaluation system does not properly evaluate on-site experience due to the limitation of experience evaluation tools, and future improvement is necessary. Third, the PEA included objective statements about providing medical services and specific information on QI compared to the patient satisfaction survey; however, subjective factors could not be complete eliminated.

The patient experience is a representative quality assessment area viewed as patient-centred [16]. The US Institute of Medicine proposes a patient-centred service with safety, effectiveness, timeliness, efficiency, and equity as a requirement for healthcare. [3] In the healthcare service assessment, the patient-centred approach has long been the subject of patient satisfaction surveys, and recently the patient's experience of assessment has become a major area of hospital services [17, 18]. Previous studies have indicated that in various assessments, medical institutions still lacked a response to the needs of patients [7, 19, 20]. A patient-centred approach is difficult to provide in the medical field. Medical care service is such an area where the biggest change is expected through the PEA.

Healthcare service assessment and accreditation systems were implemented to ensure that hospitals would provide high-quality medical services [21, 22], and healthcare staff have acknowledged that accreditation has had a positive effect on QI [22, 23, 24]. Although the patient-centred approach is at the centre of this accreditation, there is concern that a fair assessment may be difficult because patient-centredness cannot be independent of the effects of patient preferences and the underlying diseases. When the patient experience becomes a major focus of hospital assessment, the emphasis shifts to the consequent patient experience questions, rather than the veridicality of the patient experience [25].

The subjectivity of satisfaction cannot be completely overcome by objective experiences, and the fairness of the assessment cannot be ensured. The quality of healthcare is defined by the times and existing institutions. In particular, the quality of patient experiences and the path through which such experiences are gained must be shared by all members of the healthcare system. Unlike satisfaction, which is the outcome indicator, experience includes the context of process indicators, such as the patient's experience with service performance and frequency, and it is more objective [17].

Assessment is also important for the precision and validity of the tool, but acceptance depends on the procedure and method used. Since the purpose of evaluating patient experience was to evaluate services between hospitals, much confusion arose due to improper corrections in areas that are difficult to evaluate, or where the evaluation score is significantly lower, such as in the doctor's section [21]. It is necessary to reflect on whether the current tools for the PEA are adequately included [26].

To overcome the limitations of the PEA in previous satisfaction surveys must be improved. First, there are concerns about the validity of the items in the PEA. Priority should be given to what the patients want in healthcare rather than the ease of assessment. Institutions with good outcomes in PEA should be able to clearly interpret why the patient experience. Above all, patients' experiences should be measured objectively, then the results should be disclosed and utilised for improving hospital services. To enhance the objectivity and utilisation of patient experience evaluation, related research should continue.

Lastly, to improve the quality of medical care, we need to evaluate people's experiences using medical institutions, promote the need for public participation, and educate them on the evaluation process, survey contents, and utilisation of results. In expanding the scope of national health insurance coverage, the public should be properly educated about the use of healthcare services and participate in its assessment to recognise the obligations and rights as Korean citizens.

The system of PEA may vary depending on the country, time, the socio-cultural background. As an early evaluation, this study has limitations in tools, evaluation procedures, and sharing results in South Korea. Based on continuous research and clinical application experience, development of an evaluation system that can appropriately evaluate field experience, including evaluation tools, is expected in the future.

As a result of interviewing the hospital quality managers, the PEA confirmed that the patient-centred culture was expanding, and the behaviour of the hospital staff was changing. However, in order to have a positive impact on the quality improvement of medical care in Korea, the acceptance of PEA and the utilization of results needs to be improved, ensuring the validity of patient assessment items and continuous improvement of assessment methods and the procedures.