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Patient Satisfaction Surveys: Does Comfort Trump Outcomes?

Most surveys focus on ‘humanistic’ features of care rather than on clinical results, report says

Improving patient satisfaction scores is a top priority in health care, but this focus could hurt care-quality improvement efforts, according to a Hastings Center report summarized on the FierceHealthcare website.

Although patient satisfaction is an important aspect of health care, especially as a consequence of respectful treatment, the use of satisfaction surveys can have troubling effects on the delivery of care, the report notes.

“The pursuit of high patient-satisfaction scores may actually lead health professionals and institutions to practice bad medicine by honoring patient requests for unnecessary and even harmful treatments,” the authors say.

Part of the problem, according to the report, is that the definition of “satisfaction” varies widely. Patient satisfaction comprises three distinct categories, the report says. First is the provision of medically necessary care that actually improves their outcomes. The second concerns interventions that patients or families want but that are medically unnecessary and may negatively affect health outcomes. The third category includes “humanistic” aspects of health care, such as good communication and treating patients with respect, as well as peripheral aspects, such as convenient parking and designer hospital gowns.

“‘Patient satisfaction’ means something different to everyone and bears no clear relationship to the technical quality of health care,” the report states.

The “humanistic” category tends to be the focus of most patient satisfaction surveys, according to the Hastings report. Although many surveys contain questions on patient safety, most don’t address other important factors, such as readmission rates, surgical complications, mortality rates, and hospital-acquired infections. Moreover, many surveys ask patients to rate their doctors on a scale from “worst doctor possible” to “best doctor possible.” This approach both attributes a level of technical expertise to patients that they don’t have and conflates satisfaction with the overall quality of care, according to the authors.

The overall effect is that many providers are now “teaching to the test,” tailoring interventions to manipulate favorable patient responses, the report states.

Sources: FierceHealthcare; June 5, 2015; and Hasting Center Report; May–June 2015.


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