By Kim Bellard, April 24, 2015
In a provocative article for The Atlantic, Alexandra Robbins posits that we may have a "problem with satisfied patients." Ah, only in health care...
Ms. Robbins fears that hospitals may be focusing too much on making patients happier, rather than on making them well. She cites how hospitals are rushing to provide "extra amenities such as valet parking, live music, custom-order room-service meals, and flat-screen televisions," which may help patients have a better experience but which mean resources not going directly to patient care.
She may have a point.
Ms. Robbins' analysis found that hospitals that do poorly on three or more categories of patient outcome measures actually score above average on patient satisfaction. In her words: "Many hospitals seem to be highly focused on pixie-dusted sleight of hand because they believe they can trick patients into thinking they got better care."
Ms. Robbins cited a 2012 study by Fenton, et. alia, that further quantified the patient satisfaction "problem." According to their research, patients with the highest satisfaction also have higher odds of inpatient admissions, greater prescription drug expenditures, higher overall expenditures, and higher mortality.
Patient satisfaction is clearly in vogue, as evidenced by CMS unveiling its star ratings on Hospital Compare last week, based on HCAHPS results, and by Medicare's increased focus on value-based payments. The 2015 HIMSS Leadership Survey found that 87% of respondents listed patient satisfaction as their organization's top priority, higher than even sustaining financial viability (85%).
AHA's official response to the CMS ratings was cautionary: "There's a risk to oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons."
OK, fair enough...so what does AHA propose instead?
Another study on patient satisfaction, by Vanguard Communications, looked at patient reviews of physicians, and also found some unexpected results: "Ironically, the analysis indicates that generally as a doctor’s level of education and training increases, patient satisfaction actually decreases."
I didn't see that one coming.
Vanguard believes that the ratings reflect more about customer service than clinical quality. Ron Harmon King, Vanguard's CEO, says: "Does that mean more highly trained specialists deliver poorer customer service? We can’t say with any certainty, although we found a correlation."
The Physicians Foundation 2014 survey found that 42% of respondents did, indeed, list a customer-service related reason for why they were satisfied with their family physician, way ahead of actual treatment related reasons (26%).
Ms. Robbins is thus not alone in being skeptical about patient satisfaction scores. She backed up her skepticism with a quote from nurse Amy Bozeman: "The patient is NOT always right. They just don’t have the knowledge and training."
I hate to break it to either of them, but even with all our health care professionals' knowledge and training, our health system's record on quality is pretty dismal.
Look, patient satisfaction is not a perfect measure, nor should it ever be the only measure used, but it has to be an important measure. I can see patients being initially swayed by amenities or even simple courtesy, neither of which have typically been in abundance in our health system. But we can't afford to forgo the burgeoning effort to focus on improving patient satisfaction. At some point we have to trust that patients will see through smiles and nicer waiting rooms, and judge quality based on whether they are actually getting better.
And, in fact, research from Johns Hopkins suggests that patients may not fall for "pixie dusted sleight-of-hand" tricks after all. The study concluded that:
"Patients responded positively to pleasing surroundings and comfort, but were able to discriminate their experiences with the hospital environment from those with physicians and nurses...Hospital administrators should not use outdated facilities as an excuse for suboptimal provider satisfaction scores."
As Abraham Lincoln famously said: "You can fool all of the people some of the time, and some of the people all the time, but you cannot fool all the people all of the time."