Do patient satisfaction surveys value comfort over outcomes?

Improving patient satisfaction scores is a top priority in healthcare, but this focus could hurt care quality improvement efforts, according to a paper from the Hastings Center.

Although patient satisfaction is an important aspect of care, especially as a consequence of respectful treatment, use of satisfaction surveys can have troubling effects on care delivery, write Alexandra Junewicz and Stuart J. Youngner.

Part of the problem, according to the report, is that the definition of "satisfaction" varies widely. Patients can be satisfied in three distinct ways. One definition involves whether the care is medically necessary and improves outcomes. The second is whether patients and families received the treatment they wanted, regardless of necessity or effectiveness. The third is only tangentially related to outcomes and involves aspects of care such as communication, respectful treatment and convenience, which are consistently a top priority for patients.

"'Patient satisfaction' means something different to everyone and bears no clear relationship to the technical quality of healthcare," the report states. "It relates, rather, to other, less objective qualities of healthcare."

This third, "humanistic" category tends to be the focus of patient satisfaction surveys, Junewicz and Youngner write. Meanwhile, although many surveys contain questions on patient safety, most don't address 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 actually have and conflates satisfaction with overall care quality, according to the authors.

The overall effect of these phenomena is that many providers are now "teaching to the test," tailoring interventions to manipulate favorable patient responses, the report states. For patient survey responses to accurately assess care quality, patients must assume a consumer's perspective rather than that of a sick person.

To learn more:
- read the report abstract