If you’ve seen a doctor, visited an emergency room, or been hospitalized in the past decade, you’ve most likely received at least one mail, email, or phone survey asking about your experience. Most likely, you threw the envelope containing page after page of the Likert scales, pressed the delete button, or sent the unknown caller to voicemail. Who sends you these surveys? Why are they harassing you? Why should you care?
Patient satisfaction surveys started with a simple premise: increased patient satisfaction should correlate with better quality of care and lower costs. Other industries collect data on customer satisfaction; why not health care? Improving the patient experience could even improve health outcomes. Giving a voice to patients appears to empower and strengthens transparency and accountability in healthcare organizations. It all sounds good, right? Unfortunately, it didn’t work out that way.
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The idea of investigating patients remained relatively obscure until the Affordable Care Act enshrined it in law. The Centers for Medicare and Medicaid Services require public reports on patient satisfaction from hospitals and providers, which has a direct impact on their reputation and possibly their results. Underperformers can lose up to 9% of their Medicare reimbursements. Commercial insurance followed suit. Healthcare establishments pass this responsibility on to their employees. Patient satisfaction scores can represent 5-10% of a physician’s salary, although specialties with limited patient interaction, such as anesthesiologists and pathologists, are exempt.
The demand for administration, analysis and reporting of patient satisfaction surveys has produced a thriving industry, which is expected to reach $ 71 billion by 2025. Press Ganey, an Indiana-based company, owns 60% of the market, followed by rivals Gallup and National Research Corp.
However, like online physician reviews, these surveys are poor indicators of a provider’s medical expertise. Satisfaction scores are heavily influenced by a few metrics, including wait time, parking availability, and whether the patient received the medications they wanted. Providing high-quality care, such as refusing to prescribe antibiotics for a cold, can lead to low scores.
The surveys are tainted with bias. Not all patients are interviewed and the selection process is not completely random. You will not receive a survey if you have visited the same hospital within 90 days. Intended to prevent “frequent travelers” from skewing the results, this practice excludes sicker patients who do not improve or those who present with complications.
Only 5 to 15% of surveys returned. Older, female, commercially insured patients who have come for routine elective visits are the most likely to respond. A disgruntled patient can give anything low to make a point. A conflict-averse patient can value all that is high. Since weeks often elapse between the appointment or admission and the time the surveys are sent, the patient’s memory can be tainted by memory bias or unconsciousness. Patients report higher satisfaction scores for white doctors than for black doctors. Female physicians receive fewer negative comments.
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When providers and institutions divert more attention and resources to improving patient satisfaction scores, the quality of care can decline. An emergency physician may rush into resuscitation of critically ill patients, fearing that keeping less ill patients waiting will reduce their satisfaction rate. Knowing who is likely to respond to a survey can cause hospitals to favor one group of patients over others, amplifying health disparities. Providers may practice defensive medicine and overtreatment to soothe the patient, contrary to their clinical instincts.
Despite these recognized flaws, patient satisfaction surveys are here to stay because decision makers have found nothing better. And now?
We need to approach the survey results critically, understand what they represent and what they do not. Providers should be aware of potential conflicts of interest so as not to confuse clinical decision-making. Healthcare organizations need to make systemic changes to improve the patient experience (eg, shorten wait times and validate parking), without penalizing individual employees for poor scores. As for patients, if you receive a follow-up care survey, please take a moment to complete it thoughtfully and honestly. Make your voice heard. A higher response rate increases sample size, combats bias, and makes data more representative of the patient experience, giving providers the real feedback they need to take better care of you .
Qing Yang and Kevin Parker are a married couple living in Springfield. Dr. Yang received her medical degree from Yale University School of Medicine and completed her residency at Massachusetts General Hospital. She is an anesthesiologist at HSHS Medical Group. Parker has helped formulate and administer public policy in various city and state governments across the country. He was previously the Group Information Director for Education at the Illinois Department of Innovation and Technology. This column is not intended to be a substitute for professional medical advice, diagnosis or treatment. Opinions are those of the authors and do not represent the views of their employers.