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Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality, Study Finds

By Jordan Rau

April 17th, 2013, 4:00 PM

You may have found your doctor to be a great communicator, your hospital room clean and quiet and your pain well controlled. Yet a study finds these opinions are not barometers of whether your hospital’s surgical care is any good.

The study, led by researchers at the Johns Hopkins University medical and public health schools, looked at patient satisfaction and surgical quality measures at 31 urban hospitals in 10 states. Patient satisfaction was determined by the results of standard Medicare surveys given to patients after they left the hospital.   Quality was judged by how consistently surgeons and nurses followed recommended standards of care, such as giving antibiotics at the right time and taking precautionary steps to avert blood clots. The researchers also looked at how hospital employees evaluated safety attitudes at their hospital.

The researchers found little relationship between a hospital’s patient satisfaction scores and most quality ratings. “At present, little evidence supports its ability to predict the quality of surgical care,” Heather Lyu, Dr. Martin Makary and the other researchers wrote in JAMA Surgery.

Makary said that while patient satisfaction scores are a valuable component of evaluating a hospital, they are getting excessive attention because they are among the few quality measures available to the public. “It’s going to mislead patients because they’re going to think the hospital with the best lobby and the best parking and customer service is going to have the best heart surgery,” he said in an interview.

Previous studies of the relationship between patient views and the quality of care also have found that they are not necessarily correlated, but Medicare views them as useful. The patient assessments account for 30 percent of bonuses and penalties given to hospitals in the first year of Medicare’s “value-based purchasing” program, which was created by the federal health law.

Some of the surgical measures are also included in the calculations that make up the other 70 percent of the bonuses and penalties this year.  Hospitals can gain or lose 1 percent of their regular Medicare payments under the quality program. All those individual scores are available to the public on Medicare’s Hospital Compare.

The researchers found that there was some relationship between how patients rated their experiences and whether hospital workers considered themselves part of a team approach to caring for patients and felt their work environment was not excessively stressful. There was no relationship between patient scores and hospital workers’ overall assessment of the hospital’s safety culture, which also included job satisfaction, working conditions and perception of management.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

7 Responses to “Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality, Study Finds”


  2. Steven says:

    This is not surprising at all. Yet another unproven government process that looks good on paper but was never tested. How many billions have been spent in the name of Patient Satisfaction and now the more clever “Patient Experience” Companies like Press Ganey should be held liable for perpetuating these falsehoods and the money spent to bow at the altar of these surveys. Hopefully more meaningful research such as this will help expose the shortcomings of these surveys. Kudos to the researchers who dared to challenge what hospital administrators hold to be most sacred.

  3. Stephen B says:

    Unfortunately, patients do not generally have the ability to easily compare quality (due to a lack of transparency, not a defect of the patients themselves), so they will substitute an impression based upon the attractiveness of the physical plant and the amenities offered for quality.

    Note also that quality was defined by following of best practices that are measurable. While these practices certainly contribute to better outcomes, it is inferred from the article that the study did not directly measure outcomes nor control for variability in co-morbidities and contributing factors. This merely points out how difficult outcomes research is, and while some generalization can be concluded, the study really points out that there is no correlation between patient satisfaction and how well the OR team follows best practices and the overall safety attitude of the hospital. When you realize that the actions of the OR team are probably unknown to the patient (unfamiliar environment, anaesthesia), the study’s conclusions are less surprising.

  4. susan pfettscher says:

    There is a theory that patient satisfaction comes from the structure–recall that hospital administrators want registered nurses to emulate hotel staff in their interactions! Patients may not know what good care is and are using the hospitality criteria. Families are better judges and often only talk about the problems; they ascribe a good outcome as a “miracle” forgetting the nurses who cared for their loved one during a long and difficult night. As an advanced practice nurse, I have found my own recent hospitalizations and outpatient care difficult and problematic. I also had excellent care from some (sadly not all) staff. But–
    “satisfaction” and the questions used are often wrong measures. Before we can measure, the patient needs to understand what the best care is–an education that may be impossible.

  5. Neither Press Ganey nor other questionnaires I’ve seen ask about interactions with staff other than MDs and RNs, i.e. did you see a respiratory therapist? clinical dietitian? occupational therapist? etc., yes or no. If yes, several responses could be provided for patient to check and/or s/he could describe encounter. These questions wouldn’t measure satisfaction per se but would give department directors and administrators a better picture of the interactions among the multidisciplinary medical team and with the patient. Good post-op care is as important as good surgical practices!

  6. Diana Ford says:

    My father was not given antibiotics on time or for the right length of time nor the right antibiotics. He was allowed to go into septic shock numerous times, he was allowed to go into uremic shock he was given strokes and heart-attacks due to these shocks and due to the anemia he was left with for 20 months. If I was unhappy, this is why I was unhappy. Even when they gave him antibiotics it was never long enough to heal him and they never tested to see of he was healed before stopping the antibiotics. Also, at times I caught them giving him the antibiotics that he was resistant to so I told the nurse who called the doctor on call to change the prescription. He was left with the infection for 20 months until it killed him. I know why I am not happy with this Hospital and it is not the size of the smile on those hypocrite’s faces!

  7. April 20, 2013
    As an operating room RN of many years, I emphatically believe and state, “Patient Satisfaction Surveys Are a JOKE!” Just because someone smiles, and is PC, does not mean one is receiving quality care …..the sad issue is that the generic patient has no real clue as to what is quality care… matter how many sites on the internet they visit for information! For example, even nurses who work outside of their own specialty units have no understanding of the inside workings of an operating room unless they themselves have worked as an operating room nurse. Procedures, education/training of staffers, the quality of a surgeon’s work etc. and all the side issues of personalities, bullying, the actual experience with old and new techniques, equipment and etc. all play their part in ensuring good outcomes! To paraphrase an old saying, “the OR hides or buries their mistakes”…….the real records are contained only in “Risk Management” files never to see the light of day and as always, all data only reveals what is not litigious. And as far as sites which “grade” hospitals and doctors and etc., they are only making money at the “expense of patients’ lives”.
    My opinions,
    Helen M. French BSN,RN
    and author of: