Follow Us:

Follow AutoData Systems on TwitterFollow AutoData Systems on LinkedInFollow AutoData Systems on FacebookFollow AutoData Systems on YouTube
AutoData Systems > healthcare

The Problem[s] With Patient Satisfaction Surveys

Measuring patient satisfaction and quality of care has become a much talked about topic lately. Due to changes in federal law, Medicare reimbursements paid to hospitals are now tied to patient satisfaction scores. These new laws give hospitals even more incentive to improve patient satisfaction and experience – which, in theory, is a good thing. Doctors (and hospitals) should be subject to feedback and held accountable for their work. There are, however, problems with patient satisfaction surveys.

Dr. Christopher Johnson writes in a recent article that patient satisfaction surveys – as currently used – are “riddled with problems.” Dr. Johnson goes on to say, “they [surveys] don’t measure what they are suppose to measure and they can easily drive physician behavior the wrong way.” Dr. Johnson refers to his survey tools as made and facilitated by Press Ganey. Press Ganey is a massive corporation that provides hospitals and health systems full service patient experience solutions, in which Press Ganey writes, distributes, and collects the surveys and data. As such, hospitals using Press Ganey’s services essentially outsource all of their patient satisfaction and survey measurement. Dr. Johnson writes, “I’ve read the Press Ganey forms and the questions they ask are all very reasonable.” This quote raises a red flag that perhaps Dr. Johnson misses: Dr. Johnson is not, nor is anyone at his organization, writing the questions on their patient satisfaction surveys. It makes the most sense for those who are trying to benefit from collecting their own patients’ data to write their own surveys. Those closest to the patients and those working in the hospital are better suited to understand the different context and circumstances surrounding the measurement of patient satisfaction. Instead of a Press Ganey employee 800 miles away writing survey questions and processing the data; the doctors, nurses, and administrators should be more involved in the process of measuring quality of care. There is no such thing as a one-size-fits-all survey.

Dr. Johnson also speaks of the poor sample sizes used to collect the data; “[a]lthough the forms are sent out to a random sample of patients, a very non-random distribution of them are returned. Perhaps only the patients who are happy, or those who are unhappy, send them back.” This very well could be true, but it is most likely an easy fix. Again, each hospital knows (or should know) the best way to collect data from their patients. Generally, for most hospitals, the best way is with in-person paper surveys. Surveying the patient while still on site raises response rates and ensures that the sample size is more random than the one Dr. Johnson describes. Along with higher response rates, a patient’s memory of her experience is fresher when surveyed on-site and therefore the data is more accurate.

Dr. Johnson is correct in saying that patient satisfaction surveys “as currently used are riddled with problems,” but there are solutions to these problems. Understanding the quality of care provided by a doctor or a hospital or a nurse is too important to ignore or be discouraged by those obstacles. The healthcare world has been talking about measuring patient satisfaction for decades yet still have a long way to go. Getting rid of patient satisfaction surveys is not the solution. Acknowledging constructive criticism about the process and fostering open debate about improving patient satisfaction is the solution.

Is Patient Satisfaction Overrated?

A recent article on Forbes.com asked an interesting question: is patient satisfaction overrated? The question is an important one and warrants more discussion. The article (found here) uses Dr. House, the rude but extremely effective fictional doctor from the Fox television series “House,” to analogize that perhaps patient satisfaction doesn’t always equal quality health care. The author – Steven Salzberg – attempts to make the point that while Dr. House is abrasive and his patients do not have the best experience, they do receive the best care. Salzberg writes that even though large scale reforms in healthcare are pushing the importance of patient satisfaction, better patient satisfaction scores are not necessarily correlated with better care. Essentially, instead of giving patients what they want, doctors should give them what they need. Salzberg doesn’t just use the “House” analogy; he cites a study that shows higher patient satisfaction rates being tied to higher costs and higher death rates.

AutoData agrees with some of the author’s points and disagrees with others. AutoData couldn’t agree more with the premise that doctors must give their patients what they need as opposed to simply what they want. And we are not disputing the study Salzberg cites (though we’re unsure of the context and specifics of the study). However, Salzberg asserts that measuring patient satisfaction in general is the overall problem; AutoData believes the problem is in how patient satisfaction is measured.

“For patients who think a nice doctor is a good doctor, this might come as very disappointing news,” writes Salzberg. If surveys are asking patients questions like, “Was your doctor nice?” or “Did they communicate well with you?” or “Did you have a nice time?”, of course these metrics are hollow and should not be correlated with better care. But that doesn’t mean patient satisfaction doesn’t work, it means the provider of care must change how and what to measure. In other words, identify the data that will lead to better care and measure for that. Collecting data which shows that the care administered was superior will not always be the same as the data that shows the patient had a good time (AutoData discusses this in a post about the differences between patient experience and patient satisfaction here).

Salzberg also touched on the infamous standardized hospital survey, HCAHPS. He writes that Dr. House would fail this survey with flying colors, which is probably true. A one-size-fits-all, nationally standardized survey doesn’t make sense to us either. Hospitals and health clinics operate under different circumstances and contexts serving different demographics; measuring them against each other under one standardized survey is asinine. Hospitals have different objectives, goals, and ideas about delivering quality care, so why limit the ways they measure satisfaction and experience? Let the hospitals be in charge of the data they collect, ultimately it will lead to their success or their demise. The most encouraging trend AutoData has seen over the last 4 years is the consumeraztion of health care (AutoData wrote about it here). Due to advances in technology and the internet, healthcare consumers have been given a more powerful voice and as a consequence will continue to have more choices in care providers, ultimately forcing health systems to provide higher quality care. Therefore, it’s arguably more important than ever for health systems to measure patient satisfaction and experience. If the health system effectively listens to their patients through patient experience measurements, they can improve their service, advertise their superior service, and ultimately grow.

Salzberg’s article narrowly misses the point. It isn’t that patient satisfaction is overrated or unnecessary, but health systems must adapt to measure and collect the right kind of data. The right kind of data is data that will improve their care, not data that assesses whether a doctor is nice. When the right kind of data is measured and collected they can use it to persuade potential consumers to choose them as their provider of care. In that case, measuring the right kind of patient satisfaction is grossly underrated.

Patients or consumers?

“The health care landscape is changing.”

That phrase – or some variation of that phrase – has been used ad-nauseam in recent years (we’re guilty of using it). The phrase has become cliché, as most people are aware that massive change in healthcare is underway through government reform referred to as ObamaCare. Although a large portion of the general population understands that change is happening, I don’t think they are sure – present company included – what the change means or where it is headed. Further complicating things is the change happening unrelated to ObamaCare, due to advances in technology and changes in consumer sentiment. You read that correctly, consumer, not patient.

In basically every industry outside of health care, when change is needed, the consumers drive the change whether individual businesses are ready or not. The customer knows best, after all. With the advent of Yelp!, Google reviews, Angie’s List, and countless social media sites, consumers have been given a much larger voice – and businesses have been listening. But until recently, health care hasn’t listened. In 2014 and beyond, the hospitals and health systems that don’t start listening to their consumers will be left behind – quickly.

“Despite controlling nearly 20% of the economy, traditional healthcare is years if not decades behind other industries when it comes to adopting a business model and technologies that assess and meet consumer needs.”

The quote comes from a recent HealthLeadersMedia interview (found here) with Chris Wasden, a global healthcare innovation leader and SVP at PwC. The interview discusses recent empowerment of health care consumers who are now willing (and eager) to “dump the doctor’s office for cheaper and more convenient retail and remote alternatives that could amount to tens of billions of dollars of lost revenues if they fail to adapt.”

In short, if health systems want to survive they need to adapt. Step 1: Treat patients as consumers:

“Whether it’s the pharmaceutical companies, device makers, payers, or providers, nobody considers the patient as their customer so they’ve never tried to come up with solutions that were consumer-friendly or consumer-centric.”

Treating them as consumers forces a hospital to frame the experience they provide differently. If they frame it correctly, they will improve the consumer’s experience for the better. Framing it correctly depends on Step 2.

Step 2: listen to the consumers. Ask them. Survey them. Gather the data and use it to make consumer-friendly choices that enhance the experience and the care. Framing patients as consumers means asking different questions than ones found in typical patient satisfaction surveys or HCAPHS surveys. Ask about every conceivable positive or negative experience and then implement the proper changes. This will improve the experience and when you improve the experience and the care, the consumer will follow. The health systems that do this will flourish, the health systems that don’t will flounder. It is painfully simple.