Patient Satisfaction Makes a Difference

Hospital quality metrics, which are available to the public (https://www.medicare.gov/hospitalcompare), are used to rank and rate hospitals on various measures. These metrics are meaningful to patients, because they can use the published data to compare hospitals and physicians on their outcomes for specific procedures and services, and are meaningful to health organizations because the better the rankings, the more patients use their services and also because the government rewards high ranking hospitals with financial benefits. Therefore quality metrics make a difference. They are not simply numbers.

Hospitals, especially those not ranked in the top decile, often complain that the metrics are not actually reflective of the care given in their organization. They say that their patients are sicker and therefore they don’t have successful outcomes. Or that their hospital attracts patients from lower socioeconomic groups because it is in a poorer region and does not have the resources that a more advantaged community may have.

A recent study published as a National Bureau of Economic Research working paper (http://www.nber.org/papers/w23166) attempted to isolate which quality measures might accurately reflect hospital care, whether of good or poor quality, and which might be a reflection of something other than the quality of care delivered, such as differences in patient population or different resources.

A surprising result of the study was that patient satisfaction scores were an accurate indicator of quality. Those hospitals with higher satisfaction scores had lower mortality rates (a quality metric) and lower readmission rates (another quality metric). Patient satisfaction has been thought to be based on variables that are unrelated to clinical care, such as effective communication between patient and caregiver, cleanliness of rooms, or waiting times for procedures. But in fact all these variables do reflect the quality and efficiency and timeliness of care. Without good communication, patients may not reveal their issues and physicians may not be able to adequately ensure that the treatment plan is followed. Lack of cleanliness can be a proxy for lack of attention to sterile procedures and equipment which has an impact on outcomes, such as infection rates. Long waiting times for procedures may signal organizational inefficiencies that result in poor care as well. The study seems to suggest that hospitals pay attention to the experience of their patients. They want to be highly ranked. Therefore satisfaction should be made a priority.