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

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.

jrau@kff.org

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