• Patient Satisfaction Scores: Think Hotel, Not Hospital

    For physicians, the clock drives patient satisfaction

    At least for hospitals, a broad analysis of Centers for Medicare & Medicaid Services (CMS) data suggests that patient satisfaction scores are more a Yelp review of “room and board” as opposed to any actual reflection of medical care.

    Cristobal Young, PhD (Cornell University), and Xinxiang Chen, PhD (Minzu University of Beijing), evaluated CMS data for patient satisfaction, technical medical quality, patient safety, and hospitality aspects of care from 3,180 hospitals (65% of U.S. acute care/critical access hospitals). Neither medical quality nor patient survival rates had much impact on how satisfied patients were with their hospital experience. Instead, patient satisfaction was driven by highly visible measures of hospitality.

    The paper in Social Forces, a quarterly peer-reviewed journal of social science, reported that quiet rooms had a larger impact on patient satisfaction than medical quality, and communication with nurses affected satisfaction far more than the hospital-level risk of dying.

    Specifically, when nurse communication is poor (lowest decile), patient satisfaction averages just over 50%; with excellent nurse communication, satisfaction is more than 75%. But for hospitals with the highest death rates, patient satisfaction is just 2.0 percentage points lower than for centers with very low death rates. The same was true for medical quality: facilities with the highest medical quality have patient satisfaction scores just 3.3 percentage points higher than hospitals with the lowest decile of medical quality.

    While it is hoped that competition will improve quality care, that is not what Young and Chen found. They were able to match 331 hospitals with competition data. When hospitals face greater competition from other hospitals, medical quality was lower but patient satisfaction was higher.


    Halo Effect

    Overall, patients seem to treat the nonmedical aspects of their care as an overall signal of quality, creating what the authors call “a halo effect of patient goodwill” on all dimensions.

    Young told CRTonline that it was “certainly surprising” that even minor aspects of customer service – such as a quiet room – matter more for patient satisfaction than medical quality metrics.

    “The number one thing that ultimately matters to patients – are you going to survive your operation? Can they fix you? – does not really factor into patient satisfaction scores,” he said. “There's very little awareness that these (patient satisfaction scores) are essentially Yelp reviews.”

    The results suggest an unintended consequence of marketization. Efforts that drive “consumer satisfaction” create pressures for hospitals to be more like hotels.

    “Hospitals are not supposed to be selling patients a happy, feel-good marketing campaign,” Young added. “They have a responsibility to the best interests of their patients, and that means being honest about medical quality and patient survival. So, enough with the satisfaction scores; measure and focus on what the patients come in for in the first place: medical excellence.” 


    Wait Times Tank Doctor Ratings

    For clinic visits, time is the big factor in physician ratings. Rasheedat Zakare-Fagbamila, MD, of the University of Florida, Gainesville, and colleagues report that every 10-minute increase in waiting time decreases patient scores.

    Over 15 months, 22 surgeons conducted 27,090 visits. The average total time for a clinic visit was 85.17 ± 25.75 minutes. Every 10-minute increase in waiting room time was associated with decreases of 3%, 9.8%, and 2.4% in Global, Access, and Communication scores, respectively. In the paper, published in the Journal of Neurosurgery: Spine, multivariate analysis showed that all three changes were highly statistically significant. (Increased in-room – exam room – time was also an independent predictor of poor Access scores [p < 0.001]).

    Oren Gottfried, MD, senior author and a professor of neurosurgery at Duke University School of Medicine, said “While a medical visit is important, it does not have the positive feedback of an amusement park ride where a 2-hour wait seems worth it for even a short ride.”

    If an extra 10 minutes in the waiting room causes such a drop in a doctor’s ratings, he added, it is probably worthwhile to address the waiting-room issues because it would be “very hard to make up for that drop in the actual doctor-patient visit.”



    Young C, Chen X. Patients as Consumers in the Market for Medicine: The Halo Effect of Hospitality, Soc Forces. 1-28. https://doi.org/10.1093/sf/soaa007

    Zakare-Fagbamila RT, Park C, Dickson W, Cheng TZ, Gottfried ON. The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice. J Neurosurg Spine 2020 Feb 21: doi: 10.3171/2019.12.SPINE191257. [Epub ahead of print]. https://thejns.org/spine/view/journals/j-neurosurg-spine/aop/article-10.3171-2019.12.SPINE191257/article-10.3171-2019.12.SPINE191257.xml

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