Blog | Tuesday, June 16, 2015

Mistakes about 'patient satisfaction'


I had 2 experiences recently that reminded me that many doctors and nurses remain resistant to measuring and improving how patients experience the care we provide. One was a face-to-face discussion with a senior physician. The other was reading an article by a nurse. Both the doctor and the nurse denounced the growing focus on the patient experience by citing the threat to quality of care, and I believe both of them were totally wrong.

The encounter with the physician came as I addressed a group of newly hired physicians. As I typically do in these circumstances, I outlined our Medical Group's commitment to increasing the visibility of the results of our patient experience surveys. We have been providing our physicians with reports on their patients' feedback for the better part of a year, and we anticipate posting physician-specific results on our public website within a few months. During the Q&A, one of the physicians objected to the plan, saying that “patients can't judge the quality of care that we provide.”

The article was entitled “The Problem with Satisfied Patients“ and decried the effort being made to boost hospital-specific patient satisfaction scores by adding hotel-like amenities and scripting staff, both of which she characterized as threats to clinical care and patient safety.

In both cases, the case against focusing on the patient experience was based on flawed “logic” and, sadly, probably more than a small dose of self-interest.

The doctor's mistake was that while his observation about patients' inability to judge quality may be correct, it is irrelevant. We are not asking patients to judge quality. In fact, there is considerable evidence that patients—precisely because they can't judge technical quality—just assume we are all competent. Instead, we are asking them to judge their own experience (which, of course, only they can judge), and the 2 are not in conflict. Since when are empathy and good communication, key determinants of patients' experience, anathema to quality?

OK, here it comes … what about all those crafty doctors who will practice “bad medicine” to boost their satisfaction scores? You know, prescribing antibiotics to kids with viral syndromes so as not to “disappoint” those pushy parents, or handing out narcotics to make patients happy. Well, what about them? Is this “threat” any more pressing than the one posed by some doctors doing more tests than they should to boost their income? Do we stop paying all doctors because some may bill in unethical ways? Why would we stop caring about finding out how patients experience their care because some doctors may respond unethically? No one is saying that patient experience scores are more important than quality, any more than we are saying that “productivity” is more important than quality.

The logical error is to reject the use of ANY measures of patient experience because using ONLY measures of patient experience would create perverse incentives.

The nurse made a similar goof. Sure, if patient experience scores were the ONLY measure used to judge hospitals, we would be in deep trouble. And sure, some institutions respond foolishly to the pressure to improve their scores (instead of their patients' experience) by trying to goose up trivial amenities instead of really understanding what matters to patients. Neither of which invalidates the importance of understanding and improving how patients experience the care we provide.

Here's something else to consider: True empathy, respect, and effective communication, which are cornerstones of providing a good patient experience, can improve clinical outcomes by reducing patients' stress, fostering sharing of critical information and boosting adherence to care plans. Nothing in conflict with quality there.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.