young african nurse comforting female patient

Patient satisfaction is an important consideration, but hospitals and health systems may be focusing too much on it as a key metric. According to a national study conducted at UC Davis by Dr. Joshua Fenton, patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. What’s even more concerning is the finding that the most satisfied patients had a 26 percent greater mortality risk.

According to Fenton, these results could reflect that doctors who are reimbursed according to patient satisfaction scores may be less likely to talk patients out of treatments they request or to raise concerns about smoking, substance abuse, or mental-health issues. Consequently, healthcare providers may not be looking out for the best interests of their patients if they are overly focused on patient satisfaction.

In order to measure patient satisfaction, most health systems currently use a survey developed by the Centers for Medicare and Medicaid Services (CMS), the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), to gauge how patients perceive their hospital stay. When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they probably assumed that transparency and accountability would improve healthcare. The CMS officials even wrote, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.”

Patient satisfaction surveys have their place, but they need to be viewed with a realistic eye. Dr. Fenton explains that in most settings the technical quality of healthcare is invisible to patients and subsequently has a weak relationship with patient satisfaction. Several health systems are now using patient satisfaction scores as a factor in calculating nurses’ and doctors’ pay or annual bonuses. These health systems are ignoring the possibility that health providers, like hospitals, could have fantastic patient satisfaction scores yet higher numbers of deceased patients.

There is no doubt that physicians, nurses and other hospital staff members need to be mindful of patient satisfaction, but this should be balanced with quality of care as well as hospital performance. HCAHPS results do not fully assess the patient experience, and they are poor indicators of operational outcomes. As a recent McKinsey & Company article points out, HCAHPS was not designed to link the patient experience with a hospital’s financial performance. In fact, McKinsey’s analyses show that there is little correlation between HCAHPS scores and net revenue, inpatient gross revenue, or the percentage of patients with commercial insurance. While the intentions behind gauging patient satisfaction with the HCAHPS survey are good, the information from McKinsey combined with Fenton’s findings indicate that more work is needed to ensure the optimal measure is used as healthcare continues to evolve.


Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: Listeria Food Poisoning, Flickr)