Patient satisfaction does not reflect surgical care quality

Patient in wheelchair with doctor
The ability of patient satisfaction scores to properly evaluate quality of care, particularly in the operating room, has been questioned in the field for some time. Patient satisfaction may be driven by more subjective feelings and emotions at the time of survey, making it impossible to use in quantifying the objective outcomes of surgical care.
Heather Lyu
While patient satisfaction has been drawn to the forefront of discussion on healthcare policy and planning in recent months, a study published online in JAMA Surgery this week concludes that patient feedback – whether positive or negative – is not necessarily reflective of the standard of surgical care that the patient received during a stay in hospital.

The Johns Hopkins University School of Medicine researchers, led by Associate Professor Martin A. Makary, initiated the study because they deemed it necessary to interrogate the idea – which has been gaining ground – of patient satisfaction as the ultimate metric of healthcare quality. Their analysis found that the quality of operating room procedures did not correlate with patients’ perceptions of the level of care they had been given in terms of nursing, cleanliness, pain management, and follow-up after they are discharged.

This study was carried out in the United States, of course, and so it focuses on the situation there, but there are inevitably ramifications for the United Kingdom, where the same shift in attitudes is echoed by the introduction of the friends and family test. 

Although patient satisfaction is an important factor which should be a priority, the findings suggest, this should not be at the detriment of surgical and medical aspects of care, such as the blood clot prevention, infection prevention, and timely catheter removal, for example. The analysis conducted by Professor Makary and his colleagues evaluated data from 31 hospitals on their performance in the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), the Centers for Medicare and Medicaid Services (CMS) Surgical Care Improvement Program (SCIP), and the Safety Attitudes Questionnaire (SAQ).

One of the co-authors of the report, Heather Lyu, was able to answer ScienceOmega.com’s questions about the changes that are afoot and why there is reason to be cautious…

Why do you think patient satisfaction has become such a prominent measure of health care quality?
Recently, policymakers and leaders in healthcare have been emphasising measures and interventions to improve patient safety and increase patient-centred care. Patient satisfaction was designed as a metric for patient-centred care and has been supported by several stakeholders in healthcare. For example, in 2012, the CMS stated that they will start using patient satisfaction as a metric of quality to determine bonuses for hospital reimbursement.

Why is it important to interrogate the underlying basis for the assumption that patient satisfaction reflects quality of care?
While patient satisfaction may be a useful metric for the quality of service provided by hospitals – making it a very attractive measure for payers –further study is required to determine its true ability to measure quality of care, particularly in a procedure-heavy field such as surgery.

Were you surprised to find that there was no link between patient care satisfaction and surgical care quality?
The ability of patient satisfaction scores to properly evaluate quality of care, particularly in the operating room, has been questioned in the field for some time. Patient satisfaction may be driven by more subjective feelings and emotions at the time of survey, making it impossible to use in quantifying the objective outcomes of surgical care.

What did the results reveal about the importance of workplace culture in hospitals and clinics?
Our study showed a correlation between patient satisfaction and two domains of workplace culture including safety climate and teamwork illustrating that patient satisfaction may be a valuable marker of safety culture in hospitals and clinics.

How do you think your findings should be reflected by future monitoring of care quality?
While our study showed that patient satisfaction may not be an accurate indicator of surgical quality, it is still relevant and necessary as part of an entire assessment of the patient experience. More metrics need to be studied to devise a reliable assessment of total health care quality in surgery.

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