Having patient satisfaction data isn’t enough to choose a hospital

When I learned recently that I would need cataract surgery, I researched New York City hospital ratings from three well-known sponsors: US News & World Report, the federal government’s Hospital Compare and the Leapfrog Group. After writing about what I discovered, I wondered if perhaps a few measures might offer a clue or two about how to better honcho some of my care, like the one that asks hospital patients if a nurse explained medications given to them. Since many ratings schemes rely on patient satisfaction data collected by the government, I decided to explore further, still hoping to uncover the best facility for my surgery.

The Hospital Compare site — an investment of millions of public dollars — offers many ways to judge how happy patients have been with their hospital experience. You can learn whether doctors and nurses communicate well, if the area around a patient room is noisy at night, if the bathrooms are always clean and the percentage of patients who would rate their hospital 9 or 10 on a 10-point scale. Should consumers rely on these numbers?  What do they say and don’t say?

I posed these questions to Mark Schlesinger, a professor of public health at Yale who researches medical consumerism and health quality measurement. I also wanted to know what satisfaction measures were specifically focused on eye surgery. “They don’t exist,” Schlesinger said and went on to explain that this was partly due to some ongoing tension among researchers.

One group of researchers believes consumers of health care have a limited ability to process information and need a bunch of measures rolled into one giving an aggregate score that’s easy to grasp. This group believes that the public can process one score, but not ten or fifteen. The other group of researchers argues that patients need more precise information—data that would reflect their experiences with specific procedures like cataract surgery. “The whole quality movement is stuck on this debate right now,” he said.

Stuck or not, knowing that the academic community is deadlocked hardly helps. There was no overall patient satisfaction score that would point me to the best hospital among the four I was considering for cataract surgery. That left me with some quality measures that did show differences, but they, too, weren’t particular to my problem. “If that’s the case,” I asked Schlesinger, “should I care about patient satisfaction scores?”

He offered up even more ambiguity: “We don’t know the main drivers of consumer satisfaction for either health plans or hospitals.” For doctors, though, “It’s almost always how well they communicate that is the main determinant of patient satisfaction. A doctor’s communication skills drive 95 percent of consumer satisfaction,” he explained. Intangibles — humane treatment, caring, and compassion — are powerful emotional aspects of a medical experience.

Thinking that communication might also be important in a hospital, I reexamined the Hospital Compare data that seemed most closely related to these skills. These ratings included: how well staff explained medicines before giving them, how quickly patients received help, getting recovery instructions when discharged, and how well nurses and doctors communicated with patients.

Although all of these measures seemed to resemble the indicators Schlesinger mentioned, the last one was ambiguous to me. Did it rate the communication with hospital doctors like residents and interns, or did it evaluate whether a patient’s own doctor would come to the hospital to check on them?

Hospital Compare showed that there were differences in patient satisfaction ratings among some of the New York City hospitals I was considering, but were they really meaningful differences?  At New York Eye and Ear, 81 percent of patients said doctors always communicated well, at New York-Presbyterian, 79 percent did, and at Lenox Hill, the number was 78. Not much difference. Schlesinger advised looking for outliers — hospitals that had either very low or very high scores.

New York Eye and Ear ranked highest among the three hospitals on three of the five other measures I examined. New York Presbyterian was highest on two. Lenox Hill scored the lowest on four dimensions. Only 51 percent of Lenox Hill respondents reported that they always got the help they needed when they called for it. At New York Eye and Ear, 67 percent said they did. That seemed like a meaningful difference indicating that perhaps not enough nurses were around. Or it could mean in New York City, where patients tend to be more demanding, respondents were just more persnickety. For overall satisfaction, 58 percent graded Lenox Hill a 9 or a 10, while 68 percent gave the same grade to New York Eye and Ear.

Should I avoid Lenox Hill? Schlesinger said the difference between 58 and 68 could be meaningful, but he cautioned: “Patients are responsive to amenities like food, quiet rooms and friendly nurses. It might be a meaningful difference in amenities rather than quality.” After all my research, it seems that having access to patient satisfaction data is not sufficient to direct us to the best hospital. Making informed “consumer” choices about our providers of health care still remains out of our reach.

Trudy Lieberman is a journalist and an adjunct associate professor of public health at Hunter College in New York City. She blogs regularly on the Prepared Patient Forum.

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  • http://www.facebook.com/hcberkowitz Howard C. Berkowitz

    When I filled out patient satisfaction questionnaires for a couple of hospitalizations this year, there were questions as to whether the physicians and nurses communicated with me in a manner that I could understand. It was left for the comment section for me to express some frustration with nurses who didn’t understand relevant historical, or even pharmacologic, information that I was trying to give them. I needed some post-discharge assistance in dressing changes to a site that I could not easily reach, but the visiting nurses were adamant that they needed to sight-verify my medications, write a care plan to be approved by a physician, and “educate me about my disease”. The nurses were not amused, in sampling my “educational needs”, to find I wondered about some competing arguments about chemotactic recruitment of eplthelial precursor cells.

  • southerndoc1

    It’s not unusual in any community to find that a significant number of doctors are on staff at both the highest and lowest rated hospitals, but one has “good” docs and the other has “bad” docs.

  • Linda Ringquist

    Patient satisfaction nor any one single factor should be the end all be all for choosing facilities. Many factors can play into the patient satisfaction surveys. Some people just “Christmas tree” the survey to complete it quicker. Patient satisfaction is related to grading as “excellent”. Would you rather have choose care that received 95% very good/excellent or 95% good/excellent/not good? I think the surveys should also include the percentage that graded the organization as very good. I also think the notes under the accrediting bodies should be considered such as TJC.
    Linda Ringquist – BHM Healthcare Solutions http://www.bhmpc.com

  • wiseword

    When I needed cataract surgery, I chose NY Eye and Ear because (1) it was where the ophthalmologist I went to practiced (she was recommended by the eyeglass store and I liked her immediately; and (2) New York scuttlebutt says it’s the best place. So much for scientific analysis.

  • Observer1960

    Patient Satisfaction surveys are absurd. We are coached to tell patients “For your privacy, I am closing the curtain” or “I am here answering your call light for your care” or “housekeeping will be here shortly to make sure your room is clean”. After d/c, the patient is sent their survery “Was your privacy honored by closing the curtains?” “Did you feel cared for by staff?” “Was your room cleaned?”

    Robotic communication by staff to facilitate robotic answers by patients (excuse me, guests).

    The only point I see in this is to up the stats towards better pt satisfaction surveys for the hospital’s media/pr department.

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