Don’t mistake patient satisfaction for patient-centeredness

As a new physician, I find myself besieged by data about how happy patients are with the care we deliver. Press Ganey, HCAPS, Consumer Reports, US News and World Report were merely the beginning.

Now, physician reimbursement is tied to how happy patients are after facing and overcoming, at times, life-threatening illnesses in our hospitals. Given the financial incentive, hospitals across the country are seeking the aid of companies like Disney: well-known for providing memorable, enjoyable escapes from reality through unparalleled customer service. I will readily admit that as the son of a physician who practiced a Marcus Welby-style of medicine that existed more on television than in reality, I find it ironic that the medical community is now looking to the entertainment industry to guide our movement to improve the patient.

But is patient satisfaction synonymous with the patient-centeredness that experts like Don Berwick desire? I contend that it isn’t. I could bore you with the multiplicity of anecdotes that reveal a system fixated in certain segments on distraction from the care provided rather than developing innovative ways to make that care better. These actions make patients more comfortable, more empowered, and more informed but not necessarily healthier.

Recently, a nurse described to me the duties she completed in caring for her patients during a overnight shift. Four peanut butter and jelly sandwiches prepared, 3 cups of grape juice delivered, 2 cups of coffee poured for visitors, 3 garbage cans emptied, 1 pillow fluffed, and 4 TV remotes fixed. Amidst this shift, she was also asked to provide an abundance of narcotics and sleeping aids.

She was measured not on the fundamental question of what have we have done today to make our patients healthier tomorrow. Instead, nurses and doctors are increasingly measured on things that are tied to metrics of patient satisfaction. Namely, how long are you in the patient’s room, how long does it take to deliver requested medications, and how accurately do we document the myriad of quality metrics that have variable support for improving care delivery. (Have you given your patient a “golden ticket” to signify that you educated them about their new medications started on the current admission — performed at 2 a.m.) The question in this scenario we don’t ask is the one that matters most: Is the patient getting better?

Now, is there a need for customer service to be a part of good, high quality patient care? Absolutely. Are the goals of patient-centeredness important? Yes. But our preeminent job as clinicians and as a health care system is to make people well, not just happy. A recent study found that, in fact, patient satisfaction scores are not linked to higher quality care. Moreover, this analysis showed that while higher patient satisfaction led to less ED use, it also led to higher costs, more inpatient admissions, and higher rates of mortality.

I’m not here to say that patient satisfaction is not important, only to say that I’d prefer to make patients happy and healthy. So, maybe we need to look to models other than the dreamworld that is Disney.

Stanley Frencher, Jr. is a urologist who blogs at Policy Prescriptions.

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  • JR

    “These actions make patients more comfortable, more empowered, and more informed but not necessarily healthier.”

    This statement makes me think about things other than “nice drapes” or “providing coffee to family”. It makes me think you are talking about measures to improve mental health outcomes in patients at the hospital.

    Being informed about what is happening, what to expect, what the treatment plan is, all helps the patient feel safe. Being empowered to contribute to decisions regarding the treatment plan helps them feel like they retain some measure of control. These are both ways to reduce negative mental health outcomes of those staying in the hospital. They aren’t just empty gestures.

    I know people who’s negative experiences with medical care has left them refusing to even go get routine medical care, or refusing to go to a doctor until they simply can’t live with their medical condition anymore. Their physical health is definitely impacted by their negative experiences from the past. I hear anecdotes about these kinds of patients all the time, the “stubborn old fool” who didn’t come in until it’s too late.

    For many patients, feeling empowered to be a part of their treatment, knowing who people are, knowing what to expect, having their modesty protected – all these things reduce fear and anxiety which can help improve physical outcomes, as well as helping the patient not fear getting medical care the next time it’s needed.

    This is why “patient satisfaction” matters – it may not impact their health the day they are discharged, but it impacts their mental health during recovery, and their view of the health system going forward.

  • saurabh jha

    Great post. You’ve identified the crux of the problem which is that was is desirable is not always measurable, and what is measurable is not always desirable.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    The buzz about patient satisfaction is relatively new on the scene. It is a step in the right direction, but yet has many bugs to work out. Patient satisfaction does focus on the key role of communication. However we need more specifics. For example, we talk about discussing “communicating about medications.” What exactly do we say about meds? Dosages? Alternative med names? Side effects? Who explains the meds? Doctors? Nurses? Other professionals? Hospitals & practices need to determine exactly what is communicated and who communicates the specific components.