A paper in JAMA Surgery noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital. The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires. They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor the opinions of employees about the culture of the institution for half the categories questioned.

They concluded that “patient satisfaction may provide information about a hospital’s ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.”

What about patient satisfaction and the quality of medical care provided by doctors?

This is only an anecdote, but it does say volumes about the subject. In April, a New York area cardiologist admitted to defrauding government and private insurers of $19 million. This was described as the largest healthcare scam by a single physician ever recorded in New York or New Jersey. Thousands of patients underwent unnecessary and possibly dangerous tests and treatments.

He also employed unlicensed and unqualified personnel who treated patients. As noted by Dan Diamond, managing editor of the Daily Briefing, the Healthgrades patient satisfaction scores for Dr. Katz ranged from very good to excellent. In fact, Dr. Katz has received not one … not two … but three Healthgrades Quality Awards still in evidence on their website, which also reports no sanctions against him. I guess $19 million worth of fraud is not enough to impact one’s Healthgrades ratings.

Although these next two vignettes are about customer satisfaction and have nothing to do with patients, they further illustrate the folly of basing one’s opinion on satisfaction scores alone.

According to the Consumerist blog, a subsidiary of Consumer Reports, certain well-known companies have based employee pay raises and promotions on the results of customer satisfaction surveys:

Apparently, the companies considered anything less than a perfect 5 rating as failure. This resulted in employees telling patrons to either give them a 5 rating or — if they could not do so — to decline to take the survey. A friend said that when he takes his car to the dealer for service, they tell him they will be sending him a survey in the mail. Then they say if he can’t give them all 5s, he should skip the survey, and instead call and speak to the manager so they can do better next time.

I have seen this phenomenon in hospitals too. Personnel are coached about what to say to patients to help persuade them to give higher scores. I think it’s called “gaming the system.” How much weight can we really put on patient satisfaction surveys?

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.