To Cure the Patient, Treat the Whole Person

Starting in October, scores from a government-mandated patient satisfaction survey will determine a portion of hospitals’ Medicare payments, and many organizations are worried about the financial fallout. A recent study published in the prestigious Archives of Internal Medicine posited that higher patient satisfaction scores correlate with greater use of hospital services and higher mortality. Some healthcare professionals have jumped on that assertion as proof that because good clinical treatment can be painful and traumatic, patient satisfaction is ipso facto a faulty gauge of who gets the best care.

With over 30 years of experience working with physicians and nurses in organizations that provide direct care to patients and having recently joined Press Ganey, an organization with over 25 years of experience in measuring, reporting and driving improvement in the patient experience of care, my company and I hold a far different point of view. There exists a large and long-established body of research, published in equally prestigious journals, that finds patients are actually quite accurate judges of health care quality. The skeptics also forget that it was hospitals that first began surveying patients on their care experiences back in the 1970s. Hospital leaders knew back then – as thousands of medical providers know today – that respected and empowered patients are more willing to be active participants in their care and also have better outcomes.

Before addressing the skeptics’ arguments, let’s set aside the straw man in the debate: Those who advocate for service excellence in medical care are not talking about making the experience akin to that of a hotel, but rather about removing defects in care that lead to avoidable suffering. Survey questions that ask the patient to evaluate time spent with clinicians, the frequency of communication and care coordination among nurses and doctors, and the safety and cleanliness of the care setting, are all about evaluating quality of care.

Now, on to the Archives of Internal Medicine study, conducted by a research team at the University of California-Davis. The study finding – that higher patient satisfaction scores correlate with higher costs and more patient deaths – was more than surprising to those who passionately advocate for patients. That’s because it was 180 degrees away from previous research, including:

  • A Duke University study, published in the American Journal of Managed Care last year, found that higher hospital patient satisfaction scores were strongly associated with lower 30-day hospital readmission rates for heart attacks and pneumonia. An earlier report by the same team of a smaller cohort of hospitals found a correlation between higher patient satisfaction and lower inpatient mortality rates for the same conditions.
  • A major study in the New England Journal of Medicine in 2008 of clinical data from 2,429 hospitals found a strong positive correlation between patient overall satisfaction and clinical performance.
  • A 2007 analysis of data from the Pennsylvania Health Care Cost Containment Council and my company found that facilities in that state with higher patient satisfaction scores on room cleanliness, technicians’ blood-drawing skills and nurse responsiveness to patient concerns tended to have lower rates of infections and infection mortality.
  • Three research articles published from 1996 to 2002 in the Journal of Pain and Symptom Management showed that patients are satisfied with their care even though they are in pain.

Those and other studies led us to look more closely at the recent UC-Davis research. We found its conclusions and inferences controversial. It only examined patient evaluations of physicians, rather than hospitals, which made the link between satisfaction and hospital deaths not credible.

The patient satisfaction survey tool used by the UC-Davis team asked patients to rate their primary care physician over an entire year as well as the care they received from all providers in all settings. A more accurate means of establishing a relationship between patient satisfaction and care quality is obtained through surveys that are sent to patients within 12 weeks of discharge asking the specifics of each encounter.

Put into everyday language, these findings tell us that that there is a difference between simply doing something – treating the condition – and doing it in a way that meets the other needs of the patient, such as being treated as a person, acknowledging pain and letting the patient know everything possible is being done to help. Health care providers are expected to cure the illness; they excel when they also treat the patient as a human being.