I read a very interesting article this week “ Satisfied patients are dead ones” By Dr Brian Goldman. It spoke about how hospitals put the idea of patient satisfaction first. The article went on to say that patient outcomes are not determined by patient satisfaction. I remember when we did patient satisfaction surveys in ICU and patients would talk about the food and the noise, I’d think, “You have just been on triple inotropes and a ventilator for a week and you complain about the food.?” But I never thought any more about it. I just thought the powers that be knew what they were talking about and patient satisfaction surveys were important. And they are, in the right context.
But they are not an indicator of patient outcomes, or of the quality of the care given, they are just an indicator of what patients think is important in their stay. The article went on to say that satisfied patients can be dead patients and there is no correlation between satisfaction and good patient outcomes. A survey done by Hospital Compare in the states compared patient experiences in nearly 3500 hospitals. They were rated on a five star system, of the 251 hospitals that achieved five stars 213 were “tiny” hospitals fewer than 100 beds. To me this is obvious. Small hospitals can deliver the things that patients see as important, good food, consistent staff, on time appointments, a feeling of belonging.
Patients can’t and don’t measure the knowledge that a Dr was updated on a lab result which meant you were delivered a life saving medication, or a nurse reported abnormal vital signs which meant you received a life saving treatment. They don’t know if your hospital provides enough nurses to care for patients with complex needs, or if they meet with industry standards. The issue is fraught with unanswered questions. Funding in US hospitals is being linked to patient satisfaction surveys. Bonuses in some US hospitals are linked to patient satisfaction surveys. Consider this, clinicians may be inclined to do or give a patient something to make them happy, or conversely to be reluctant to deliver bad news that may make a patient unhappy. Until we link positive patient outcomes to patient satisfaction surveys and look at the whole of hospital experience including the rate of adverse events putting all of our faith in patient satisfaction surveys is a red herring.