Don’t down­play pa­tient sat­is­fac­tion

Modern Healthcare - - COMMENT - By Ir­win Press Ir­win Press is co-founder of Press Ganey, pro­fes­sor emer­i­tus of the Univer­sity of Notre Dame and ad­junct fac­ulty at Rush Univer­sity’s depart­ment of health sys­tems man­age­ment.

Al­though var­i­ous stud­ies note some cor­re­la­tion be­tween clin­i­cal qual­ity mea­sures and pa­tient sat­is­fac­tion, oth­ers stress the lack of a con­sis­tent, close sta­tis­ti­cal re­la­tion­ship be­tween them. Such “dis­crep­an­cies” are de­tailed in what of­ten ap­pears to be a cam­paign to cast doubt on the pa­tient’s ex­pe­ri­ence as a rel­e­vant in­di­ca­tor of qual­ity care.

This raises an im­por­tant ques­tion: Must there be a one-to-one cor­re­la­tion be­tween the tech­ni­cal de­liv­ery and per­sonal ex­pe­ri­ence of care? An even more im­por­tant ques­tion: How should we de­fine “care”?

It can be ar­gued that di­ag­nos­tic pro­ce­dures, surg­eries and ther­a­pies con­sti­tute treat­ment, but not care. Treat­ment alone isn’t care.

“Care” would be de­scribed as the treat­ment and the in­ter­per­sonal con­text in which treat­ment is de­liv­ered. This “con­text” de­fines the ex­pe­ri­ence. It in­cludes em­pa­thy and be­hav­iors that ad­dress the emo­tional, in­for­ma­tional, so­cial, cul­tural and eco­nomic is­sues that ac­com­pany sick­ness and its treat­ment.

Treat­ment and ex­pe­ri­ence are dif­fer­ent as­pects of care. One is ob­jec­tive, in­volv­ing highly stan­dard­ized tech­ni­cal, me­chan­i­cal or chemical in­ter­ven­tions. The other is sub­jec­tive, com­posed of be­hav­iors, de­ci­sions and in­ter­ac­tions of hu­mans with idio­syn­cratic per­son­al­i­ties, stresses, agen­das and sen­si­tiv­i­ties. Pro­vid­ing treat­ment and man­ag­ing the per­sonal ex­pe­ri­ence of care re­quire dis­tinct com­pe­ten­cies. Ideally, of course, we would want tech­ni­cal qual­ity and ex­pe­ri­ence qual­ity to be a sin­gle en­tity. Maybe they will, some day.

Un­til that day, it should not be sur­pris­ing that a hospi­tal with a great rep­u­ta­tion, high core mea­sures and good out­comes might have lower-than-aver­age pa­tient-sat­is­fac­tion scores. Or that an in­sti­tu­tion with higher mor­tal­ity or poor core mea­sures might pro­vide a pos­i­tive ex­pe­ri­ence for pa­tients.

In ei­ther case, care is in­com­plete and of lower qual­ity.

Such “dis­crep­an­cies” should in no way cast doubt on the rel­e­vance of the pa­tient’s ex­pe­ri­ence as both a valid com­po­nent and in­di­ca­tor of qual­ity care. Rather, any dis­con­nect that we cur­rently have be­tween the two qual­ity in­di­ca­tors re­flects a jour­ney still in­com­plete. Let’s fo­cus less on bash­ing pa­tient-sat­is­fac­tion mea­sures and more on try­ing to fig­ure out how to make con­cern for the pa­tient’s ex­pe­ri­ence an in­te­gral part of all treat­ment, so that the qual­ity of one au­to­mat­i­cally re­flects the qual­ity of the other and the process of care be­comes truly uni­fied.

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