Pa­tient sat­is­fac­tion sur­veys of­fer in­sight into full scope of care

Modern Healthcare - - COMMENT -

I can’t be­lieve we’re still bash­ing pa­tient sat­is­fac­tion as a valid com­po­nent—and mea­sure—of health­care. A June 20 let­ter (“Tread care­fully on mea­sures of pa­tient sat­is­fac­tion,” p. 26) crit­i­cizes sat­is­fac­tion sur­veys for fo­cus­ing on trivia (“a hos­pi­tal is not a ho­tel nor a theme park”); en­cour­ag­ing docs to pre­scribe in­ap­pro­pri­ate or harm­ful meds to earn good scores; and yield­ing sub­jec­tive data that don’t al­ways mir­ror tech­ni­cal clin­i­cal mea­sures.

Enough of th­ese as­sump­tions and opin­ions. Let’s fo­cus on facts:

■ The HCAHPS sur­vey (on which CMS re­im­burse­ment is par­tially based) mea­sures com­mu­ni­ca­tion and empa- thy. There is not a sin­gle amenity or “ser­vice” item. Pa­tients would much rather have good in­for­ma­tion about what’s be­ing done to them than 600thread-count sheets.

■ While there ap­pears to be a na­tional ten­dency to over­pre­scribe some meds and tests, there is no em­pir­i­cal ev­i­dence link­ing such prac­tices largely to docs’ de­sire to achieve good pa­tient sat­is­fac­tion scores.

■ Of course pa­tient sat­is­fac­tion rat­ings are sub­jec­tive. That’s be­cause a ma­jor com­po­nent of “care” is sub­jec­tive. Com­mu­ni­ca­tion about the ill­ness, its treat­ment and af­ter­math; and em­pa­thy and ac­com­mo­da­tion for the stress, dis­com­fort and vul­ner­a­bil­ity caused by the med­i­cal is­sue and hos­pi­tal­iza­tion—th­ese sub­jec­tive as­pects of care go un­rec­og­nized in clin­i­cal process and out­come mea­sures. Thus, the dis­con­nect be­tween pa­tient sat­is­fac­tion and tech­ni­cal mea­sures should not be sur­pris­ing. They re­flect dif­fer­ent as­pects of care and re­quire dis­tinct con­cerns and com­pe­ten­cies (which are clearly still in short sup­ply).

The sooner we stop sur­vey-bash­ing, the sooner we can pay nec­es­sary at­ten­tion to the full con­tent of care—not just the tech­ni­cal part.

Ir­win Press, Ph.D. Ad­junct fac­ulty, Rush Uni­ver­sity Med­i­cal Cen­ter Chicago Co-founder, Press Ganey In­di­anapo­lis

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