Validity as a metric for evaluating health care quality
Because patients may be dissatisfied with health care which improves their health or satisfied with health care which does not, there are circumstances in which patient satisfaction is not a valid indicator of health care quality even though it is often used as such.
Factors influencing patient satisfaction
Patients' satisfaction with an encounter with health care service is mainly dependent on the duration and efficiency of care, and how empathetic and communicative the health care providers are. It is favored by a good doctor-patient relationship. Also, patients who are well-informed of the necessary procedures in a clinical encounter, and the time it is expected to take, are generally more satisfied even if there is a longer waiting time. Another critical factor influencing patient satisfaction is the job satisfaction experienced by the care-provider.
A study in UK Primary Care, where there has been discussion around the linking of patient satisfaction data to funding showed that there are concerns with this due to negative correlations with both practice list size and deprivation potentially penalising some high performing practices and thus serious thought needs to be given prior to any such implementation.
In United States, hospitals whose surgery patients reported being highly satisfied also by other measures had higher quality care for their surgery. The implication of this is that patient satisfaction does not need to hinder quality care, and that both can exist together.
The Consumer Assessment of Healthcare Providers and Systems or CAHPS survey is an ongoing research project to guide the development of consumer surveys being used assess the quality of care provided by health plans, physician groups, and clinicians. It is an example of a major research effort which studies the significance of consumer responses to surveys.
By 1998 the process of measuring and reporting of patient satisfaction had become an established industry.
A concern about asking patients about the quality of their care is that patients tend to be more satisfied by attractive healthcare than by effective healthcare, and satisfaction reports may not give good information about the ability of a hospital, doctor, or treatment to improve their health. Despite these concerns, more and more research has established customer satisfaction as a valid and reliable measure of customer behaviors and organizational performance. reduced complaint behavior about their primary-care physician, and lower likelihood of terminating a relationship.
Among healthcare consumers—i.e., patients—satisfaction is best understood as a multi-attribute model with different aspects of care determining overall satisfaction. Importantly, lower performance on an attribute creates much more dissatisfaction than the satisfaction generated by higher performance on an attribute; in other words, negative performance is more consequential than positive performance. Thus, ensuring overall patient satisfaction, it is more important reduce negative performance on the patient-care dimension with the worst perceived performance than to maximize positive performance on another dimension.
- Farley, Heather; Enguidanos, Enrique R.; Coletti, Christian M.; Honigman, Leah; Mazzeo, Anthony; Pinson, Thomas B.; Reed, Kevin; Wiler, Jennifer L. (2014). "Patient Satisfaction Surveys and Quality of Care: An Information Paper". Annals of Emergency Medicine. 64: 351–357. doi:10.1016/j.annemergmed.2014.02.021. ISSN 0196-0644.
- The Farley paper cites these and others:
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- Solberg, LI; Asche, SE; Fontaine, P; Flottemesch, TJ; Pawlson, LG; Scholle, SH (January 2011). "Relationship of clinic medical home scores to quality and patient experience.". The Journal of ambulatory care management. 34 (1): 57–66. doi:10.1097/jac.0b013e3181ff6faf. PMID 21160353.
- Avery, KN; Metcalfe, C; Nicklin, J; Barham, CP; Alderson, D; Donovan, JL; Blazeby, JM (June 2006). "Satisfaction with care: an independent outcome measure in surgical oncology.". Annals of Surgical Oncology. 13 (6): 817–22. doi:10.1245/aso.2006.08.019. PMID 16614882.
- Simple Tips to Improve Patient Satisfaction By Michael Pulia. American Academy of Emergency Medicine. 2011;18(1):18–19.
- Ebbage, James T Gray, Nicola Richmond, Andrew. "Influences on patient satisfaction survey results: is there a need for a rethink?". Quality in Primary Care.
- Tsai, Thomas C.; Orav, E. John; Jha, Ashish K. (2014). "Patient Satisfaction and Quality of Surgical Care in US Hospitals". Annals of Surgery. 261: 1. doi:10.1097/SLA.0000000000000765. ISSN 0003-4932.
- Kravitz, Richard (1998). "Patient satisfaction with health care". Journal of General Internal Medicine. 13 (4): 280–282. doi:10.1046/j.1525-1497.1998.00084.x. ISSN 0884-8734.
- Falkenberg, Kai (21 January 2013). "Why Rating Your Doctor Is Bad For Your Health". forbes.com. Retrieved 3 April 2015.
- Rosenbaum, Lisa (23 July 2013). "When Doctors Tell Patients What They Don't Want to Hear". newyorker.com. Retrieved 3 April 2015.
- Otani K, Harris L, Tierney W. A paradigm shift in patient satisfaction assessment. Medical Care Research And Review [serial online]. September 2003;60(3):347-365.