November 20, 2013
Today's healthcare providers and companies alike are facing a question they've never had to confront before: Are patients happy? Logically, practitioners have generally focused more on outcomes and quality of care, such as the rates of post-procedure complications, readmissions, and morbidity and mortality.
Now, more healthcare providers find themselves analyzing marketing and survey results, as issues like "net promoter scores" are becoming part and parcel of every practice. These issues have an added importance because, for the first time, they will affect a hospital's bottom line. Starting in FY2013, the US Centers for Medicare and Medicaid Services (CMS) set reimbursements based in part on a 32-question survey aimed at patient satisfaction, with a reduction in revenue of up to 1 percent and increasing up to 2 percent in FY2017 as more emphasis is placed on the survey results.
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The CMS surveys ask the same questions the agency has asked for years: How well did nurses and doctors communicate? How clean was the facility? How well was your pain managed? How did they prepare you for leaving the hospital?
But do these questions of satisfaction result in better outcomes? The answer is mixed. Many studies have shown no clear correlation between satisfaction scores and patient outcomes. In fact, Thomas Jefferson University health economist Robert Liebenthal found that answers to the CMS questions have no relation to health quality. Moreover, larger hospitals with higher quality scores tended to have lower patient satisfaction scores (based on the CMS questions).
Perhaps the questions of satisfaction, then, are too broad (it's difficult to quantify the difference between "always" and "usually" communicating, for example). But other studies indicate that some correlations do exist between satisfaction and quality/outcomes.
A recent Johns Hopkins University study also found that patient satisfaction didn't translate into overall quality of care. But there was one caveat discovered by the Hopkins team: If employees work better as a team, that teamwork can translate into patient satisfaction (and, one would assume, outcomes). A happier staff, working well together, may make it easier to speak out if somebody misses something, so issues get corrected when they should.
Earlier studies also found that satisfaction was in fact tied to nursing levels. Higher ratings on clean facilities, ability to draw blood, and how well nurses responded to queries and issues were correlated with fewer hospital-acquired infections and mortality, both important quality scores. Yet another study connected patient involvement in decision making with better outcomes.
So, the initial conclusion from these studies -- that there's no relationship between satisfaction and outcomes -- becomes murkier when asking different, more probing questions. Healthcare quality isn't just about a clean lobby and patients who feel "happy." Instead, it's the result of a cooperative staff culture, involvement of the patient in decision-making, and more interactive communications. While maintaining a productive, cooperative hospital culture is important, some technology solutions can help improve key satisfaction and outcome scores. Hospitals, for example, could design interactive surveys during the patient's stay, so an intervention could correct any issues before the patient is discharged.
Surveys like these can help patients and providers communicate, which can be a challenge in today's hospital environment. As a physician, I can often feel pinched by time constraints. And patients themselves can also be overloaded with forms and instructions. I've found myself repeating information or instructions if something's important in an effort to make it stick, because I know my patient may be overwhelmed!
As the impact of the Affordable Care Act, patient-centered care, and the increased influence of patient opinion begin to change how healthcare is managed, we are starting to see some solutions take shape. A number of medical technology companies, for example, are creating software packages that can identify either patient satisfaction issues or events that could impact outcomes. Clinical decision support software could alert staff and clinicians if standards of care are not being followed during the patient's stay. Fortunately, research is starting to show that all the goals of healthcare -- quality, satisfaction, and efficiency -- can be achieved simultaneously.
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