Patient Satisfaction Surveys: Negative Effects on Health Care Delivery
John C. Pope, IV, MD1, Anne G. Dudley, MD2, John W. Brock, III, MD1, Mark C. Adams, MD1, John C. Thomas, MD1, Stacy T. Tanaka, MD1, Abby S. Taylor, MD1, Douglass B. Clayton, MD1, Chevis N. Shannon, MBA, MPH, DrPH1.
1Monroe Carell Jr Children's Hospital at Vanderbillt, Nashville, TN, USA, 2Connecticut Children's Medical Center, Hartford, CT, USA.
BACKGROUND: Patient satisfaction surveys have been increasingly utilized as a metric to determine patient satisfaction with the health care they receive from their provider. This is significant in today’s environment as patient satisfaction has been recently linked to payment. Many studies, however, have failed to show a relationship between the current measurement of patient satisfaction and the quality of health care delivered. We hypothesized that increasing pressure to receive good reviews has led providers to alter their delivery of healthcare to accommodate patient demands/expectations rather than providing practical and standard care. METHODS: A 13-question RedCap survey was developed and emailed anonymously to participants. Sixty-two providers across all surgical subspecialties at our children’s hospital were asked to voluntarily complete the online questionnaire. Questions regarding the impact of patient satisfaction or dissatisfaction on clinical practice were included. Additionally respondents had the opportunity to provide feedback through open ended questions. The Delphi method was used to acquire general consensus and descriptive statistics, including frequencies, were conducted. RESULTS: Response rate 42/62 (68%). 41 (97%) participants were familiar with the patient satisfaction metrics. 25 (60%) of respondents follow their online reviews. 23 (55%) stated that they have changed their clinical practice patterns due to concerns regarding patient dissatisfaction while 18 (43 %) stated they have made no such changes. Examples of such changes include: requesting imaging tests, blood work, or other laboratory studies; performing operative or anesthetic procedures; referring to alternative specialist/second opinion; giving a prescription for medication. Only 2.5% felt that these interventions led to any significant change in outcome or management of the patient’s condition. Forty percent of providers who altered their practice felt time constraints often led them to intervene unnecessarily. Several expressed the concern that unhappy patients are more likely to fill out the surveys and that the surveys are often quite cumbersome to complete, thus leading patients with no displeasure to simply ignore and not complete the survey. These factors would introduce inherent bias into the reviews. Other factors outside the providers’ control (scheduling problems, parking availability and ease of access, wait times, insurance issues, etc) determine patient satisfaction other than their actual experience with the provider yet the review is tied only to the provider. A dichotomy appears to exist between patient expectations regarding time spent with the provider and the actual amount of time the provider has to spend with them. CONCLUSIONS: A significant number of providers are altering their clinical practice for the sole purpose of meeting sometimes unrealistic patient expectations in the name of patient satisfaction even when not indicated as part of standard care. Concerned that poor patient reviews will harm their practice, providers are succumbing to patient demands and performing unnecessary interventions. For an instrument that has not been proven to improve the quality of health care, utilizing patient satisfaction surveys seems counterproductive to containing healthcare costs and avoiding physician burnout.
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