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Even More Problems With Patient Satisfaction Surveys

Author Information (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 900 page views per day, and he has over 6000 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 900 page views per day, and he has over 6000 followers on Twitter.

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The doc responsible for the largest healthcare scam by a single physician ever recorded in New York or New Jersey had Healthgrades patient satisfaction scores ranging from very good to excellent.

A paper in April’s JAMA Surgery journal noted that patient satisfaction ratings have very little to do with the quality of care provided by a hospital.

The study analyzed data from 31 hospitals that participated in patient satisfaction surveys, the CMS Surgical Care Improvement Project (SCIP), and employee safety attitudes questionnaires.

They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor the opinions of employees about the culture of the institution for half the categories questioned.

They concluded that “patient satisfaction may provide information about a hospital’s ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.”

What about patient satisfaction and the quality of medical care provided by doctors?

This is only an anecdote, but it does say volumes about the subject.

In April, a New York area cardiologist admitted to defrauding government and private insurers of $19 million. This was described as the largest healthcare scam by a single physician ever recorded in New York or New Jersey.

Thousands of patients underwent unnecessary and possibly dangerous tests and treatments. He also employed unlicensed and unqualified personnel who treated patients.

As noted by Dan Diamond, managing editor of the Daily Briefing, the Healthgrades patient satisfaction scores for Dr. Katz ranged from very good to excellent.

In fact, Dr. Katz has received not one … not two … but three Healthgrades Quality Awards still in evidence on their website, which also reports no sanctions against him. I guess $19 million worth of fraud is not enough to impact one’s Healthgrades ratings.

Although these next two vignettes are about customer satisfaction and have nothing to do with patients, they further illustrate the folly of basing one’s opinion on satisfaction scores alone.

According to the Consumerist blog, a subsidiary of Consumer Reports, certain well-known companies have based employee pay raises and promotions on the results of customer satisfaction surveys.

Apparently, the companies considered anything less than a perfect 5 rating as failure. This resulted in employees telling patrons to either give them a 5 rating or — if they could not do so — to decline to take the survey.

A friend said that when he takes his car to the dealer for service, they tell him they will be sending him a survey in the mail. Then they say if he can’t give them all 5s, he should skip the survey, and instead call and speak to the manager so they can do better next time.

I have seen this phenomenon in hospitals too. Personnel are coached about what to say to patients to help persuade them to give higher scores. I think it’s called “gaming the system.”

How much weight can we really put on patient satisfaction surveys?

For more of my thoughts on patient satisfaction surveys, click here and here.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 900 page views per day, and he has over 6,000 followers on Twitter.

8 Comments

  1. Thank you for sharing this topic in health care. Patient satisfaction must be a key factors for any hospital. But when it didn’t match we must have to configure out the whole scene. This issue also came existence with family medical doctor. Anaheim health medical center- California Urgent Care agree . Do you know that some of the rating companies offer “consulting” services?

    Reply
    • Yes, I am aware that some of the rating companies offer consulting services. I mentioned that in a blog post from 2010. If you’d like to read it, here’s the link: http://skepticalscalpel.blogspot.com/2010/08/hospital-profiling-is-healthgrades.html
      ***
      If not, this is what I said about such consulting. “It would be like a gymnastics judge charging for advice on how a gymnast could improve her score at the next Olympics. Would it not be in the best interest of the judge to have said gymnast’s score be better?”

      Reply
  2. As a solo private practice gyn oncologist, i am leery about employee satisfaction surveys. I have seen two separate unaffiliated hospitals, in two separate towns, receive the same 10th place in the nation rating by a well know pole/survey company advertised on highway posters at the same time. Surveys are more propaganda and marketing to the public than meaningful statistics. It appears to me they hospitals buy their results rather than obtain results from valid surveys.

    Reply
    • Mark, I agree. Are you aware t hat some of the rating companies offer “consulting” services? For a fee, they can tell you how to improve your scores. Seems like a bit of conflict of interest to me.

      Reply
  3. Thank you for bringing this topic. This in my view is another instrument in the hand of management(all known levels) to rain in the providers and keep them obedient and compliant. It is expensive and often oppressive. I believe that a system of privately managed health care with simple interactions between provider and patient, with available choice of providers is a much better way to maintain good level of service. However this is a lost cause. We are all going to be employed and eventually will have to organize to provide us with minimum guarantees for employment.

    Reply
    • I agree. It’s a lost cause. I doubt the docs will ever organize an effective union.

      Reply
  4. Not surprising to me that medical care is so hard to measure. Medical practice is an art, not a science. Politicians, planners, regulators and PhDs do nof know it.

    Reply
    • Sergio, good point. I agree.

      Reply

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