Critics point out issues in patient satisfaction ratings

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On the heels of a government proposal to tie hospital incentive payments to patient satisfaction ratings, a few outlets have started looking at the validity of such measurements.

At HealthLeaders Media, Cheryl Clark reports that regional differences in tendency to be satisfied (the numbers show that New Yorkers are harder to please than Midwesterners and New Englanders, for instance) mean that any absolute number thresholds issued by the feds would penalize hospitals in parts of the country where folks are less likely to respond well to surveys.

And on KevinMD.com, William Sullivan, D.O., J.D., takes a few swings of his own, first taking aim at the ratings’  sampling and statistical grounding, then moving on to what he says is hospitals’ over-reliance on percentile quality ratings.

The problem, according to Sullivan? Overall patient satisfaction is quite high, thus doctors’ ratings cluster tightly around the low 90s on a 100-point scale. That means even a small shift in absolute rating will cause a huge jump in percentile. On at least one system, a 4-percentage-point absolute drop will take a doctor from the 90th percentile to the 50th. And, thanks to the aforementioned sampling issues, that drop can be caused by a handful of particularly ornery patients. Patients who, Sullivan writes, are thus given massive leverage.

With our employment and our compensation hinging on every “5” we can get, doctors are being coerced into giving patients whatever they want, regardless of medical appropriateness. When we cater to satisfaction scores more than we cater to proper medical care, we are violating our oath, devaluing our education, and potentially harming our patients.

AHCJ Resource:Analyze patient satisfaction surveys for your local hospitals

“Numbers can be a start – not the end – of a story,” the AHCJ website notes. Remember that patient satisfaction scores only mean so much. Sometimes the best doctors have gruff demeanors while those with inferior skills have great bedside manners. Patients may not recommend hospitals to friends because they dislike the food or think their roommates were too loud.  But if patients report that doctors or nurses didn’t communicate well, that very well could affect the care the patients received. Using data can give you a valuable tip sheet to generate ideas and questions in your pursuit of a story.

For hospital overall survey results, AHCJ includes comparison of data first released in March 2008 then updated quarterly, allowing journalists to compare overall survey results over a lengthy timeline.

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