Watercooler wisdom: Patient satisfaction
Dr Schuman discusses the role of patient satisfaction as a metric for assessing physician performance
“I'm just trying to keep the customers satisfied.”
My clinic is restructuring its physician compensation model, which has led to much consternation among my colleagues. Consequently, our watercooler conversations have become quite interesting. Some are concerned that our pay may decrease, while others argue that the quality measures that are being put in place cannot possibly reflect our “performance” as physicians. Creating a realistic compensation system based on “quality” as well as productivity has plagued medical practice for years. However, the process has been accelerated as our government seeks wider control over the healthcare payment system in an effort to contain costs by rewarding those practicing “cost-effective medicine.”
I was recently informed by a colleague who insisted that “patient satisfaction,” often considered a “safe” metric for assessing physician performance, should not be included in our mix of quality measures. After doing a bit of googling, I discovered he was absolutely correct. In this article, let’s review the importance of patient satisfaction in the big picture of patient care.
It's very complicated!
Physicians are not only providers of healthcare, we are patients as well. As such, we are exposed to 2 sides of our onerous healthcare system. As providers we know what we need to do to expedite diagnosis and treatment for our patients. Because we are patients, we are concerned about the cost of care. Many patients have large insurance deductibles, thanks to the Affordable Care Act, and are very sensitive to the exorbitant price of healthcare. (I recently had a father cry when I suggested ordering a magnetic resonance imaging test.)
To keep costs down, we prescribe the least-expensive medication when options are available, and perform only tests that are necessary to expedite a diagnosis. We believe in presenting options and working with patients to provide the best outcome. In other words, we treat the patient as we would like to be treated ourselves (aka, the Golden Rule of Pediatric Practice). By providing care in this manner, physicians are “satisfied” that they have done their best to care for patients. However, not all patients are “satisfied” with the care we provide.
Parents can be difficult and demanding. Some will not vaccinate, despite advice to do so. Some want antibiotics for viral illnesses, and others request seemingly endless referrals to specialists. Unless we provide what these patients want, they will never be truly pleased with the care provided. There are also patients who left the office following a well visit in good spirits, but who may be disappointed after receiving their bill. And of course, there are patients who want to lose weight but are unwilling to diet and exercise, and some patients are displeased when we try to convince them to stop smoking or remind them of the importance of taking their prescribed medication. The bottom line is that there are patients who have unreasonable expectations and will never be happy.
For decades, hospitals and healthcare systems have used patient satisfaction surveys to help improve the patient experience. The most popular of these is the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, originated by the Agency for Healthcare Research and Quality, a branch of the US Department of Health and Human Services (HHS). There are different CAHPS surveys for assessing hospitals, health plans, medical practices, home healthcare, hospice care, hemodialysis, surgical care, dental plans, Indian healthcare, and nursing home care. These surveys are administered and interpreted by organizations such as Press Ganey that use data analytics to make recommendations to institutions sponsoring the survey.