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Could Satisfaction Surveys Be Harming Patient Care?

SurveysA couple of weeks ago, I posted a survey about patient satisfaction surveys. To this point, 642 people responded to the survey, which is outstanding.

Some of the responses were surprising. I’m getting the impression that the surveys really are more about satisFICTION that satisfaction, but you can judge for yourselves.

Health care providers
Of the health care providers that responded to the survey, 82% of their hospitals/employers/practices collected patient satisfaction data.
57% of those collecting data used a paid service such as Press Ganey or Rand. 23% used in-house surveys.
More than two thirds of respondents did not know their survey response rate. Of those that did know, most had a response rate between 2% and 10%.
65% of respondents said that their satisfaction scores correlated below average or poorly with the opinions of the patients they treat.
Regarding treatment, more than 40% of respondents had altered treatment due to the potential for a negative patient satisfaction survey. Of those that altered treatment, 67% gave treatment that was probably not medically necessary more than half of the time. Eleven percent of respondents described adverse outcomes from performing such treatment, including kidney damage from IV dye, allergic reactions to medications, hospital admits for “oversedation” with pain medications, and Clostridium difficile diarrhea.
Because of the effects of patient satisfaction surveys, more than 25% of respondents performed testing and gave medications that were probably not indicated, 18% admitted patients who probably did not require admission, and 20% wrote work notes for patients that were probably not warranted. Others mentioned that they did not perform patient education that they feared would anger patients and that they spent “prolonged” amounts of time in rooms selling a treatment plan.
More than 75% of respondents felt that patient satisfaction scores decreased the quality of care that they provided and nearly 90% of respondents believed that patient satisfaction scores decreased the efficiency with which they were able to evaluate and treat patients. More than half stated that patient satisfaction scores increased the amount of testing they performed.
Eighty one percent of medical providers were aware of instances in which patients intentionally provided inaccurate derogatory information on a satisfaction survey and 84% felt that patients used the threat of negative satisfaction surveys to obtain inappropriate medical care.
Nearly one in eight respondents had their employment threatened due to low patient satisfaction scores.

Administrators
Administrators seemed to agree that patient satisfaction scores do not correlate well with general opinions of patients treated in their facilities. All administrators answering the question rated the reliability of patient satisfaction scores from average to below average. The importance of satisfaction scores varied. 25% felt that scores were very important while 75% felt that scores were mildly to moderately unimportant. Administrators seemed to feel that satisfaction scores had little effect on efficiency or amount of testing performed. However, in contrast to answers given by the providers, a vast majority of administrators felt that the effect of patient satisfaction scores made it significantly less likely that providers would render inappropriate medical treatment.
All administrators wanted their percentage/percentile of “excellent” scores on satisfaction surveys to be 90% or greater.
Only one administrator would discount or ignore low survey scores from specific patients and only one administrator reviewed the medical records of patients who provided low satisfaction scores.

Patients
More than half of patients responding to this survey did not fill out satisfaction surveys after visiting a hospital or medical practice.
Of those that did complete surveys, 70% did so to provide complimentary information, 23% did so to complain about care received or a specific provider, and about 7% did so to provide suggestions for improvement. 73% never received follow up after completing a satisfaction survey despite the fact that nearly 60% expressed a desire for feedback.
Of the patients that did not complete satisfaction surveys, 40% stated that the facilities they visit do not offer them. 18% felt that surveys were a waste of time. 21% did not believe that anyone would act upon their responses. Many other respondents noted that they felt the surveys were irrelevant to the care they received and that they find it “insulting” for medical professionals to be graded on their medical care by laymen knowing little about medicine.

The responses about what question respondents would add to a satisfaction survey were quite insightful. Many advocated for shorter surveys. Several suggested asking about the one best experience and one worst experience they had at the facility. One suggested asking whether the amount of money charged was worth the care received. Several asked about the one thing a facility could do to improve. Many asked about the effectiveness of the communications.
There always have to be some smart asses in the crowd. One suggested a question asking why “the porridge-bird lays his egg in the air.” I’ll leave that one to all of you to figure out.

Probably the biggest surprise to me was the number of medical providers who stated that patient satisfaction surveys caused them to provide inappropriate medical care while administrators seemed to believe that just the opposite would occur. I also found it statistically interesting that all administrators wanted their facilities to be in the 90% or above club when only 10% of a given survey population can ever be in the 90th percentile.

I plan to leave the survey open for another week or so to see whether any extra responses are generated by this post. If you haven’t completed the questions, please give them a look. It shouldn’t take more than 5 minutes.

The survey is at this link on www.esurveyspro.com

Once the survey is closed, I’ll analyze the data a little further and see whether EP Monthly will publish the results. If not, I’ll post a .pdf of the results for everyone to download.

Thanks again for participating!

3 Responses to “Could Satisfaction Surveys Be Harming Patient Care?”

  1. Doctor D says:

    I’m sure Michael Jackson would have given Dr. Murray glowing reviews on patient satisfaction surveys. Desire to please is what made Dr. Murray kill MJ.

    We should always care about our patients, but healthcare isn’t retail. The customer ain’t always right.

  2. paul says:

    my hospital is part of a health system that is obsessed with press-ganey.

    recently (about 6 months ago?) two local hospitals closed and our volume shot up. with longer wait times and a new patient population that is generally more hostile and demanding… i suddenly became a worse doctor. at least according to press-ganey. i was scolded for my worsening scores.

    then, a couple of months ago, they took the question of satisfaction with wait time for consultant to come in off the survey… and i suddenly became a better doctor. at least according to press-ganey. i was commended for my improved scores.

    each time they tell me about my scores i smile, nod, and change nothing about the way i practice. what a joke.

  3. David Wagner says:

    Press Ganey surveys have definitely affected my practice. I order more tests. I feel pressured to prescribe narcotics liberally and sometimes inappropriatly. When patients want antibiotics inappropriately, I’m more likely to acquiesce. I feel more impetus to make patients happy than to make them well. I’m reluctant to address uncomfortable subjects with patients for fear of a bad survey. I’m very threatened by bad patient encounters, whether my fault or not. And my facility expects 90%ile and my job is directly and openly jeopardized by lower scores.

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