Challenges in Patient Experience and Satisfaction Measurement

Assurances of patient satisfaction measures of experience are mentioned throughout the Compilation of Patient Protection and Affordable Care Act (2010). For example, under Part D grants or awards are prioritized to measure the assessment of quality of care, including “patient experience and satisfaction” (page 298) and, specifically for home care, “achieving beneficiary and family caregiver satisfaction.”

 

Lack of consensus on what is included   Reflection of clinical and adherence outcomes as well as a variety of events and occurrences   Influence of survey responses: •Self-reporting accuracy •Factors not related directly to care •“Myths and Misperceptions”   Linking patient satisfaction to reimbursement   Supporting successful medical practices

Lack of consensus

As we have seen, there is a lack of consensus around a definition of, and what, comprises patient satisfaction and patient experience. Resulting from this is the variety of ways that patient satisfaction and experience is measured. It has been suggested that there are many measurement and evaluation approaches, and that getting a full picture may include mixed methods and approaches. This may support cross validation of responses. The type of measurement tool may also include considerations to the timing of the evaluation to meet specific needs and tools that can be used to evaluate practical and purposeful information. A measurement tool should reflect the domains and dimensions of the definition; in this case it will be a chosen definition.

 

Reflection of clinical and adherence outcomes

Patient satisfaction and experience does not only reflect clinical and adherence outcomes, it may reflect a wide variety of events and occurrences throughout the health incident.

 

Influence of survey responses

Many concerns about measurement of patient perspectives have been discussed in the literature. For instance, self-reporting may not always be accurate or reflect the actual quality of care. Survey responses can be influenced by factors not related directly to care, including subjective assessment of current health status and fulfillment of immediate desires, regardless of quality of care. At this point it may be appropriate to mention some potential myths and misperceptions about patient satisfaction surveys as discussed in the American Medical Association’s Journal of Ethics. The first myth is that very few patients will fill out surveys. The author suggests that response rates are actually higher for health care surveys. The second myth suggests that most people filling out surveys are unhappy with their care. However, results of surveys do not seem to back this up. The third myth is that only patients who are very happy or very unhappy will add comments. This did not bear out in a review of client responses in 2010 where as many patients giving medium ratings commented. The fourth myth is that patient satisfaction and quality are not related. While this remains controversial, there is evidence that patient satisfaction ratings go beyond a popularity contest and are able to identify the difference between friendliness and competence.

 

Linking patient satisfaction to reimbursement

Patient satisfaction generally addresses how a patient feels and their assessment of progress or attainment of their goals. Typical terminology in patient satisfaction include being pleased, happy, and satisfied. As we discussed, this can be important information for marketing purposes and can affect loyalty, referrals, and positive personal testimonies. Factors that predict patient satisfaction include provider-patient communications, symptom outcome, unmet expectations, and functional status of the patient. Interactions with health providers were especially key and included compassion and demonstration of concern, clear explanations of treatment, prompt resolution of requests, and properly addressing the patient. Satisfaction with quality of service tended to improve satisfaction with safety procedures and activities. Dissatisfaction was related to a lack of explanation regarding treatments, the provider’s attention focused on devices rather than the patient, or regarding patients as objects, a lack of medical staff presence, a lack of privacy, and others.

 

Supporting successful medical practices

here was some concern that basing reimbursement on satisfaction will not necessarily represent quality care. Even if care provided is based on evidence and even considered standard of care (from a legal perspective), the patient and family may not express satisfaction with care. Criticisms of patient satisfaction surveys include patient lack of experience to evaluate health care quality, the terms used tend to be subjective, patient scoring is outside of provider control, response levels tend to be low, and surveys are often customized, which can lead to bias. Additionally, there was a concern that seeking to assure good and improved patient experiences may lead to compromising optimally effective care. Another point of view suggests that pursuing patient satisfaction may support successful medical care practice profitability, increased market share, employee retention and productivity, as well as reducing risk for malpractice lawsuits. Interestingly, some research has demonstrated greater patient satisfaction when cared for by providers with adequate staffing, positive relations between providers, and good administrative support.