Today, patient satisfaction is considered a key data point for measuring the quality of healthcare. But this wasn’t always the case. Although evidence-based quality improvement is as old as Florence Nightingale, the concept of patient satisfaction as an essential measure is relatively recent. Early healthcare quality improvements generally focused on health outcomes rather than patient experience.
In recent years, however, the “patient-as-a-customer” concept has gained traction, along with a growing focus on patient-centered care. Questions about communication and patient experience have become vital quality measures in national data on healthcare providers, and there’s an increasing focus on patient perspective when measuring healthcare quality.
But many providers are still skeptical. Does it matter how patients feel about their healthcare experience if they leave your office healthier than when they arrived? And does patient satisfaction have a significant influence on other healthcare outcomes? Is patient satisfaction really an important goal in healthcare?
Here’s what the evidence says: Yes, patient satisfaction matters – but its relationship with other metrics is complex. Understanding how and why patient satisfaction influences outcomes is key to providing quality care.
What is patient satisfaction?
In service-based industries, no one questions the centrality of customer satisfaction. But for many healthcare providers, focusing on patient satisfaction may seem unnecessary. This lack of focus is partly because it’s a subjective metric. Compared to “where does it hurt?” or “what’s your oxygen saturation?”, the question “how satisfied are you with the care you received today?” is easy to deprioritize.
The concept of patient satisfaction in healthcare is surprisingly ill-defined. There’s no definitive, recognized survey or measures for patient satisfaction, and its relationship with outcomes is still relatively unknown.
In marketing, where the concept originates, customer satisfaction is generally defined as the alignment of a customer’s expectations with their experience. It seems simple to extend this definition to healthcare. When a patient’s experience of care meets their expectations, then the patient is satisfied.
In other words, if a patient comes to your dental office expecting to get a cavity filled, and you fill their cavity and end their tooth pain, they’ll be satisfied. If you pull their tooth, they’ll be dissatisfied.
The challenge with this framework is obvious. A service industry like a coffee shop can reasonably measure its performance by customer expectations. If a customer expects a cappuccino (because that’s what they ordered) and gets an Americano, the service failed to meet the customer’s expectations, and the coffee shop has failed. The customer’s resulting dissatisfaction is reasonable.
In healthcare, however, the customer’s expectations may not be reasonable or accurate. In fact, they may be harmful.
Your patient might need that tooth pulled.
And as a healthcare provider, it’s your job to provide the intervention that will result in the best outcome for your patient’s health – even if that means pulling the tooth.
Due to the difficulty in leveraging customer satisfaction concepts to define patient satisfaction in healthcare, the frameworks and measures used in healthcare studies on patient satisfaction vary widely. A 2015 systematic review found that in scholarly literature, the frameworks used to define the concepts of expectations and satisfaction, and the variables used to define the relationship between them, are inconsistent. These differences make it difficult to compare providers to each other or to define patient satisfaction in a healthcare context.
However, patient experience has a clear definition. It is simply “what a patient experiences during their care visit” (as opposed to satisfaction, which is how the patient feels about their experience). Patient experience is closely related to satisfaction. The research-based framework for understanding both of these concepts is used in the national Consumer Assessment of Healthcare Providers & Systems surveys, or CAHPS.
Created by the Agency for Healthcare Research and Quality, the CAHPS surveys have been developed and refined since the 1990s. Although administering CAHPS surveys is voluntary for private providers, they are an important quality measurement tool for Medicare/Medicaid reimbursement (and can give you higher reimbursement if your ratings on these surveys are high).
There are specific CAHPS surveys tailored for different providers, including private practice groups, dentists, and community clinics. You can administer these surveys to your patients and collect the data to measure their experiences in your practice.
CAHPS surveys ask questions in several categories: appointment setting, provider communication, care coordination, staff communication, and overall rating. The main purpose of these surveys is to directly measure the patient experience by asking whether specific events occurred during a visit. For example, common questions on CAHPS surveys are: “Did the provider explain things to you in a way that was easy to understand?” and “Did your visit start on time?”
CAHPS surveys also measure overall patient satisfaction by asking patients to rate their visit on a scale of 0 to 10. Therefore, the CAHPS survey database is the most broad and accurate measure currently available of what experiences and interactions during a healthcare visit correlate with higher patient satisfaction.
What affects patient satisfaction?
The concept of patient satisfaction may be hazy, but the experiences that correlate with satisfaction are very clear. Communication is at the top of the list: between patient and provider, between patient and staff, and among administrative staff.
One literature review found that providers’ “interpersonal care quality” was the most important factor in patient satisfaction. When patients feel respected and understood by their provider, they’re more satisfied with their care. More specifically, providers who give clear, understandable explanations about treatment and care are the most likely to get high satisfaction ratings. Providers who express concern for patients’ anxieties are also more likely to have satisfied patients. This level of effective communication goes beyond a good bedside manner; providers achieve it by listening to patient concerns and taking the time to answer questions, using ordinary language that patients understand.
But provider communication is only one piece of the puzzle; staff communication is also key. Patients who feel that staff are friendly and courteous are more likely to be satisfied with the practice and recommend it to friends. Staff teamwork and attitude is also an important factor here: when patients feel that staff work together well to provide care, they are more likely to recommend the practice. Improving this metric of patient satisfaction requires providers to empower staff to communicate and function as an effective team.
Most providers can easily accept that communication is an important goal. After all, a patient who understands their condition and treatment is more likely to cooperate with procedures. But is patient satisfaction a necessary goal? How important is it, and what is its impact on health outcomes? Much of the research in this area is still new, but some clear conclusions are evident.
Why is patient satisfaction important?
Many clinicians are hesitant to emphasize patient satisfaction, believing that they should prioritize more objective measures of healthcare. After all, does your curt bedside manner matter if you just saved a patient’s life? But there is growing indication that satisfaction influences many other metrics and impacts healthcare quality in a variety of ways.
First, and perhaps most important, patient satisfaction correlates with higher provider trust. Provider communication is the most important factor that builds patient trust, especially the use of open-ended questions and the practice of active listening to patient concerns. It makes logical sense that when patients trust providers, they’re more likely to follow treatment plans, and the evidence supports this conclusion. The correlations among provider communication, patient-provider trust, and patient treatment adherence are well documented. Treatment adherence – following a treatment plan at home and returning for follow-up care as recommended – is the clinical outcome with the strongest demonstrated relationship to provider communication and patient satisfaction.
Patient satisfaction is a less important factor in other clinical outcomes, but it still has an impact. One analysis found possible correlations between patient satisfaction and provider adherence to best clinical guidelines for procedures and between patient satisfaction and safe practice. However, the outcomes most strongly influenced by patient satisfaction are less “hard” measures. For example, another analysis found that patients who receive a good education and emotional support have a quicker recovery and shorter hospitalization time after surgery.
For healthcare practitioners, clinical outcomes are the most important measure of quality, so the limited influence of patient satisfaction on those outcomes reduces its importance in the mind of many. But private providers need to address business outcomes and clinical ones, and in this area, patient satisfaction is king. Higher patient satisfaction means fewer malpractice lawsuits and higher patient loyalty. These outcomes build a provider’s reputation in a community, bringing new patients to the practice.
How do you achieve patient satisfaction?
Once you’ve established the goal of improving patient satisfaction with your practice, there are steps you can take toward improvement. First, as with any goal, take a baseline measurement so you can know where you’ve started from and whether your changes are effective. The CAHPS surveys are available for any provider’s use, with specific versions designed for dental practices, medical practices, outpatient clinics, and other types of providers.
If you’re planning specific changes to your practice that you want to measure, then you could design custom surveys to address issues of concern in your practice. You can also leverage marketing techniques and use open-ended online reviews to gather information and build your practice reputation online. The latter step can significantly impact your practice growth, since 71% of patients use online reviews when they’re searching for a new doctor.
Once you’ve begun to gather data about your practice’s current level of patient satisfaction, you can identify areas of improvement. Since communication has the biggest influence on patient satisfaction, every provider should focus on this area. Consider improving your communication skills with training on evidence-based techniques like motivational interviewing or techniques taught by the Institute for Healthcare Communication. Offer CE training on your staff’s communication skills, especially for individuals who regularly interview or assess patients.
Next, free up you and your staff to spend more time with patients by automating administrative tasks and streamlining office processes. The more you can focus on patients without rushing, the more you can explain processes, answer questions, and address concerns. Make the logistic processes like scheduling appointments and paying bills easy and convenient for your patients, so you and your staff can focus on providing quality care.
You can also improve patient satisfaction by improving your staff’s communication and morale. Happier staff offer better customer service, and better communication among staff members improves continuity of care. When you can integrate your patient communication tools with EHR records, front office and back rooms can quickly access the same information, notes, and records about patient care. This integration reduces the need for patients to answer the same questions and helps patients feel that staff is working together as an organized team.
Finally, continue to measure patient satisfaction using the same surveys you used at baseline. Pay attention to the changes that have the most significant impact, which will enable you to continue to improve.
Keep in mind that the research on this topic is still ongoing. Patient satisfaction is still a vague and evolving concept, and it’s not beneficial for healthcare providers to spend time chasing after measures that don’t have significant impact. Rather than getting caught up in pleasing patients with surface-level improvements, focus on processes and communication that will add efficiency and clarity to your entire office. The most important goals for a private provider are the practice goals you set for yourself and the quality outcomes you achieve for your patients.
