How should we measure patient satisfaction?

After a stay in a local hospital, I received a phone call from a company hired to administer a patient satisfaction questionnaire. While I was satisfied with the overall care I received, I did have some issues with the process. When I attempted to offer my opinions, I was told my issues were not part of the questionnaire template. Instead, I was given a telephone number to call to discuss my issues. When I called the number, I was put on hold. I finally gave up after 20 minutes. From what I have found out since, I am not alone in my experience.

Many medical practices and hospitals undertake patient satisfaction surveys in an attempt to improve their quality of care. Many will bring in consultants or purchase patient satisfaction templates. Great pride is taken in reporting high patient satisfaction scores. But, are our patients truly "satisfied?"

If one looks to automobile manufacturers during the 1990s, they reported that over 90 percent of individuals who purchased a new automobile were satisfied with their purchase. However, only 30 percent of those "satisfied" individuals repeated their purchase. Why was there a disconnect between the satisfaction scores and the purchases?

Like automobile manufacturers, we are falling into the trap of patient satisfaction scores. We determine a satisfaction score without attempting to identify, measure and understand the key determinants of patient satisfaction. Satisfaction scores have become an end in and of themselves. We produce a score, which makes us feel better, but does not necessarily address the real needs of our patients.

How should we measure patient satisfaction? First, understand why we should measure it. Measuring patient satisfaction helps us to identify patients' expectations. Expectations are important because patients' judge the quality of the care they receive based on their internal standards of what defines quality. These internal standards are based in expectations. In addition, it allows us to learn about patients' perceptions of our service. By understanding their expectations and perceptions, we can begin to bridge the gap between how health care providers and patients define quality service.

The first step is to identify the key determinants of patient satisfaction through qualitative research. This research may be accomplished via focus groups or openended questionnaires. It is the initial step in determining patient expectations. Unfortunately, this crucial first step often is omitted. We assume we know what the key determinants are, or we use "cookie cutter" templates that do not address issues important to our patients.

For example, a pediatric practice, with a well-insured patient base, consistently received high patient satisfaction scores (98%) on a survey, which they purchased. Despite the high scores, they noticed a trend in patient defections to a rival group. When they turned to qualitative research, using open-ended questionnaires with current and departing patients, they discovered that patient families were very satisfied with the medical care given by the physicians, but found the office staff difficult to deal with.

Once the key determinants are established, the next steps involve developing a survey, collecting the data and performing a statistical analysis. Determining a percentage of patients who are satisfied--or a percentage of patients who respond positively to a particular question--will not yield meaningful data. At a minimum, correlation analysis should be undertaken.

The next step involves taking the knowledge gained from the quantitative analysis and initiating improvements in patient care. It makes no sense to measure quality unless you intend to improve it. To initiate improvements, the pediatric practice undertook major changes in their staffing and focus of their office staff. Formal training in customer relations and telephone etiquette were provided.

The final step in measuring patient satisfaction is to review patient comments and to reconvene focus groups or redistribute questionnaires, in order to revise the key determinants to be measured as patient expectations and needs change.

In the end, patients' perceptions of the quality of care and service they have received are based on two factors. Their expectations of the service and their perceptions of the actual service they received. Only by undertaking this process of measuring patient satisfaction, can we hope to find out if our patients truly are satisfied.

By David P. Tarantino, MD, MBA 

David P. Tarantino, MD, MBA, is the executive medical director of Shock Trauma Associates. P.A., a 50+ physician, multispecialty practice associated with the University of Maryland School of Medicine. In addition, be is the chief executive officer of The MD Consulting Group, LLC, a health care management consulting firm in Baltimore. He can be reached by phone at 410-328-2036 or by e-mail at [e-mail]

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