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Patient feedback may not reflect surgical care

Wednesday April 17, 2013
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Patient satisfaction does not necessarily reflect the quality of the surgical care patients receive, according to a study.

"We found that the quality of what goes on in the operating room doesnít closely correlate with the patientís perception of the quality of his or her medical care," Martin A. Makary, MD, MPH, the studyís lead author and an associate professor of surgery at the Johns Hopkins University School of Medicine in Baltimore, said in a news release. "It is important for patient satisfaction to be tracked and transparent, but the quality of the actual care may be independent of that. Itís misleading to say a patient satisfaction score says it all."

Patient satisfaction is becoming a front-and-center issue in the healthcare conversation, Makary noted, because the Centers for Medicare & Medicaid Services in 2012 finalized details of a new reimbursement method that adjusts payments based in part on patient satisfaction scores. The measure also is being adopted by private insurers. Patient satisfaction scores may appear as the only scores on websites seeking to help patients make more informed choices about where to seek healthcare.

Makary and his colleagues thought the notion of patient satisfaction as the ultimate metric of healthcare quality needed to be evaluated. Published in the April issue of JAMA Surgery (formerly the Archives of Surgery), their research found that while the metric may be easy to apply, it does not appear to be a comprehensive measure of overall quality, particularly for procedure-based care such as surgery.

The researchers compared the performance of 31 U.S. hospitals on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, the CMS Surgical Care Improvement Program and the employee Safety Attitudes Questionnaire.

Among the questions asked of patients on the HCAHPS were inquiries about nursing care, cleanliness of the hospital, experiences such as pain management, and explanations of new medicines and follow-up on discharge. Surgical care quality was judged on evidence-based measures such as infection prevention, blood clot prevention and timely removal of catheters. Safety attitude questions focused on teamwork, job satisfaction, working conditions and perceptions about the management of the hospital.

Results showed no link between patient satisfaction scores and surgical care quality scores, although the researchers did find a correlation between patient satisfaction scores and employeesí feelings about the teamwork and safety climate in their hospital.

"The better the workplace culture for staff, the more satisfied the patients," Makary said. "In any industry, if the employees feel good about their workplace, they are more likely to have satisfied customers.

"Doctors and nurses feel strongly that wide variations in teamwork culture are behind wide variations in quality, but there hasnít been a lot of focus on culture in the past."

Makary emphasized that patient satisfaction should be a hospital priority, patients should receive prompt and timely care, should be educated about their medical options and should feel they have been treated with courtesy and respect. But he wants to see better instruments developed to capture good technical skills, sound medical judgment and other aspects of quality medical care.

The study abstract is available at http://archsurg.jamanetwork.com/article.aspx?articleid=1679648.

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