Study shows link between safety and satisfaction

Two-way connection for hospitals

A new study initiated by patient satisfaction firm Press Ganey Associates Inc., of South Bend, IN, appears to show a strong correlation between hospitals that perform well on their patient satisfaction surveys and the stronger performers in the publicly reported Leapfrog Hospital Quality and Safety Survey, sponsored by the Washington, DC-based Leapfrog Group.

For example, the study shows that Press Ganey clients are more likely than non-Press Ganey clients to achieve either good progress or fully implemented ratings for CPOE, ICU physician staffing, and the Leapfrog Safe Practices Score, key measures in the Leapfrog survey.

Leapfrog uses four classifications, in ascending order: willing to report, good early-stage effort, good progress, or fully implemented.

"The average score of a hospital that does participate in Leapfrog is almost a year ahead of the average score achieved," explains Deirdre Mylod, PhD, vice president of public policy at Press Ganey.

Conversely, those Press Ganey clients that share their quality and safety information with Leapfrog have statistically higher patient satisfaction scores than hospitals that did not volunteer information. The mean score for the 226 Press Ganey clients who also submitted data to Leapfrog was 84, compared with a score of 82.7 for the 176 clients who were not willing to submit data. "The mean score difference between the two groups represents a difference of 20 percentiles when comparing each mean score against the national database," explains Mylod.

"This study starts making that link between patient experience and public reporting of public safety initiatives and hospitals' focus on patient safety and the care they provide," adds Catherine Eikel, director of programs at the Leapfrog Group. "We see through this analysis that a hospital's focus on patient safety does translate into more satisfied patients — those hospitals that focus on patient safety are more likely to be more patient-centered; their patients receive the safest care and are satisfied with their stay."

Not a zero sum game

The study was initiated by Press Ganey as a follow-on to earlier research. "We had done a previous study where we linked patient satisfaction to the publicly available clinical data on Hospital Compare," notes Mylod. "Higher clinical quality correlated with higher satisfaction."1

Quality, she continues, "Is not a zero sum game. That is, this is not a situation where focus on patient satisfaction is at the detriment of focus on safety — or vice versa."

Since Leapfrog makes its data publicly available, she continues, you can purchase its dataset for research purposes. "Our hypothesis was that there would be a relationship somehow," says Mylod.

How does Mylod explain the results? "What we found was that, in fact, hospitals that voluntarily submit data to Leapfrog have statistically significantly higher satisfaction scores with our data," she observes. "In order to do this, you have to be willing to be transparent." That entails a willingness to publicly share the "bad" news of your performance results as well as the good, she emphasizes.

In addition, she says, you must be willing to spend the time and the resources required to gather the data. "Having done all of that is a 'flag' for a hospital that seems better able to provide a higher quality of care — and their patient evaluations are better," she asserts.

Part of the reason for the link, adds Eikel, is that a hospital's efforts to provide safer care, in addition to being publicly reported by Leapfrog, do not go unnoticed by patients during their stay. "Some of the things hospitals do to meet Leapfrog standards are highly visible, like a CPOE system," she explains. "The patient can see the doctor is entering their prescription in the computer, vs. writing it down. They can also see when the doctor is washing his hands — and a careful consumer should be keeping a lookout for such practices."

The public, she notes, is becoming much more aware of aspects of patient safety they should be looking for. "And more importantly," she adds, "they are becoming more aware of what to look for when they are helping with the care of a loved one."

The study's results, Mylod adds, underscore the importance of pursuing improvement in patient quality and safety, and of publicly reporting those results. "Participating in Leapfrog appears to be a flag for a hospital that is actively engaged on a quality journey," she says. "Among Press Ganey clients, Leapfrog hospitals are also getting better faster ... in particular, Leapfrog hospitals in the 'good early-stage effort' category have the greatest positive change in patient satisfaction over a year."

Being a Leapfrog hospital, she concludes, "Is also a flag for hospitals that are more able to overcome significant quality challenges on the patient satisfaction side. Those who are faced with low satisfaction performance but who participate in Leapfrog appear to be better able to improve patient evaluations more rapidly."


  1. Gesell S, Clark PA, Mylod DE, Wolosin RJ, Drain M, Lanser P, and Hall MF. Hospital-Level Correlation Between Clinical and Service Quality Performance for Heart Failure Treatment. Journal for Healthcare Quality; Vol 27 No. 6: 33-44.

For more information, contact:

Deirdre Mylod, PhD, Vice President of Public Policy, Press Ganey Associates Inc., South Bend, IN. Phone: (800) 232-8032, Ext. 178.

Catherine Eikel, Director of Programs, The Leapfrog Group, Washington, DC. Phone: (202) 292 6706.