Age can make a difference in patient satisfaction

Lower, higher expectations depend on patient age

Every patient in your ED may receive the same level of care and attention, but that doesn't mean they will all perceive that care and attention with the same level of appreciation, according to a new patient satisfaction survey by South Bend, IN-based Press Ganey Associates.

Press Ganey's 2007 Healthcare Satisfaction Report showed, for example, that younger patients are generally much harder to please. More specifically, it found:

  • Patients between 18 and 34 were the most displeased, with only 76% saying they were satisfied with their experience.
  • The 35-49 age group was the second least satisfied in the ED, with a rate of 82.7%.
  • The highest satisfaction level, 87.6%, was reported among those 56 to 79.

These findings make a great deal of sense to Wanda Della-Calce, RN, director of emergency services at North Mississippi Medical Center in Tupelo. "The 18-year-olds have grown up with computers, cell phones, and so forth, so they are not used to waiting; they have different expectations," she notes. "They will be harder to satisfy because they want quick, fast service, and will not understand why they have to sit in the lobby four or five hours."

As for those in the 35-49 range, says Della-Calce, they are well informed, because they tend to look up their diagnoses on the Internet before arrival. "They, too, have higher expectations and will not like it if you are not on top of your game," she says.

Older patients, on the other hand, often find companionship and compassion in the ED that they do not have at home, she continues. "A lot times when we do patient callbacks, they enjoy and appreciate the fact that someone is checking on them," she says.

Matt Mulherin, a spokesman for Press Ganey, says this trend of expectations determined by age has been fairly consistent over the past few years. "Typically, the younger patients have higher expectations and lower satisfaction," he says. "It reflects an emerging perspective of consumers of health care."

Part of the reason, Mullherin notes, is that many people are investing more of their own money in their health care through vehicles such as health savings accounts. "That makes someone like me have higher expectations," he says.

Data such as this can be valuable to an ED manager, Mulherin continues. "Patients in the younger age groups are not only less satisfied and potentially less loyal, but they will also be your prime consumers in the next 20 or 30 years, so it's more essentially important to build loyalty among them," he says.

This type of data "lets folks know where you might have the greatest opportunity to improve patient satisfaction," Mulherin says. In fact, he adds, with patients who subscribe to Press Ganey services, he sees a significant number of managers breaking down their statistics demographically. "We have an online tool that lets them set up as many as 200 users who can then break out the data into the areas they want to study," he says. "It could be a nurse manager, a shift supervisor, and so forth."

When they identify a drop in their overall patient satisfaction score, they typically will break it out by demographics to see what could be causing the problem, Mulherin says. "If I'm the ED director, and I see we have a dip in our scores, I want to get to the bottom of it."

Adjust your care?

Identifying these groups is one thing, says Della-Calce; treating them differently is a bit more complicated.

"I think you have to look at your all processes and the populations you are serving," she says. "You try not to differentiate, [but instead] to treat the same patient the same way every time."

However, when pressed about whether it might be advisable, for example, to take a little extra time explaining to a younger patient why the wait was so long, Della-Calce conceded there might be a place for such an adjustment. "I think [demographic data] is one more tool in your toolbox," she says. "The culture here is patient- and family-centered, with quality care for everybody, but knowing how to address different patients gives you one more way of doing that."

It's important to know your audience, know their expectations, communicate clearly, know what they are expecting of you and how to address those expectations, Della-Calce says.

Mulherin says there can be a place for using such departmental data, "but it really depends on what your data says." In other words, he continues, such surveys can be used to show you where you will get your biggest return on investment in patient satisfaction. Mulherin calls that a "priority index." "So if, for example, your patients who are between the ages of 35 and 49 are not as satisfied as some other groups of patients, while you would not want to role out a program just for them, you might look to provide them with a lot of information about their care, how long it will take to see a doctor, and so forth."

However, you should never lose sight of the basic principles of patient satisfaction, he says. "All patients want the same kinds of things," he says. "Some may just want more of it."

So if your data show a certain group of patients is less satisfied, "you could definitely give your staff a special heads-up, but make sure they adhere to the same principles," Mulherin concludes.


For more information on analyzing patient satisfaction surveys, contact:

  • Wanda Della-Calce, RN, Director of Emergency Services, North Mississippi Medical Center, Tupelo, MS. Phone: (662) 377-4164.
  • Matt Mulherin, Press Ganey Associates, 404 Columbia Place, South Bend, IN 46601. Phone: (800) 232-3485.