Patient Satisfaction Planner

Study: Patient satisfaction not what it could be

Yet programs have positive impact on outcomes

There's good news and bad news in a new study just released by the Health Research & Educational Trust, an affiliate of the American Hospital Association, and the Boston University Health Policy Institute: Of 470 hospital chief quality officers surveyed, 97% reported that QI activities had a positive effect on patient care outcomes. However, when that same group was asked about patient satisfaction, only 28% agreed it was at the level it should be.

In addition, they found, hospitals in which the chief quality officers perceived high levels of patient care quality were more likely than others to have embraced QI as a strategic priority, fostered staff training and involvement in QI methods, and engaged in an array of QI activities and clinical QI strategies.

"The overall picture is that there is a lot of progress being made, but we still have a long way to go as far as moving in the direction of high-performing organizations and a high-performing national health system," says Alan B. Cohen, ScD, professor of health policy and management and executive director of the Boston University Health Policy Institute, and one of the study's principal authors, who noted that the respondents came from hospitals of all sizes and types. "We have a long way to go, and a lot of work to do."

While more than 80% of the respondents said they had seen important gains in quality in the three years prior to the survey, he continues, they did believe their hospitals were "falling down in the area of increasing patient satisfaction."

In this particular study, he adds, the respondents we not asked to identify potential causes. "We hope to do that this fall with a small set of institutions," Cohen says. "We'll go into some high-performing organizations to see what it is they do to improve patient satisfaction and quality of care in general."

Hospitals still 'falling short'

Although hospitals have continued to improve in terms of complying with certain recognized quality and safety strategies, says Cohen, there are other areas where the results are still disappointing.

"We found a number of clinical QI strategies that are being used, many of which follow on the recommendations of the IHI [Institute for Healthcare Improvement] — such as preventing surgical site infections, central line infections, and ventilator-associated pneumonia," Cohen notes. "They really have gotten hospitals focused on preventing these things. But a sizable majority of the institutions surveyed show there is not the desired level of diffusion of other things that IHI, the IOM [Institute of Medicine], and the Leapfrog Group have been talking about for a long time." For example, he says, the survey indicated that:

  • Only 47% of the respondents reported that they use evidence-based practice guidelines widely;
  • Only 52% said they use standing orders widely;
  • Only 62% said they use medication reconciliation widely.

"If left to their own devices, many hospitals will likely fall short," says Cohen. "The IHI has been pushing the notion that there really is some value to using reminders and setting up systems with prompts and alerts and reinforcing the notion that these are things you have to do."

Compliance, he continues, also comes down to checklists. "These are busy professionals, and they constantly have to be reminded of certain routines that are important in terms of reducing medication errors, wrong-site surgeries, and so forth," Cohen says. "We constantly have to stay vigilant."

One key problem, he acknowledges, is that such vigilance can be costly. "The question is, how do we define optimal levels and when do they become too burdensome from a cost standpoint?" he poses. "Some will say we can never do enough, while others will say there are limits to what institutions can afford to spend."

Some surprises

Cohen says that not all the survey results were what he and his colleagues anticipated. "We were surprised that almost half of the hospitals did not monitor wait times for outpatient services," he says. "There is much evidence that if people do not have access to good outpatient or primary care it will most likely lead to serious illnesses and conditions that result in avoidable hospitalization. It makes sense from a QI and cost perspective to prevent this from occurring."

The bottom line, he says, is that hospitals "Should be vigilant about how long it takes to get a patient a clinic appointment because delays can lead to adverse outcomes."

Another survey finding, he says, is that the jury is still out on the issue of rapid response teams. Noting conflicting evidence in the medical literature, Cohen reports the following: "We found that two-fifths of all the hospitals said they were using rapid response teams widely, and another two-fifths said they were using them minimally or not at all.

"We surmise that some hospitals might have been convinced by the weight of evidence that [rapid response teams] made sense, and they had the necessary resources to use them widely, while the others probably adopted a 'wait and see' attitude concerning whether they proved to be both clinically effective and cost-effective. If more positive evidence is produced, these hospitals will be more likely adopt rapid response teams and make them part of their QI plans."

[For more information, contact:

Alan B. Cohen, ScD, Professor of Health Policy and Management, Executive Director, Boston University Health Policy Institute, 53 Bay State Road, Boston, MA 02215. Phone: (617) 353-9222. Fax: (617) 353-9227.E-mail:]