Why Patient Satisfaction Surveys Hurt More Than They Help

Patient satisfaction has become a focal performance indicator for hospital administrations, and for good reason. Numerous studies have shown patient satisfaction to be linked to higher profitability, better patient compliance, and a decrease in malpractice suits. However, in many cases, patient satisfaction surveys have become to doctors what standardized testing is to teachers.

Allow me to explain. Standardized testing is used to assess a student's academic abilities relative to their peers by providing accurate comparisons across different populations of students. It is useful for measuring a student's progress and allows teachers to manage their time effectively by giving them guidance about what to teach their students, and when. Standardized testing gives teachers an opportunity to identify gaps in students' learning and adjust their curriculum accordingly.

Despite the apparent benefits of standardized testing, the pressure put on teachers to have their students perform well on these tests ultimately results in worse teaching and learning styles in many cases. There has been a widespread pattern of teachers adjusting their curriculum according to the standardized test, rather than teaching material in a way that will be useful to students in non-academic applications. The result is that students are well-prepared for standardized tests and ill-prepared for real life.

Similarly, patient satisfaction surveys have become a standard tool for hospital administrators to measure and address this key performance indicator. But doctors, under immense administrative pressure to receive high satisfaction scores, are now tending to focus more on making patients happy than on producing beneficial health outcomes. The result is that patients are indeed satisfied, but they aren't necessarily receiving better care.

Image by David Castillo Dominici from freedigitalphotos.net

Image by David Castillo Dominici from freedigitalphotos.net

When doctors are incentivized to place such a large emphasis on patient satisfaction instead of health outcomes, patients are actually at risk for more expensive, less effective treatment.

When patient satisfaction is so heavily stressed by hospital administrators, doctors may become extremely hesitant to deny any patients' requests for antibiotics, potentially addictive medications, scans, and other expensive and possibly harmful treatments. Especially when doctors are reimbursed according to their patient satisfaction scores, this practice increases the amount of unnecessary treatment a patient will receive, causing healthcare costs to skyrocket without producing any more favorable health outcomes - and even creating potential dangers for patients further down the road.

Many doctors, in fear of receiving poor patient satisfaction scores, have developed habits of over-treating and over-prescribing. In 2014 a group of researchers from UC Davis used satisfaction scoring from over 50,000 patients and discovered that the patients who were most satisfied accounted for a 9% increase in healthcare costs. These satisfied patients were 12% more likely to be admitted to a hospital and unsurprisingly, were also more likely to die due to higher instances of adverse effects caused by unnecessary medications and operations.

Relying on patient satisfaction surveys to assess the quality of health services does not provide an accurate picture of quality of care. Using satisfaction as such an essential metric can often be downright dangerous for the patients, yet it is increasingly used to measure physician performance.

There is no contesting that patient satisfaction is a valuable metric in many cases. The issue is that hospital administrators and government reimbursement policies are incentivizing high rates of satisfaction above actual health outcomes for the physician workforce. A physician might be able to improve his or her satisfaction scores by giving patients the unnecessary treatments they demand - but hospitals are not hotels, and especially when it comes to healthcare, the customer is not always right.

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