Healthcare industries have seen a movement towards maintaining patient centered care through assessing patients’ experiences. This growing interest helps consumers choose among providers and plans and to stimulate, guide, and monitor quality improvement efforts targeting patients’ experiences of care (Price et al., 2014). Patient satisfaction surveys not only enhance the patient’s experience but also improve healthcare management, health professionals’ behaviors, procedures, and prioritizing resource allocations and training needs (Batbaatar, Dordagva, Luvsannyam, & Amenta, 2015). The combination of improvements from the patient and provider’s views allow for an increase in adherence to recommended prevention and treatment processes, better clinical outcomes and better patient safety within hospitals.
Following the evaluation of the term ‘patient satisfaction’ through published articles; there are three commonalties between all definitions. First, satisfaction is an affective evaluation of the service based on cognitive processes which were shaped by expectations. Second, satisfaction is a comparison of expectations and actual experiences of a health service. Finally, it is an overall evaluation of different aspects of a health service (Batbaatar, Dordagva, Luvsannyam, & Amenta, 2015).
With this in mind, the Centers for Medicare and Medicaid Services implemented the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is a standardized survey instrument and data collection methodology that has been in use since 2006 to measure patients' perspectives of hospital care. While many hospitals collect information on patient satisfaction independently, HCAHPS created a national uniform standard for collecting and public reporting information that enables valid comparisons to be made across all hospitals to support consumer choice (Centers 2017). HCAHPS is designed to produce comparable data on patients' perspectives of care that allows objective and meaningful comparisons among hospitals on topics that are important to consumers. Furthermore, public reporting of the survey results is designed to create incentives for hospitals to improve quality of care and to enhance public accountability in health care by increasing transparency (Centers 2017).
Congress authorized the development and implementation of the patient quality reporting systems (PQR) through legislation. The Tax Relief and Health Care Act of 2006 required the Centers for Medicare and Medicaid Services to establish the PQRS as a voluntary pay-for-reporting program that included claims based reporting (Koltov & Damle, 2014). Eligible professionals who met the criteria for submitting quality data could earn a 1.5% payment increase. The program continued to grow and was made permanent in the Patient Protection and Affordable Care Act (Koltov & Damle, 2014).
This literature review will discuss how patient satisfaction surveys can be used to improve patient care. As well as, analyze the positives and negatives of these surveys and their determinants.
Review of literature
There are multiple theories attempting to explain patient satisfaction by a relationship of expectation. The most prevalent theory is value expectancy. Expectancy value theory was originally developed to explain and predict an individual’s attitudes towards actions (Batbaatar, Dordagva, Luvsannyam, & Amenta, 2015). First, individuals respond to novel information about an item or action by developing a belief about the item or action. If a belief already exists, it can and most likely will be modified by new information. Second, individuals assign a value to each attribute that a belief is based on. Third, an expectation is created or modified based on the result of a calculation based on beliefs and values (Zhang, Xie, Wee, Thumboo, & Li, 2008). These expectations are what a patient has in mind when walking into a clinic or hospital and ultimately what they rate on their satisfaction surveys. Measuring patient experiences of care may help promote accountability and quality improvement efforts targeted at patient-centeredness (Price et al., 2014). According to the Institute of Medicine, core elements of high-quality health care are safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. “Patient-centered” care is “. . . respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” (Price et al., 2014). This also means that patient satisfaction is multi-dimensional and must be looked at from different angles.
Results of patient satisfaction surveys allow health care providers to identify service factors that need improvement. It also enables policy makers to understand patients’ needs and, consequently, to make strategic plan for effective and better quality services. Patient satisfaction is a complex and multidimensional concept with numerous determining factors; however, which set of factors influence patient satisfaction the most remains debatable in varying settings or conditions (Batbaatar, Dorjdagva, Luvsannyam, Savino, & Amenta, 2017).
There are many determinants of health, but the majority of literature focus on: technical care, interpersonal care, physical environment, access, organizational characteristics, continuity of care, and outcome of care. All of which, may have played a role in variations in patient satisfaction. Among the service related determinants, the strongest positive association was found between health professionals’ interpersonal skills and patient satisfaction (Batbaatar, Dorjdagva, Luvsannyam, Savino, & Amenta, 2017). Therefore, first, it may be necessary to attempt to formulate patient satisfaction based on the health service quality indicators and how the patients develop their satisfaction with health services. Second, if patient satisfaction is a central issue of the health services, clinics should be establishing or strengthening the training of interpersonal skills to increase communication and empathetic skills of medical students and to ensure the continuity of the training at the workplace for health professionals. Third, persistent evaluation of health professionals’ competence and interpersonal skills is essential to prioritize resources, so that patient satisfaction can increase efficiently by training and incentives for health professionals (Batbaatar, Dorjdagva, Luvsannyam, Savino, & Amenta, 2017). The better a physician’s interpersonal skills the more likely a patient trusts the physician, and belief that physicians had a comprehensive “whole person” knowledge of them, were associated with patients’ adherence to physician advice and medicine (Price et al., 2014).
Furthermore, the physical related determinants also play a big role in patient satisfaction. As aspects of the physical environment became more appealing, patient satisfaction increased (Manji et al., 2017). This includes: room comfort, bedding, cleanliness, noise level, temperature convenience, lighting convenience, food service, bathroom comfort, clarity of sign and directions, arrangement of equipment and facilities, and parking (Manji et al., 2017). Patients who were in appealing rooms evaluated physicians’ affective behavior, competence, and their time spending more favorably. Also, they evaluated the overall higher rating of the hospital and reported strong intentions to return to the hospital and recommend the hospital to others (Manji et al., 2017). In addition, the availability of sleeping accommodations for family had a certain influence on patient satisfaction.
The determinants of patient satisfaction reflect on hospital’s HCAHPS, which contains questions regarding the previously mentioned determinants. Hospitals with the highest HCAHPS scores perform significantly better on CMS’s clinical process of care measures for acute myocardial infarction, congestive heart failure, pneumonia, and surgery than hospitals with the lowest HCAHPS scores (Price et al., 2014). Thus patient satisfaction ultimately has an impact on the patient’s health, whether mentally or physically.
While patient satisfaction surveys and their analysis have many positives, there are downfalls to the process. Online surveys can easily be manipulated (Price et al., 2014). Some hospitals use third party websites to generate and send out their surveys. These websites can allow one to change the survey questions after results have been received which can skew data. Sometimes online reviews may be insufficient because providers could put a fake account and rate themselves higher than their actual scores (Price et al., 2014). While HCAHPS is less likely to have skewed data, low HCAHPS scores can lead to low Medicare/Medicaid reimbursements for offices (Koltov & Damle, 2014). This can lead to a decrease or a complete stop in the number of patients a clinic will see that are covered by Medicare/Medicaid. Ultimately affecting the health of the patient since they can no longer find a physician willing to accept their insurance. Assuming the data is not skewed, a physician may see low scoring surveys’ or negative responses and become afraid. This fear could lead to a decrease in diagnosis, seeing “easy” cases, and seeing less patients. Constantly analyzing surveys and implementing the necessary adjustments based of those surveys require time, money, and hiring new employees to do the job (Robinson et al., 2016). In addition, those clinics which allow students to learn on patients must constantly analyze these surveys to find a balance between meeting the needs of the student and the patient (Ebn Ahmady, Pakkhesal, Zafarmand, & Lando, 2015).
Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations (Al-Balushi & Al-Abri, 2014). Overall, the better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes; better clinical outcomes, particularly in the inpatient setting; better patient safety culture within hospitals; and less health care utilization (Price et al., 2014). Due to this the University of Illinois at Chicago College of Dentistry analyzes their patient satisfaction survey’s quarterly to visualize the areas of the clinic that need improvement. This analysis also allows the University to set new benchmarks for satisfaction to reach for the next year.