Patient Satisfaction as a Possible Indicator of Quality Surgical Care

Citation: Lyu H., Wick E.C., Housman M.G., Freischlag J.A., & Makary M.A. “Patient Satisfaction as a Possible Indicator of Quality Surgical Care,” JAMA Surgery, April 2013, 148(4): 362-367.

Importance: In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care.

Objective: To determine whether patient satisfaction is independent from surgical process measures and hospital safety.

Design: We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire.

Setting: Thirty-one US hospitals.

Participants: Patients and hospital employees.

Interventions: There were no interventions for this study.

Main Outcomes and Measures: Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey.

Results: Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R=0.216 [P=.24]; appropriate hair removal,R=0.012 [P=.95]; Foley catheter removal,R=0.089 [P=.63]; deep vein thrombosis prophylaxis, R=0.101 [P=.59]). In addition, patient satisfaction was not associated with a hospital’s overall safety culture score (R=0.295 [P=.11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R=0.327 [P=.07]), working conditions (R=0.191 [P=.30]), or perceptions of management (R=0.223 [P=.23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R=0.439 [P=.01]), safety climate (R=0.395 [P=.03]), and stress recognition (R=0.462 [P=.008]).

Conclusions and Relevance: Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital’s ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.