Hospitality, not medical care, key to patient satisfaction

Would you choose a hospital based on its Yelp reviews?

Relying on hospitals’ patient satisfaction scores as a guide amounts to much the same thing, according to new Cornell research.

The scores – collected in surveys by hospitals and a top priority in the era of consumer-driven health care – overwhelmingly reflect patients’ satisfaction with hotel-like amenities and hospitality services, such as quiet rooms, better food and friendly nurses, said Cristobal Young, associate professor of sociology in the College of Arts and Sciences.

Patients’ ratings of hospitals and willingness to recommend them have almost no correlation to the quality of medical care provided or to patient survival rates, he said.

“The No. 1 thing that ultimately matters to patients – are you going to survive your operation? Can they fix you? – does not really factor into patient satisfaction scores,” said Young. “There’s very little awareness that these are essentially Yelp reviews.”

Young is the lead author of “Patients as Consumers in the Market for Medicine: The Halo Effect of Hospitality,” co-written with Xinxiang Chen of Minzu University in China and published Feb. 13 in the journal Social Forces.

The study examined how patients judge the quality of their hospital care. Patients are increasingly expected to have a customer orientation to medical treatment, and to pay more out-of-pocket, like shopping for other consumer goods. It also looked at whether satisfaction levels drive better treatment.

Young and Chen analyzed Centers for Medicaid and Medicare Services data on patient satisfaction, mortality and technical medical quality for roughly two-thirds of U.S. general and acute-care hospitals – more than 3,000 hospitals – between 2007 and 2010.

They found patient satisfaction was higher at hospitals with the lowest death rates – but barely. Scores were only 2 percentage points lower at hospitals with the highest death rates.

“Patients do not have much awareness of their hospital’s patient safety standards,” the researchers wrote.

In contrast, interpersonal communication by nurses – such as their responsiveness and compassion (not their technical skill) – was a far bigger factor in patient satisfaction, with scores varying by nearly 27 percentage points.

The tidiness and quietness of rooms also had much bigger impacts on satisfaction than death rates or medical quality.

The fundamental problem, Young said, is one of visibility. Patients generally can only see and understand a hospital’s “front stage” room-and-board presentation.

“They know when the food is cold and tasteless, when their room is loud and overcrowded, when the nurses are too busy to tend to their pains and frustrations,” the researchers wrote.

They have little insight, however, into the “backstage” operations where critical medical care happens – sometimes while patients are heavily medicated or completely sedated. As a result, the study concludes, front stage room-and-board care creates a “halo effect” of patient goodwill, but the backstage delivery of medical excellence does not.

Patient satisfaction surveys hardly existed 20 years ago, Young said, but have emerged as a key metric of consumer-driven care, tied to hospitals’ Medicare reimbursement rates and to executive compensation.

At the same time, research has shown, many hospitals, particularly in competitive markets, have invested heavily in hotel-like amenities: Grand atriums with waterfalls; private rooms with patios and scenic views; “healing gardens”; artwork; music; gourmet food; Wi-Fi; and premium TV channels.

Those investments, Young said, represent a distraction and a shifting of resources away from hospitals’ core mission: excellent medical care.

“No one would object to nurses being friendly or to patients having private rooms and great food and manicured gardens,” Young said. “But none of those things are medical treatment. They won’t fix your health problem. And hospitals have limited resources and razor-thin margins.”

The unintended consequences of a consumer-driven health care model can be seen, the study says, in markets where hospitals compete to attract patients. Analyzing a representative sample of 330 such hospitals, Young and Chen found that local competition “leads to higher patient satisfaction, but lower medical quality.”

Hospitals’ growing emphasis on patient satisfaction is unexpected, Young said, in a U.S. health care system that is roughly twice as expensive as other high-income countries but has worse outcomes – lower life expectancy and higher rates of illness, according to the study.

If patients are truly to act as discerning consumers, Young said, they must have a better view of medical quality than satisfaction scores provide.

“If I’m a patient, I know that three days in the hospital will be rough,” he said. “Just make it worthwhile – give me the best medical treatment and the highest survival rate.”

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Rebecca Valli