Hospital Patients Speak Their Mind in Satisfaction Surveys

Should you face a possible trip to the hospital, wouldn't you like to know what recent inpatients thought of the place? Surely you'd be interested in nurses' responsiveness to patients' requests for help, attention to controlling their pain, and the cleanliness of their rooms. What overall mark would they give the hospital, and would they recommend it to friends and family? Anyone would want to go to a hospital whose staff cares about people, not just for them. And who better to judge than patients who have had a recent stay?

You don't have to hunt up people to ask. For nearly 3,800 U.S. hospitals—the vast majority of the nation's centers—you can now go to the facility's individual page at America's Best Hospitals and click on the "What Patients Say" tab to see how satisfied patients were in 10 respects. These hospitals now sample a year's worth of recently discharged patients and ask them to respond to a survey consisting of a standardized set of questions and multiple-choice answers. The federal government (which uses the unsubtle threat of losing a precious slice of Medicare money as a compliance inducement) posts a year's worth of responses, updated quarterly, on its Hospital Compare page. The latest information covers patients discharged in all of 2008.

The elite centers in the annual U.S. News America's Best Hospitals rankings showed pretty well—though none of the 154 ranked hospitals that reported patient satisfaction results in the latest survey came out at the upper end. It would be surprising if they had. Most such facilities are teaching hospitals that care for the sickest patients, and kid-glove treatment tends to take second place to medical quality. Neither did most of them do badly, however.

The Centers for Medicare and Medicaid Services, the agency that administers the survey and posts the results online, says the information gives consumers an objective and meaningful way to compare hospitals, encourages centers to clean up their act or do even better, and speaks to the desire for transparency—making key information available to public scrutiny.

The last two hold up. At a time when hospitals are battling like ultimate fighters for customers—patients, that is—looking bad is not a way to increase market share. And the whole point of transparency is opening windows to let data out. When it comes to comparing hospitals, however, the survey numbers don't add up to meaningful information about care, which is why patient satisfaction won't be integrated into the America's Best Hospitals ranking methodology for the foreseeable future. In brief, here's why not:

• The reason for going to the hospital is to be expertly and successfully treated. But various studies, the most recent in October 2008 in the New England Journal of Medicine, have been unable to identify a significant relationship between patient satisfaction and quality of clinical care.

• Hospitals where stays are very short and procedures are elective shouldn't be compared with hospitals that deal with complex, difficult cases, many referred from other centers. The highest overall satisfaction ratings in the latest survey results are dominated by small surgery centers—some with fewer than 10 inpatient beds—specializing in hip and knee replacement, minimally invasive heart bypass surgery, and other elective procedures that require only a couple of nights in the hospital. That patients are happier when they can leave soon and go home fixed is predictable.

• The online results may be based on a small number of patients. Of the top 25 hospitals in the overall ratings, seven had fewer than 100 responses, and response rates were as low as 6 percent.

What, then, are patient satisfaction ratings good for? They certainly are worth examining by those who need routine care and who have some choice of local hospital. And the results are worth spotlighting because patient satisfaction speaks to ordinary human dignity. "Healthcare should honor the individual patient," Donald Berwick, president of the Institute for Healthcare Improvement, wrote in 2002, "respecting the patient's choices, culture, social context, and specific needs."

[Photos: Take a tour of the America's Best Hospitals Honor Roll.]