Hospital Patients Speak Their Mind in Satisfaction Surveys
Nursing, pain relief, and whether they would recommend the hospital to others are among the questions
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.]
Reader Comments
thank you
my mother is currently in st jophes MN ICU after a severe brain hemorage. the hospital and staff are very helpful and caring. my mothers procedure went very well, and her recovery is great. the family waiting rooms and hospitality rooms are wonderful. the nurses and doctors are all helping my family understand everything that my mother has underwent. parking is convenient, the deli and cafe are great, the the gift shop has everything we need. thank you very much.
OSU Medical Center
My daughter was transferred to OSU Med Center after her bile duct and duodenum were butchered by a "surgeon????" in another Oklahoma community where she underwent gall bladder surgery. Had I understood why he was transferring her to a colleague at OSU (to cover his mistake) I would never have allowed it. She lay for 3 days while bile leaked from her duodenum onto her intestines severely burning them and causing them to become inflamed. I requested continually day after day for nursing staff to examine the bile leakage and have a staff doctor to correct the problem. I had to physically drag the nursing staff from their chair relaxed at the nurse station down to her room and force them to examine the bile leaking through the bandages. Their only response was to add more gauze to the problem or replace the bandage with a fresh one. On the third night I was finally able to get a night resident to examine the problem and he immediately scheduled her for emergency surgery. Unfortunately the damage was done. Her intestines were so inflamed they were unable to close the incision, about 15" across her abdomen. They performed multiple surgeries on her after that and she was in and out of ICU several times. They utilized a vacuum healing device to close the wound and it failed to close the wound even after 5 weeks. They had to repair the tissues and perform another surgery. She remained in the hospital for three months until the vacuum system had finally closed the wound excluding about two inches. She recovered after almost two months on the vacuum at home. The nursing staff on the whole was about the same during her stay there. I was continually fighting them to administer pain relief to her. They either did not show up after pressing the call button several times, I could not find them at the nursing station, and even after contacting them to administer the med it could be up to an hour after the prescribed time before I could get the med administered to her. Sometimes it might take two to three trips to the nurse to get the med. All the while she lay in bed crying from pain, sometimes up on all fours crying in pain. The nursing staff on many ocassions were rude and calloused.
In addition they infected her with MRSA while in surgery which we continue to fiht today.
I would not recommend OSU Med Center to anyone who loves their family member. There are many other stories I could go into during her stay at OSU and would never allow her to receive "care?????" at that hospital again.
employee satisfaction
Patient satisfaction begins with the employees. If management does not respect, appreciate and value each and every employee regardless of their position, patients will suffer. This is the case with Banner Gateway. Morale is low, employees are not valued or appreciated in any way. No wonder patient satisfaction is in the red. Communication is non-existent. We see and hear things every day that should not be happening. We are there for our patients, not Banner Gateway. Management refuses to listen, address problems within the hospital, etc. To improve scores this will need to change. Will it? I seriously doubt it.
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