Q&A: The difference between patient satisfaction and quality

Briefings on Accreditation and Quality, January 24, 2017

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Editor’s note: CMS, Joint Commission, hospital organizations, and private vendors each have their own way of calculating a hospital’s ranking and to improve patient care. While hospitals are already expected to conduct certain surveys by various agencies, how often should they conduct their own research? What measures should they use? And how do you use the information you have to drive improvement? Two definitions that are used often in conjunction with a hospital’s merit are patient satisfaction and quality of care. The following is an edited Q&A with Craig Deao, senior leader at Studer Group, on the differences between the two and how they can be used to drive improvement.

BOAQ: How do you differentiate between patients’ satisfaction with their care and the quality of the care they received?
Deao: The definitions of what you’re trying to measure are very different things. The healthcare industry about 30 years ago really started looking into satisfaction, which is “what does the organization do for you? How satisfied are you with that?” Plus, the experience and a lot of service hygiene factors.

The quality of care traditionally has been measured by the healthcare industry’s view of what makes for good outcomes and good process measures to predict those outcomes. [Examples are] process of care measures such as “Did you get your aspirin on time?” and outcome measures like morbidity and mortality.

But nobody gets to define quality without the voice of the customer. The more contemporary measures looking at patient experiences are really the experiences of quality. I think if you look at the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) series of surveys, those were survey questions that CMS wanted AHRQ (Agency for Healthcare Research and Quality) to help them determine over a decade ago so that they could measure a patient’s view into quality.

These surveys are getting at whether patients can accurately rate things that correlate with quality. The HCAHPS series of surveys are not satisfaction surveys; they’re frequency surveys. They don’t ask if your care is very “excellent” or “poor” or “good.” They’re asking if you “never,” “sometimes,” “usually,” or “always” saw some evidence-based practice at the bedside.

The only measures we had in the early days were satisfaction measures, which remain good, important, vital measures. And we’ve now added measures on how patients perceive the quality of care. And the best way to assess that is how frequently they saw specific evidence-based things happening at the bedside, like having their pain level controlled or understanding side effects of medications. Those aren’t satisfaction questions; those are quality questions.

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