In Hospitals, the Customer is NOT Always Right – Understanding the Links between Patient Satisfaction and Mortality, Part I  

“Satisfaction” is a word long associated with consumerism. With every receipt you receive from Target, every time you call your bank, and every confirmation of an Amazon order, there is some customer satisfaction survey attached. How then, does the situation change when the satisfaction survey is not for a store or retailer, but a hospital or physician? A visit to the ER still involves a business transaction, but isn’t there a difference when the commodity being purchased is one’s life?

Recently, data has emerged that is leading experts to question whether patient satisfaction leads to better care, and many warn that it does not. In fact, studies have even demonstrated the connection between higher patient satisfaction and higher patient mortality rates. In this article, the first of a two-part series, the emphasis placed on patient satisfaction will be explored, as well as its negative impact on today’s care. Knowing how this counter-intuitive phenomenon impacts both medical professionals and patients can help you to detect problems and better advise clients when demanding higher quality healthcare.


What Incentives Drives Patient Satisfaction?

Hospitals naturally want their patients leaving good reviews for obvious reasons. Without positive reports, doctors lose patients, hospitals lose credibility. However, the emphasis on patient satisfaction grew significantly in 2012 when the Affordable Care Act implemented a policy wherein Medicare reimbursements would be withheld if satisfaction ratings were not high enough.1 Hospitals risk losing approximately $850 million annually due to low patient satisfaction survey scores, and that number will double next year.2 Alternatively, hospitals with high patient-satisfaction scores earn back the reimbursement while top performers receive bonus money.3 Then, in turn, medical professionals who score high on satisfaction will often receive a bonus from the hospital.4


Why is This a Bad Thing?

Subjective scores have led many hospitals and professionals to change their behavior to cater towards the wants of patients, rather than their needs.5 Because many physicians receive incentive compensation based on patient satisfaction, they order requested tests and treatments not out of medical necessity, but to please patients and obtain higher ratings.6 Medical professionals are reluctant to waste precious time carefully explaining the downsides of these requests, and therefore expose patients to unnecessary risks.7 In a similar vein, doctors fearing negative ratings may be less likely to talk patients out of treatments they request or to raise concerns about substance abuse, mental health issues, or smoking.8 Another complication of reliance on satisfaction is that mental health, personality, and socio-cultural factors contribute to how patients express themselves on satisfaction surveys, yet these factors are currently ignored.9 This is highly problematic when satisfaction ratings are often reported as being the sole physician comparator on hospital websites, distorting the concept of what actually makes a good physician, while making patients more loyal to physicians that may not actually be representing their best interests.10


What with incentivized satisfaction ratings influencing physicians to act against their medical training, the costs of patient-driven care can have serious costs. Want to know the consequences? Stay tuned for Part II where that, along with the changes medical institutions can make to better serve the needs of their patients, will be explored.