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

While the previous article introduced the reasons hospitals value patient satisfaction rates, this post will focus on the consequences of this shift, and what can be done to remedy the model that is currently in place. What with the concerns that “satisfaction” teaches doctors to give patients what they want, not necessarily what they need, along with the cyclical population contest that keeps likable but not necessarily competent doctors in high demand, consequences need to be considered. The following delves into these alarming effects, and suggests some ways in which hospitals and medical professionals could implement changes to better serve their patients.


What are the Consequences?

Satisfaction is the result of a warped perception of a physician’s competence, and its costs for patients are unnecessary expenditures or even death. When examining Medicare’s provider data for thousands of hospitals, The Atlantic’s Alexandra Robbins found that nearly two-thirds of poorly performing hospitals in the U.S. scored higher than the national average on questions such as, “YES [they] would definitely recommend the hospital.[1] Patients at these hospitals were generally more satisfied, but they certainly weren’t receiving better care; in fact, it appears they were receiving worse care. Also, one study found that approximately 30% of healthcare expenditures in the U.S. are for discretionary or inappropriate care, meaning healthcare practitioners are calling for unnecessary tests or, more likely, their patients are.[2] These expenditures are highlighted by researchers from UC Davis, who found that people who were more satisfied with their doctors faced healthcare and prescription drug expenses 9% higher than those less satisfied with their care.[3] Furthermore, more satisfied patients are also 12% more likely to be admitted to the hospital and 26% more likely to die before their less-satisfied counterparts.[4] Instead of rushing to solve the real problems behind these expenditures and deaths, hospitals are resorting to expensive consultants who work to improve hospital “experience” and provide scripts and other resources to boost satisfaction scores.[5] Satisfaction is slowly wearing away the integrity of hospitals concerned with losing their funding.

How Can We Change the Current Model? 

Satisfaction is not synonymous with quality care, and everyone involved has to recognize this. Doctors can be more forward with their patients. Patients can be more understanding of the complexities of medicine. And hospitals can start funding real solutions. As one doctor says, “it is easier and cheaper to provide pedicures, gourmet food, and valet parking than increase the number of FTEs [full-time staff].”[6] However, a lower patient to nurse ration is one of those real solutions that can dramatically increase mortality. A higher staffing of registered nurses is linked with fewer patients being readmitted, a drop in failure-to-rescue rates, lower levels of fatigue-related errors in nurses, fewer patient deaths, and general improved quality of health for both nurses and patients.[7] Quality of care improves when hospitals improve nurse working conditions, not through tricking patients into believing they’re getting better care.[8] Though quality of care may not directly affect satisfaction ratings, hospitals can also help patients to understand that happiness is not always what is achieved by a trip to the hospital; medical professionals, when not pressured by ratings, lend their expert opinion to improve health long-term, not to fulfill instant gratification.


Satisfaction should not be completely disregarded in a medical setting – without confidence in a physician or nurse, a patient is unlikely to continue entrusting them with their health – but it certainly should not be the driving factor that keeps doctors and other providers employed and hospitals funded. All parties involved need to understand their role. With better communication, honesty, and transparency, “satisfaction” may not be immediate, but it will follow for a patient who experiences improved care and a longer future.