Patient Satisfaction as a Possible Indicator of Quality Surgical Care—Reply

Abstract

Importance In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care. Objective To determine whether patient satisfaction is independent from surgical process measures and hospital safety. Design We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire. Setting Thirty-one US hospitals. Participants Patients and hospital employees. Interventions There were no interventions for this study. Main Outcomes and Measures Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey. Results Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = −0.216 [P = .24]; appropriate hair removal, R = −0.012 [P = .95]; Foley catheter removal, R = −0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = −0.462 [P = .008]). Conclusions and Relevance Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.