Patient satisfaction a poor surgical quality indicator

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1. Patient satisfaction scores were not associated antibiotic prophylaxis, pre-surgical hair removal, and DVT prophylaxis.  

2. Although patient satisfaction was not associated with the hospital’s overall safety culture score, individual parts of the safety culture score such as teamwork climate, safety climate and stress recognition were associated.  

Evidence Rating Level: 2 (Good) 

Study Rundown: Starting in 2010, patient satisfaction began to be used as a measure of surgical quality to establish hospital reimbursement. This study found little correlation between the other metrics of quality tracked by the Surgical Care Improvement Program (SCIP) and employee safety culture scores. Although this study analyzed a large number of hospitals in a variety of states, there still exists a potential selection bias as the hospitals included in this study were all urban and mostly academic centers that elected to participate in the employee Safety Attitudes Questionnaire (SAQ). Additionally, the patient satisfaction survey was not specifically aimed to evaluate surgical care. Although process measures and safety culture scores have correlation to patient outcomes, it is possible that patient satisfaction captures a discrete facet of quality care. A more definitive study would measure the correlation between patient satisfaction scores and surgical outcomes.

Click to read the study in JAMA Surgery

Relevant Reading: Using the AHRQ Hospital Survey on Patient Safety Culture as an Intervention Tool for Regional Clinical Improvement Collaboratives

In-Depth [retrospective review]: This study analyzed data from thirty-one hospitals across ten states to compare results from a patient satisfaction survey to reported standard measures of surgical quality such as DVT prophylaxis and hospital safety culture scores. Patient satisfaction was evaluated by the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) with questions that focused on areas such as responsiveness of hospital staff and pain management. Pearson correlation analysis did not demonstrate a correlation between patient satisfaction and hospital adherence to process measures. Although the overall safety culture score was also not associated with patient satisfaction, patient satisfaction did correlate with the individual domains of safety culture. Teamwork climate and safety climate had the strongest positive correlation (R =0.439, p=0.01 and R=0.395, p=0.03). However, employee job satisfaction, working conditions and perceptions of management were also positively correlated. Stress recognition was inversely related.

By Asya Ofshteyn and Allen Ho

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