Continuing on our July theme of reposting, this 2 part series came from Oct 2005.  I think it is even more relevant in today’s healthcare reform-we shouldn’t be focusing on patient satisfaction at all.

I have expressed my opinion that it is totally a worthless exercise in the administration, collection, and analysis of patient satisfaction surveys.  I will provide a few posts to explain why but this first post will give a few reasons and some reference to some quality work in this arena that is helpful.  Don’t misinterpret my approach-I really do believe it is a waste of a clinics time to collect such information and will offer my opinion on information what is helpful in part II.

There is a whole body of patient satisfaction literature within medicine in general and a fair amount of studies published specifically in physical therapy.  They have all basically told us the same thing-patient satisfaction scores are highly inflated and generally determined by when and where the survey was taken.  Do it in the clinic after the initial visit and the resulting score is most likely overstated, do it two weeks after the patient gets the bill and it most likely is underinflated (side note:  this phenomenon about service in general has been coined by Roger Dawson -the “call girl principle” which states that the value of any service is greatly diminished after the service has been renderred).

In addition to being inflated, they seldom tell us anything about the status of the patient from a health outcome (an earlier post on this blog gave us the most recent study on this relative to LBP.  You can be satisfied but that doesn’t mean your physical status has been improved).  There is also no standard measurement instrument desite attempts by outside bodies to change this.

Why are they inflated?  We know in general that patient satisfaction is a multidimensional concept, however, under most circumstances of surveying the notion of a unidimensional construct whereby a dominant dimension-overall satisfaction cannot be differentiated from other dimensions (see:

Goldstein MS, Elliot SD, Guccione AA. The development of an instrument to measure satisfaction with physical therapy. Phys Ther. 2000:, 80:853-863.  side note:  this study was done on our clinics in KY).

Using Hertzberg’s Motivation-Hygiene Theory as the basis for their work, (Roush SE, Sonstroem RJ. Development of the Physical Therapy Outpatient Satisfaction Survey (PTOPS). Phys Ther. 1999;79:159-170.) identified factors (“detractors”) that must be minimally evident and do not increase satisfaction (e.g meeting basic communication needs) yet if lacking lead to poor satisfaction as well as those that can result in increased satisfaction (”enhancers”) such as privacy, respect, and affirmation by the staff.  Location and cost which are common domains in many satisfaction studies across medicine were studied and manifested in their analyses.  Helpful information but no compelling reason to waste effort in doing lots of patient surveys.
The most helpful study regarding patients satisfaction in physical therapy is in a since discontinued journal (Burke TE. Measuring patient satisfaction in an outpatient orthopedic setting, Part I: key drivers and results, J Rehab Outcomes. 1997 ;1(1):18-25).  An independent company, the Gallup Organization, assisted in the design, administration, and analysis of surveys conduction on 19,834 patients in 12 states.  This landmark study is often omitted from the annals of PT literature as the journal that it was published existed for two years and is not part of any journal database.  Nonetheless, in my opinion the information from this study is particularly relevant, valid, and useful.  A series of patient focus groups assisted in the design of this phone instrument.  They identified 26 areas representing 5 services dimensions that were used in the survey:  overall satisfaction, therapist interaction, center operations, facility, and billing.  This results clearly showed the significance of the interaction between the therapist and the patient.  It is important for the therapist to know the diagnosis of osteoarthritis of the knee.  However, it is more important to know Mrs. Jones’ knee arthritis.  If a large number of treating clinicians were part of the patient’s case, this drove down patient satisfaction.  Obtaining input from the patient relative to their goals was an enhancer of patient satisfaction.

So, if all this information has been helpful, how can one be against surveying patients for their feedback and assessing their level of patient satisfaction?  Easy.  Patient satisfaction is not the goal in physical therapy.  Satisfied patients means that you have met an acceptable level of service, it was ok.  Satisfied patients won’t necessarily return to your clinic for a future need when the doc writes the prescription to attend therapy at their office.  Satisfied patients won’t necessarily refer friends and family to you.  Satisfaction is an easy thing to measure but won’t really help your practice beyond what the research has told us.  For real answers, let’s measure the more difficult construct-patient loyalty.  Stay tuned for part II.

Your thoughts?

Larry