Don't downplay patient satisfaction

Although various studies note some correlation between clinical quality measures and patient satisfaction, others stress the lack of a consistent, close statistical relationship between them. Such “discrepancies” are detailed in what often appears to be a campaign to cast doubt on the patient's experience as a relevant indicator of quality care.

This raises an important question: Must there be a one-to-one correlation between the technical delivery and personal experience of care? An even more important question: How should we define “care”?

It can be argued that diagnostic procedures, surgeries and therapies constitute treatment, but not care. Treatment alone isn't care.

“Care” would be described as the treatment and the interpersonal context in which treatment is delivered. This “context” defines the experience. It includes empathy and behaviors that address the emotional, informational, social, cultural and economic issues that accompany sickness and its treatment.

Treatment and experience are different aspects of care. One is objective, involving highly standardized technical, mechanical or chemical interventions. The other is subjective, composed of behaviors, decisions and interactions of humans with idiosyncratic personalities, stresses, agendas and sensitivities. Providing treatment and managing the personal experience of care require distinct competencies. Ideally, of course, we would want technical quality and experience quality to be a single entity. Maybe they will, some day.

Until that day, it should not be surprising that a hospital with a great reputation, high core measures and good outcomes might have lower-than-average patient-satisfaction scores. Or that an institution with higher mortality or poor core measures might provide a positive experience for patients.

In either case, care is incomplete and of lower quality.

Such “discrepancies” should in no way cast doubt on the relevance of the patient's experience as both a valid component and indicator of quality care. Rather, any disconnect that we currently have between the two quality indicators reflects a journey still incomplete. Let's focus less on bashing patient-satisfaction measures and more on trying to figure out how to make concern for the patient's experience an integral part of all treatment, so that the quality of one automatically reflects the quality of the other and the process of care becomes truly unified.

Irwin Press is co-founder of Press Ganey, professor emeritus of the University of Notre Dame and adjunct faculty at Rush University's department of health systems management.