- Văn bản
- Lịch sử
Patient Satisfaction: History, Myth
Patient Satisfaction: History, Myths, and Misperceptions
Richard Bolton Siegrist, Jr., MBA, MS, CPA
Patient satisfaction is top of mind today for most health care organizations, from hospitals to physician practices to home health care agencies. Not only do a majority of senior health care executives have compensation tied to patient satisfaction scores, but hospital reimbursement is also being directly affected by inpatient satisfaction ratings as a part of the Centers for Medicare and Medicaid Services (CMS) value-based purchasing program and private payer initiatives.
History of Patient Satisfaction in Health Care
It was certainly not always so. When Notre Dame professors Irwin Press, PhD, a medical anthropologist, and Rod Ganey, PhD, a sociologist and statistician, started Press Ganey in 1985, they essentially created a new market. They brought the science of sound survey design and administration to health care.
Press Ganey started out with just a handful of hospital clients. Each year over the next decade and a half, more and more hospitals saw the value that could be gained from tracking their patients’ satisfaction and comparing it with that of other similar organizations. The number of companies providing services correspondingly grew to include such firms as NRC, Gallup, HealthStream, PRC, and Avatar.
During that same period, the survey’s subject sites expanded from inpatient units to emergency, outpatient, ambulatory surgery, and medical practice departments, as well as other areas. The sophistication of data collection, analysis, and reporting continued to increase. Survey companies began to offer health care organizations advice on how to improve their satisfaction scores after the surveys had been administered and analyzed.
The federal government first became active in patient satisfaction in 2002 [1]. That year CMS and the Agency for Healthcare Research and Quality (AHRQ) collaborated to research, develop, and test the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS is a standardized 27-question survey administered randomly by approved vendors or the hospital to adult hospital inpatients after discharge.
After an extensive review process that included multiple opportunities for public comment, the HCAHPS survey was approved by the National Quality Forum in October 2005 and implemented by CMS in October 2006. The first public reporting of HCAHPS results occurred in March 2008, with voluntary reporting by hospitals.
As part of the Deficit Reduction Act of 2005, hospitals received a financial incentive (i.e., pay for reporting) for participating in HCAHPS starting in 2007 [1]. Not surprisingly, eligible hospital participation rose to nearly 95 percent that year [2]. These financial incentives were strengthened through the Affordable Care Act of 2010, under which hospital Medicare reimbursement (i.e., pay for performance) was influenced by comparative performance and improvement on HCAHPS [1]. Since HCAHPS results were first made publicly available, hospital scores overall have consistently increased with each new release of HCAHPS data [3-9].
Myths and Misperceptions
With patient satisfaction assuming such a prominent role in health care, a number of myths and misperceptions about it have arisen. The rest of this article explores some of those myths and their implications.
Myth #1: Very few patients fill out satisfaction surveys. In most industries, the average response rate to customer satisfaction surveys is relatively low. The response rates in health care are substantially higher, most likely due to the relative importance of the health care experience compared to experiences with non-health-related products or services.
On the HCAHPS national results for hospital inpatient care covering patient surveys for the 12-month period of October 2011 through September 2012 [10], the average hospital response rate was 32 percent. Three-quarters of the hospitals had response rates greater than 27 percent, and one-quarter exceeded a 37 percent response rate.
Myth #2: Patients who fill out surveys are generally unhappy with their care. While this may be the case in non-health care industries, it is decidedly not true in health care. In the most recent HCAHPS national results, 70 percent of responding patients rated their hospitals 9 or 10 overall (often referred to as “top box”) on a scale of 0 to 10 [10]. As impressively, 92 percent of responding patients rated their hospitals a 7 or higher [10]. This positive experience led 71 percent of patients nationally to say they would definitely recommend the hospital to friends and family; 95 percent would probably or definitely recommend the hospital to friends and family [10].
Patients are particularly pleased with the communication from nurses and doctors. In the most recent HCAHPS results, 78 percent of patients said their nurses always communicated well, and 81 percent indicated that their doctors always communicated well [10].
While it does vary from one hospital to another, in general, respondents are happy with the care they receive.
Myth #3: Only very unhappy or happy patients make comments on their surveys. Patient comments may be one of the most useful aspects of a patient satisfaction survey. While numerical ratings are important, the comments can provide deeper insights for the hospital into what is leading to high or low ratings. If only very unhappy or very happy patients were to add comments, then the comments could be misleading. However, this is not the case. According to a Press Ganey analysis of client hospital data for 2010, almost half of responding patients took the time to add comments on inpatient surveys, for an average of almost 3 comments per survey. The analysis indicated that 47 percent of patients who gave medium ratings commented (in addition to 59 percent of respondents who gave low ratings and 45 percent of those who gave high ratings). These comments are a rich, often underutilized resource for health care institutions to better understand how they can improve patient satisfaction.
Myth #4: Patient satisfaction is primarily a popularity contest. Patient satisfaction and quality are not related. Patients can’t evaluate the quality of care that is being delivered. There is a fair amount of controversy about this area of discussion in the health care literature. Some research questions whether patient satisfaction correlates with quality. A 2012 article in the Archives of Internal Medicine, for example, reported that higher patient satisfaction was associated with lower emergency room use, but with higher levels of inpatient care, expenditure on drugs, and rates of mortality [11]. Despite this, a number of studies support the idea that, while patients may not understand the technical details of care, their perceptions of quality from what they see, hear, and feel can be remarkably accurate [12, 13]. Patients seem to be able to distinguish reasonably well between friendliness and competence. Is friendliness something that patients’ value? Yes, but they see it as only part of the optimal patient experience.
A study reported in Circulation: Cardiovascular Quality and Outcomes in 2010 found that higher patient (and patient family) satisfaction was associated with lower risk-adjusted inpatient mortality rates for acute myocardial infarction, even after controlling for hospital performance on the core process measures for treating acute myocardial infarction [14]. The study authors conclude that “higher patient satisfaction is associated with improved [hospital] guideline adherence and lower inpatient mortality rates, suggesting that patients are good discriminators of the type of care they receive” [15]. Similarly, a 2011 article in the American Journal of Managed Care reported that higher patient satisfaction was associated with lower 30-day readmission rates for heart failure, heart attack, and pneumonia patients [12]. Additional studies have shown that organizations with higher patient satisfaction ratings tend to have fewer patient lawsuits and stronger financial performance [16, 17].
A 2013 systematic review of 55 studies in BMJ Open concluded that “the data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare” [13]. At the end of the day, patients’ perception of their care matters from both service and quality perspectives.
Myth #5: You can’t improve patient satisfaction scores significantly in any reasonable timeframe. It is clearly not easy to improve patient satisfaction scores dramatically over a relatively short period of time. It requires a true commitment throughout the organization, constant attention to results, and usually a big change in the organization’s culture. Yet, organizations have demonstrated that it can be done.
The Cleveland Clinic is a prime example. As a major academic medical center, it has a long-standing reputation for clinical excellence, consistently being ranked at the top of such surveys as that of the U.S. News and World Report. But until recently, it had not distinguished NEWS | February 13, 2012
Patient satisfaction linked to higher health-care expenses and mortality
Doctors may agree to patient requests for services to increase patient satisfaction
Editor's note:
Read this press release [en español]
1K
(SACRAMENTO, Calif.) —
A team of UC Davis researchers found that people who are the most satisfied with their doctors are more likely to be hospitalized, accumulate more health-care and drug expenditures, and have higher death rates than patients who are less satisfied with their care.
Published today in the Archives of Internal Medicine, the national study is believed to be the first to suggest that an overemphasis on patient satisfaction could
Richard Bolton Siegrist, Jr., MBA, MS, CPA
Patient satisfaction is top of mind today for most health care organizations, from hospitals to physician practices to home health care agencies. Not only do a majority of senior health care executives have compensation tied to patient satisfaction scores, but hospital reimbursement is also being directly affected by inpatient satisfaction ratings as a part of the Centers for Medicare and Medicaid Services (CMS) value-based purchasing program and private payer initiatives.
History of Patient Satisfaction in Health Care
It was certainly not always so. When Notre Dame professors Irwin Press, PhD, a medical anthropologist, and Rod Ganey, PhD, a sociologist and statistician, started Press Ganey in 1985, they essentially created a new market. They brought the science of sound survey design and administration to health care.
Press Ganey started out with just a handful of hospital clients. Each year over the next decade and a half, more and more hospitals saw the value that could be gained from tracking their patients’ satisfaction and comparing it with that of other similar organizations. The number of companies providing services correspondingly grew to include such firms as NRC, Gallup, HealthStream, PRC, and Avatar.
During that same period, the survey’s subject sites expanded from inpatient units to emergency, outpatient, ambulatory surgery, and medical practice departments, as well as other areas. The sophistication of data collection, analysis, and reporting continued to increase. Survey companies began to offer health care organizations advice on how to improve their satisfaction scores after the surveys had been administered and analyzed.
The federal government first became active in patient satisfaction in 2002 [1]. That year CMS and the Agency for Healthcare Research and Quality (AHRQ) collaborated to research, develop, and test the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS is a standardized 27-question survey administered randomly by approved vendors or the hospital to adult hospital inpatients after discharge.
After an extensive review process that included multiple opportunities for public comment, the HCAHPS survey was approved by the National Quality Forum in October 2005 and implemented by CMS in October 2006. The first public reporting of HCAHPS results occurred in March 2008, with voluntary reporting by hospitals.
As part of the Deficit Reduction Act of 2005, hospitals received a financial incentive (i.e., pay for reporting) for participating in HCAHPS starting in 2007 [1]. Not surprisingly, eligible hospital participation rose to nearly 95 percent that year [2]. These financial incentives were strengthened through the Affordable Care Act of 2010, under which hospital Medicare reimbursement (i.e., pay for performance) was influenced by comparative performance and improvement on HCAHPS [1]. Since HCAHPS results were first made publicly available, hospital scores overall have consistently increased with each new release of HCAHPS data [3-9].
Myths and Misperceptions
With patient satisfaction assuming such a prominent role in health care, a number of myths and misperceptions about it have arisen. The rest of this article explores some of those myths and their implications.
Myth #1: Very few patients fill out satisfaction surveys. In most industries, the average response rate to customer satisfaction surveys is relatively low. The response rates in health care are substantially higher, most likely due to the relative importance of the health care experience compared to experiences with non-health-related products or services.
On the HCAHPS national results for hospital inpatient care covering patient surveys for the 12-month period of October 2011 through September 2012 [10], the average hospital response rate was 32 percent. Three-quarters of the hospitals had response rates greater than 27 percent, and one-quarter exceeded a 37 percent response rate.
Myth #2: Patients who fill out surveys are generally unhappy with their care. While this may be the case in non-health care industries, it is decidedly not true in health care. In the most recent HCAHPS national results, 70 percent of responding patients rated their hospitals 9 or 10 overall (often referred to as “top box”) on a scale of 0 to 10 [10]. As impressively, 92 percent of responding patients rated their hospitals a 7 or higher [10]. This positive experience led 71 percent of patients nationally to say they would definitely recommend the hospital to friends and family; 95 percent would probably or definitely recommend the hospital to friends and family [10].
Patients are particularly pleased with the communication from nurses and doctors. In the most recent HCAHPS results, 78 percent of patients said their nurses always communicated well, and 81 percent indicated that their doctors always communicated well [10].
While it does vary from one hospital to another, in general, respondents are happy with the care they receive.
Myth #3: Only very unhappy or happy patients make comments on their surveys. Patient comments may be one of the most useful aspects of a patient satisfaction survey. While numerical ratings are important, the comments can provide deeper insights for the hospital into what is leading to high or low ratings. If only very unhappy or very happy patients were to add comments, then the comments could be misleading. However, this is not the case. According to a Press Ganey analysis of client hospital data for 2010, almost half of responding patients took the time to add comments on inpatient surveys, for an average of almost 3 comments per survey. The analysis indicated that 47 percent of patients who gave medium ratings commented (in addition to 59 percent of respondents who gave low ratings and 45 percent of those who gave high ratings). These comments are a rich, often underutilized resource for health care institutions to better understand how they can improve patient satisfaction.
Myth #4: Patient satisfaction is primarily a popularity contest. Patient satisfaction and quality are not related. Patients can’t evaluate the quality of care that is being delivered. There is a fair amount of controversy about this area of discussion in the health care literature. Some research questions whether patient satisfaction correlates with quality. A 2012 article in the Archives of Internal Medicine, for example, reported that higher patient satisfaction was associated with lower emergency room use, but with higher levels of inpatient care, expenditure on drugs, and rates of mortality [11]. Despite this, a number of studies support the idea that, while patients may not understand the technical details of care, their perceptions of quality from what they see, hear, and feel can be remarkably accurate [12, 13]. Patients seem to be able to distinguish reasonably well between friendliness and competence. Is friendliness something that patients’ value? Yes, but they see it as only part of the optimal patient experience.
A study reported in Circulation: Cardiovascular Quality and Outcomes in 2010 found that higher patient (and patient family) satisfaction was associated with lower risk-adjusted inpatient mortality rates for acute myocardial infarction, even after controlling for hospital performance on the core process measures for treating acute myocardial infarction [14]. The study authors conclude that “higher patient satisfaction is associated with improved [hospital] guideline adherence and lower inpatient mortality rates, suggesting that patients are good discriminators of the type of care they receive” [15]. Similarly, a 2011 article in the American Journal of Managed Care reported that higher patient satisfaction was associated with lower 30-day readmission rates for heart failure, heart attack, and pneumonia patients [12]. Additional studies have shown that organizations with higher patient satisfaction ratings tend to have fewer patient lawsuits and stronger financial performance [16, 17].
A 2013 systematic review of 55 studies in BMJ Open concluded that “the data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare” [13]. At the end of the day, patients’ perception of their care matters from both service and quality perspectives.
Myth #5: You can’t improve patient satisfaction scores significantly in any reasonable timeframe. It is clearly not easy to improve patient satisfaction scores dramatically over a relatively short period of time. It requires a true commitment throughout the organization, constant attention to results, and usually a big change in the organization’s culture. Yet, organizations have demonstrated that it can be done.
The Cleveland Clinic is a prime example. As a major academic medical center, it has a long-standing reputation for clinical excellence, consistently being ranked at the top of such surveys as that of the U.S. News and World Report. But until recently, it had not distinguished NEWS | February 13, 2012
Patient satisfaction linked to higher health-care expenses and mortality
Doctors may agree to patient requests for services to increase patient satisfaction
Editor's note:
Read this press release [en español]
1K
(SACRAMENTO, Calif.) —
A team of UC Davis researchers found that people who are the most satisfied with their doctors are more likely to be hospitalized, accumulate more health-care and drug expenditures, and have higher death rates than patients who are less satisfied with their care.
Published today in the Archives of Internal Medicine, the national study is believed to be the first to suggest that an overemphasis on patient satisfaction could
0/5000
Bệnh nhân sự hài lòng nhất: Lịch sử, thần thoại và MisperceptionsRichard Bolton Siegrist, Jr., MBA, MS, CPABệnh nhân hài lòng là hàng đầu của tâm trí vào ngày hôm qua cho hầu hết các tổ chức Chăm sóc sức khỏe, từ các bệnh viện để bác sĩ thực hành cho các cơ quan nhà chăm sóc sức khỏe. Không chỉ làm một phần lớn các chăm sóc sức khỏe cao cấp giám đốc điều hành có bồi thường gắn với điểm số bệnh nhân hài lòng, nhưng hoàn trả chi phí bệnh viện cũng được trực tiếp bị ảnh hưởng bởi xếp hạng sự hài lòng của bệnh nhân nội trú là một phần của Trung tâm cho Medicare và Medicaid dịch vụ (CMS) dựa trên giá trị mua chương trình và sáng kiến người nộp tiền riêng.Lịch sử của sự hài lòng của bệnh nhân trong chăm sóc sức khỏeĐó là chắc chắn không phải luôn luôn như vậy. Khi giáo sư nhà thờ Đức Bà Irwin Press, tiến sĩ, một nhà nhân chủng học y tế, và Rod Ganey, tiến sĩ, một nhà xã hội học và thống kê, bắt đầu báo chí Ganey năm 1985, họ về cơ bản tạo ra một thị trường mới. Họ đưa khoa học của âm thanh khảo sát thiết kế và quản lý chăm sóc sức khỏe.Báo chí Ganey bắt đầu với chỉ một số ít các bệnh viện khách hàng. Mỗi năm qua các tiếp theo thập kỷ rưỡi, các bệnh viện càng thấy giá trị mà có thể thu được từ theo dõi sự hài lòng của bệnh nhân của họ và so sánh nó với các tổ chức tương tự khác. Nhiều công ty cung cấp dịch vụ tương ứng đã tăng trưởng để bao gồm các công ty như NRC, Gallup, HealthStream, Trung Quốc, và Avatar.Trong cùng thời kỳ, các cuộc khảo sát chủ đề trang web mở rộng từ các đơn vị nội trú khẩn cấp, ngoại trú, phẫu thuật di động, và bộ phận y tế thực hành, cũng như các khu vực khác. Tinh tế của thu thập dữ liệu, phân tích và báo cáo tiếp tục tăng. Công ty khảo sát bắt đầu cung cấp tổ chức Chăm sóc sức khỏe lời khuyên về cách cải thiện điểm số sự hài lòng của họ sau khi các cuộc điều tra đã được quản lý và phân tích.Chính phủ liên bang đầu tiên bắt đầu hoạt động trong sự hài lòng của bệnh nhân vào năm 2002 [1]. Năm đó CMS và cơ quan y tế nghiên cứu và chất lượng (AHRQ) phối hợp để nghiên cứu, phát triển và kiểm tra các cuộc khảo sát bệnh viện người tiêu dùng đánh giá của y tế nhà cung cấp và hệ thống (HCAHPS). HCAHPS là một cuộc khảo sát 27 câu hỏi tiêu chuẩn quản lý một cách ngẫu nhiên bởi nhà cung cấp được chấp thuận hoặc bệnh viện để dành cho người lớn bệnh viện inpatients sau khi xuất viện.Sau khi một quá trình xem xét rộng lớn bao gồm nhiều cơ hội cho các bình luận công khai, cuộc khảo sát HCAHPS được chấp thuận bởi diễn đàn chất lượng quốc gia vào tháng 10 năm 2005 và thực hiện bởi CMS trong tháng 10 năm 2006. Báo cáo công cộng đầu tiên của kết quả HCAHPS xảy ra trong tháng 3 năm 2008, với báo cáo tự nguyện của bệnh viện.Là một phần của đạo luật giảm thâm hụt năm 2005, bệnh viện đã nhận được một khuyến khích tài chính (tức là, trả tiền cho báo cáo) đã tham gia HCAHPS bắt đầu vào năm 2007 [1]. Không ngạc nhiên, bệnh viện hội đủ điều kiện tham gia tăng đến gần 95 phần trăm năm đó [2]. Những ưu đãi tài chính đã được tăng cường thông qua các hành động chăm sóc giá cả phải chăng của năm 2010, theo bệnh viện mà Medicare bồi hoàn (tức là, trả tiền cho hiệu suất) bị ảnh hưởng bởi so sánh hiệu suất và cải thiện trên HCAHPS [1]. Kể từ khi HCAHPS kết quả đầu tiên đã được thực hiện công khai có sẵn, bệnh viện điểm tổng thể đã liên tục tăng với mỗi bản phát hành mới HCAHPS dữ liệu [3-9].Huyền thoại và MisperceptionsVới sự hài lòng bệnh nhân giả định một vai trò nổi bật trong chăm sóc sức khỏe, một số huyền thoại và misperceptions về nó có phát sinh. Phần còn lại của bài viết này khám phá một số những huyền thoại và tác động của họ.Chuyện hoang đường #1: Rất ít bệnh nhân điền khảo sát sự hài lòng. Trong hầu hết các ngành công nghiệp, mức trung bình phản ứng để cuộc khảo sát sự hài lòng của khách hàng là tương đối thấp. Giá phản ứng y tế đáng kể cao hơn, có nhiều khả năng do tầm quan trọng tương đối của kinh nghiệm chăm sóc sức khỏe so với kinh nghiệm với phòng không sức khỏe-liên quan đến sản phẩm hoặc dịch vụ.Trên các kết quả quốc gia HCAHPS cho việc chăm sóc bệnh nhân nội trú của bệnh viện, bao gồm khảo sát ý kiến bệnh nhân trong giai đoạn tháng 12 tháng 10 năm 2011 thông qua tháng 9/2012 [10], tỷ lệ phản ứng bệnh viện trung bình là 32%. Ba phần tư của các bệnh viện có tỷ lệ phản ứng lớn hơn 27 phần trăm, và một phần tư vượt quá tốc độ phản ứng 37 phần trăm.Chuyện hoang đường #2: Các bệnh nhân điền vào cuộc điều tra được thường không hài lòng với việc chăm sóc của họ. Trong khi điều này có thể là các trường hợp trong ngành công nghiệp phòng không-y tế, đó là decidedly không đúng trong chăm sóc sức khỏe. Trong các kết quả quốc gia đặt tại HCAHPS, 70 phần trăm của bệnh nhân đáp ứng xếp của bệnh viện 9 hoặc 10 tổng thể (thường được gọi là "hàng đầu hộp") trên một quy mô 0-10 [10]. Theo ấn tượng, 92 phần trăm bệnh nhân đáp ứng đánh giá bệnh viện của một 7 hoặc cao hơn [10]. Kinh nghiệm tích cực này dẫn 71 phần trăm của bệnh nhân trên toàn quốc để nói họ chắc chắn muốn giới thiệu bệnh viện cho bạn bè và gia đình; 95 phần trăm muốn có lẽ hoặc chắc chắn giới thiệu bệnh viện cho bạn bè và gia đình [10].Bệnh nhân được đặc biệt hài lòng với các giao tiếp từ y tá và các bác sĩ. Trong các kết quả HCAHPS đặt, thị trấn này có 78 phần trăm của bệnh nhân nói của họ y tá mà luôn luôn truyền đạt tốt, và 81% chỉ ra rằng các bác sĩ luôn luôn truyền đạt tốt [10].Trong khi nó khác nhau từ một trong những bệnh viện khác, nói chung, người trả lời được hài lòng với sự chăm sóc mà họ nhận được.Chuyện hoang đường #3: Bệnh nhân chỉ rất không hài lòng hay hạnh phúc làm cho ý kiến về cuộc điều tra của họ. Ý kiến bệnh nhân có thể là một trong những khía cạnh hữu ích nhất của một cuộc khảo sát sự hài lòng của bệnh nhân. Trong khi số xếp hạng là quan trọng, các ý kiến có thể cung cấp những hiểu biết sâu sắc hơn cho bệnh viện vào những gì đang dẫn đầu để xếp hạng cao hay thấp. Nếu chỉ rất không hài lòng hoặc rất hạnh phúc bệnh nhân đã là để thêm ý kiến, sau đó các ý kiến có thể gây hiểu nhầm. Tuy nhiên, đây không phải là trường hợp. Theo một báo chí Ganey phân tích dữ liệu bệnh viện khách hàng cho năm 2010, gần một nửa số bệnh nhân đáp ứng mất thời gian để thêm ý kiến vào cuộc điều tra nội trú, cho một trung bình của gần như 3 bài mỗi cuộc khảo sát. Các phân tích chỉ ra rằng 47 phần trăm của bệnh nhân đã cho xếp hạng trung bình nhận xét (ngoài 59 phần trăm của người trả lời người đã xếp hạng thấp và 45 phần trăm của những người đã cho xếp hạng cao). Những ý kiến là một nguồn tài nguyên phong phú, thường sử dụng đúng mức cho các tổ chức Chăm sóc sức khỏe để hiểu rõ hơn về cách họ có thể cải thiện sự hài lòng của bệnh nhân.Chuyện hoang đường #4: Các bệnh nhân hài lòng là chủ yếu là một cuộc thi phổ biến. Sự hài lòng của bệnh nhân và chất lượng không liên quan. Bệnh nhân không thể đánh giá chất lượng chăm sóc đang được giao. Có là một số tiền hợp lý của tranh cãi về khu vực này của cuộc thảo luận trong các tài liệu chăm sóc sức khỏe. Một số nghiên cứu câu hỏi cho dù bệnh nhân hài lòng tương quan với chất lượng. Một bài viết năm 2012 trong Archives of Internal Medicine, ví dụ, báo cáo rằng sự hài lòng cao của bệnh nhân được liên kết với thấp sử dụng phòng cấp cứu, nhưng với các cấp độ cao hơn của chăm sóc bệnh nhân nội trú, các chi phí về ma túy, và tỷ lệ tử vong [11]. Mặc dù vậy, một số nghiên cứu hỗ trợ ý tưởng rằng, trong khi bệnh nhân có thể không hiểu các chi tiết kỹ thuật chăm sóc, nhận thức của họ về chất lượng từ những gì họ nhìn thấy, nghe, và cảm thấy có thể được chính xác đáng [12, 13]. Bệnh nhân có vẻ để có thể phân biệt hợp lý tốt giữa thân thiện và năng lực. Là thân thiện với một cái gì đó giá trị đó bệnh nhân? Có, nhưng họ nhìn thấy nó như chỉ là một phần của kinh nghiệm bệnh nhân tối ưu.Một nghiên cứu báo cáo trong lưu thông: tim mạch chất lượng và kết quả trong 2010 tìm thấy rằng bệnh nhân cao hơn (và gia đình bệnh nhân) sự hài lòng là liên kết với tỷ lệ tử vong thấp hơn điều chỉnh rủi ro nội trú cho nhồi máu cơ tim cấp tính, ngay cả sau khi kiểm soát cho bệnh viện vào lõi quá trình các biện pháp để điều trị nhồi máu cơ tim cấp tính [14]. Các tác giả nghiên cứu kết luận rằng "sự hài lòng cao của bệnh nhân được kết hợp với cải tiến [bệnh viện] hướng dẫn tuân thủ và tỷ giá tỷ lệ tử vong thấp hơn bệnh nhân nội trú, gợi ý rằng bệnh nhân là tốt discriminators loại chăm sóc họ nhận được" [15]. Tương tự, một bài viết năm 2011 trong các American Journal của quản lý chăm sóc báo cáo rằng sự hài lòng cao của bệnh nhân được liên kết với tỷ giá thấp hơn 30 ngày readmission cho tim, đau tim, và bệnh nhân viêm phổi [12]. Bổ sung nghiên cứu đã chỉ ra rằng các tổ chức với sự hài lòng của bệnh nhân cao có xu hướng có ít hơn các vụ kiện bệnh nhân và mạnh mẽ hơn hiệu suất tài chính [16, 17].Một xem xét có hệ thống 2013 55 nghiên cứu trong BMJ mở kết luận rằng "các dữ liệu trình bày Hiển thị là bệnh nhân kinh nghiệm tích cực liên quan đến hiệu quả lâm sàng và bệnh nhân an toàn, và hỗ trợ các trường hợp cho sự bao gồm của bệnh nhân kinh nghiệm như là một trong những trụ cột trung tâm về chất lượng trong chăm sóc sức khỏe" [13]. Vào cuối ngày, bệnh nhân nhận thức về chăm sóc của vấn đề từ quan điểm chất lượng và dịch vụ.Chuyện hoang đường #5: Bạn không thể cải thiện sự hài lòng của bệnh nhân điểm số đáng kể trong bất kỳ khoảng thời gian hợp lý. Nó rõ ràng là không dễ dàng để cải thiện điểm số bệnh nhân hài lòng đáng kể trong một khoảng thời gian tương đối ngắn. Nó đòi hỏi một cam kết thực sự trong suốt tổ chức, thường xuyên quan tâm đến kết quả, và thường là một sự thay đổi lớn trong nền văn hóa của tổ chức. Tuy vậy, tổ chức đã chứng minh rằng nó có thể được thực hiện.Cleveland Clinic là một ví dụ nguyên tố. Là một trung tâm y tế lớn học tập, đô thị này có một danh tiếng lâu dài xuất sắc lâm sàng, luôn được xếp hạng ở đầu các cuộc điều tra như của U.S. News and World Report. Nhưng cho đến gần đây, nó đã không phân biệt với tin tức | Ngày 13 tháng 9 năm 2011Sự hài lòng của bệnh nhân liên kết với chi phí chăm sóc y tế cao hơn và tỷ lệ tử vongBác sĩ có thể đồng ý với các yêu cầu bệnh nhân cho các dịch vụ để tăng sự hài lòng của bệnh nhânChú ý:Đọc này phát hành báo chí [en español] 1K(SACRAMENTO, California) —Một nhóm các nhà nghiên cứu UC Davis tìm thấy rằng những người là hài lòng nhất với bác sĩ của họ có nhiều khả năng được nhập viện, tích lũy thêm chi phí chăm sóc sức khỏe và ma túy, và có tỷ lệ tử vong cao hơn bệnh nhân ít hài lòng với việc chăm sóc của họ.Được đăng vào ngày hôm nay trong Archives of Internal Medicine, nghiên cứu quốc gia được tin là người đầu tiên đề xuất rằng một overemphasis trên bệnh nhân hài lòng có thể
đang được dịch, vui lòng đợi..
Patient Satisfaction: History, Myths, and Misperceptions
Richard Bolton Siegrist, Jr., MBA, MS, CPA
Patient satisfaction is top of mind today for most health care organizations, from hospitals to physician practices to home health care agencies. Not only do a majority of senior health care executives have compensation tied to patient satisfaction scores, but hospital reimbursement is also being directly affected by inpatient satisfaction ratings as a part of the Centers for Medicare and Medicaid Services (CMS) value-based purchasing program and private payer initiatives.
History of Patient Satisfaction in Health Care
It was certainly not always so. When Notre Dame professors Irwin Press, PhD, a medical anthropologist, and Rod Ganey, PhD, a sociologist and statistician, started Press Ganey in 1985, they essentially created a new market. They brought the science of sound survey design and administration to health care.
Press Ganey started out with just a handful of hospital clients. Each year over the next decade and a half, more and more hospitals saw the value that could be gained from tracking their patients’ satisfaction and comparing it with that of other similar organizations. The number of companies providing services correspondingly grew to include such firms as NRC, Gallup, HealthStream, PRC, and Avatar.
During that same period, the survey’s subject sites expanded from inpatient units to emergency, outpatient, ambulatory surgery, and medical practice departments, as well as other areas. The sophistication of data collection, analysis, and reporting continued to increase. Survey companies began to offer health care organizations advice on how to improve their satisfaction scores after the surveys had been administered and analyzed.
The federal government first became active in patient satisfaction in 2002 [1]. That year CMS and the Agency for Healthcare Research and Quality (AHRQ) collaborated to research, develop, and test the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS is a standardized 27-question survey administered randomly by approved vendors or the hospital to adult hospital inpatients after discharge.
After an extensive review process that included multiple opportunities for public comment, the HCAHPS survey was approved by the National Quality Forum in October 2005 and implemented by CMS in October 2006. The first public reporting of HCAHPS results occurred in March 2008, with voluntary reporting by hospitals.
As part of the Deficit Reduction Act of 2005, hospitals received a financial incentive (i.e., pay for reporting) for participating in HCAHPS starting in 2007 [1]. Not surprisingly, eligible hospital participation rose to nearly 95 percent that year [2]. These financial incentives were strengthened through the Affordable Care Act of 2010, under which hospital Medicare reimbursement (i.e., pay for performance) was influenced by comparative performance and improvement on HCAHPS [1]. Since HCAHPS results were first made publicly available, hospital scores overall have consistently increased with each new release of HCAHPS data [3-9].
Myths and Misperceptions
With patient satisfaction assuming such a prominent role in health care, a number of myths and misperceptions about it have arisen. The rest of this article explores some of those myths and their implications.
Myth #1: Very few patients fill out satisfaction surveys. In most industries, the average response rate to customer satisfaction surveys is relatively low. The response rates in health care are substantially higher, most likely due to the relative importance of the health care experience compared to experiences with non-health-related products or services.
On the HCAHPS national results for hospital inpatient care covering patient surveys for the 12-month period of October 2011 through September 2012 [10], the average hospital response rate was 32 percent. Three-quarters of the hospitals had response rates greater than 27 percent, and one-quarter exceeded a 37 percent response rate.
Myth #2: Patients who fill out surveys are generally unhappy with their care. While this may be the case in non-health care industries, it is decidedly not true in health care. In the most recent HCAHPS national results, 70 percent of responding patients rated their hospitals 9 or 10 overall (often referred to as “top box”) on a scale of 0 to 10 [10]. As impressively, 92 percent of responding patients rated their hospitals a 7 or higher [10]. This positive experience led 71 percent of patients nationally to say they would definitely recommend the hospital to friends and family; 95 percent would probably or definitely recommend the hospital to friends and family [10].
Patients are particularly pleased with the communication from nurses and doctors. In the most recent HCAHPS results, 78 percent of patients said their nurses always communicated well, and 81 percent indicated that their doctors always communicated well [10].
While it does vary from one hospital to another, in general, respondents are happy with the care they receive.
Myth #3: Only very unhappy or happy patients make comments on their surveys. Patient comments may be one of the most useful aspects of a patient satisfaction survey. While numerical ratings are important, the comments can provide deeper insights for the hospital into what is leading to high or low ratings. If only very unhappy or very happy patients were to add comments, then the comments could be misleading. However, this is not the case. According to a Press Ganey analysis of client hospital data for 2010, almost half of responding patients took the time to add comments on inpatient surveys, for an average of almost 3 comments per survey. The analysis indicated that 47 percent of patients who gave medium ratings commented (in addition to 59 percent of respondents who gave low ratings and 45 percent of those who gave high ratings). These comments are a rich, often underutilized resource for health care institutions to better understand how they can improve patient satisfaction.
Myth #4: Patient satisfaction is primarily a popularity contest. Patient satisfaction and quality are not related. Patients can’t evaluate the quality of care that is being delivered. There is a fair amount of controversy about this area of discussion in the health care literature. Some research questions whether patient satisfaction correlates with quality. A 2012 article in the Archives of Internal Medicine, for example, reported that higher patient satisfaction was associated with lower emergency room use, but with higher levels of inpatient care, expenditure on drugs, and rates of mortality [11]. Despite this, a number of studies support the idea that, while patients may not understand the technical details of care, their perceptions of quality from what they see, hear, and feel can be remarkably accurate [12, 13]. Patients seem to be able to distinguish reasonably well between friendliness and competence. Is friendliness something that patients’ value? Yes, but they see it as only part of the optimal patient experience.
A study reported in Circulation: Cardiovascular Quality and Outcomes in 2010 found that higher patient (and patient family) satisfaction was associated with lower risk-adjusted inpatient mortality rates for acute myocardial infarction, even after controlling for hospital performance on the core process measures for treating acute myocardial infarction [14]. The study authors conclude that “higher patient satisfaction is associated with improved [hospital] guideline adherence and lower inpatient mortality rates, suggesting that patients are good discriminators of the type of care they receive” [15]. Similarly, a 2011 article in the American Journal of Managed Care reported that higher patient satisfaction was associated with lower 30-day readmission rates for heart failure, heart attack, and pneumonia patients [12]. Additional studies have shown that organizations with higher patient satisfaction ratings tend to have fewer patient lawsuits and stronger financial performance [16, 17].
A 2013 systematic review of 55 studies in BMJ Open concluded that “the data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare” [13]. At the end of the day, patients’ perception of their care matters from both service and quality perspectives.
Myth #5: You can’t improve patient satisfaction scores significantly in any reasonable timeframe. It is clearly not easy to improve patient satisfaction scores dramatically over a relatively short period of time. It requires a true commitment throughout the organization, constant attention to results, and usually a big change in the organization’s culture. Yet, organizations have demonstrated that it can be done.
The Cleveland Clinic is a prime example. As a major academic medical center, it has a long-standing reputation for clinical excellence, consistently being ranked at the top of such surveys as that of the U.S. News and World Report. But until recently, it had not distinguished NEWS | February 13, 2012
Patient satisfaction linked to higher health-care expenses and mortality
Doctors may agree to patient requests for services to increase patient satisfaction
Editor's note:
Read this press release [en español]
1K
(SACRAMENTO, Calif.) —
A team of UC Davis researchers found that people who are the most satisfied with their doctors are more likely to be hospitalized, accumulate more health-care and drug expenditures, and have higher death rates than patients who are less satisfied with their care.
Published today in the Archives of Internal Medicine, the national study is believed to be the first to suggest that an overemphasis on patient satisfaction could
Richard Bolton Siegrist, Jr., MBA, MS, CPA
Patient satisfaction is top of mind today for most health care organizations, from hospitals to physician practices to home health care agencies. Not only do a majority of senior health care executives have compensation tied to patient satisfaction scores, but hospital reimbursement is also being directly affected by inpatient satisfaction ratings as a part of the Centers for Medicare and Medicaid Services (CMS) value-based purchasing program and private payer initiatives.
History of Patient Satisfaction in Health Care
It was certainly not always so. When Notre Dame professors Irwin Press, PhD, a medical anthropologist, and Rod Ganey, PhD, a sociologist and statistician, started Press Ganey in 1985, they essentially created a new market. They brought the science of sound survey design and administration to health care.
Press Ganey started out with just a handful of hospital clients. Each year over the next decade and a half, more and more hospitals saw the value that could be gained from tracking their patients’ satisfaction and comparing it with that of other similar organizations. The number of companies providing services correspondingly grew to include such firms as NRC, Gallup, HealthStream, PRC, and Avatar.
During that same period, the survey’s subject sites expanded from inpatient units to emergency, outpatient, ambulatory surgery, and medical practice departments, as well as other areas. The sophistication of data collection, analysis, and reporting continued to increase. Survey companies began to offer health care organizations advice on how to improve their satisfaction scores after the surveys had been administered and analyzed.
The federal government first became active in patient satisfaction in 2002 [1]. That year CMS and the Agency for Healthcare Research and Quality (AHRQ) collaborated to research, develop, and test the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS is a standardized 27-question survey administered randomly by approved vendors or the hospital to adult hospital inpatients after discharge.
After an extensive review process that included multiple opportunities for public comment, the HCAHPS survey was approved by the National Quality Forum in October 2005 and implemented by CMS in October 2006. The first public reporting of HCAHPS results occurred in March 2008, with voluntary reporting by hospitals.
As part of the Deficit Reduction Act of 2005, hospitals received a financial incentive (i.e., pay for reporting) for participating in HCAHPS starting in 2007 [1]. Not surprisingly, eligible hospital participation rose to nearly 95 percent that year [2]. These financial incentives were strengthened through the Affordable Care Act of 2010, under which hospital Medicare reimbursement (i.e., pay for performance) was influenced by comparative performance and improvement on HCAHPS [1]. Since HCAHPS results were first made publicly available, hospital scores overall have consistently increased with each new release of HCAHPS data [3-9].
Myths and Misperceptions
With patient satisfaction assuming such a prominent role in health care, a number of myths and misperceptions about it have arisen. The rest of this article explores some of those myths and their implications.
Myth #1: Very few patients fill out satisfaction surveys. In most industries, the average response rate to customer satisfaction surveys is relatively low. The response rates in health care are substantially higher, most likely due to the relative importance of the health care experience compared to experiences with non-health-related products or services.
On the HCAHPS national results for hospital inpatient care covering patient surveys for the 12-month period of October 2011 through September 2012 [10], the average hospital response rate was 32 percent. Three-quarters of the hospitals had response rates greater than 27 percent, and one-quarter exceeded a 37 percent response rate.
Myth #2: Patients who fill out surveys are generally unhappy with their care. While this may be the case in non-health care industries, it is decidedly not true in health care. In the most recent HCAHPS national results, 70 percent of responding patients rated their hospitals 9 or 10 overall (often referred to as “top box”) on a scale of 0 to 10 [10]. As impressively, 92 percent of responding patients rated their hospitals a 7 or higher [10]. This positive experience led 71 percent of patients nationally to say they would definitely recommend the hospital to friends and family; 95 percent would probably or definitely recommend the hospital to friends and family [10].
Patients are particularly pleased with the communication from nurses and doctors. In the most recent HCAHPS results, 78 percent of patients said their nurses always communicated well, and 81 percent indicated that their doctors always communicated well [10].
While it does vary from one hospital to another, in general, respondents are happy with the care they receive.
Myth #3: Only very unhappy or happy patients make comments on their surveys. Patient comments may be one of the most useful aspects of a patient satisfaction survey. While numerical ratings are important, the comments can provide deeper insights for the hospital into what is leading to high or low ratings. If only very unhappy or very happy patients were to add comments, then the comments could be misleading. However, this is not the case. According to a Press Ganey analysis of client hospital data for 2010, almost half of responding patients took the time to add comments on inpatient surveys, for an average of almost 3 comments per survey. The analysis indicated that 47 percent of patients who gave medium ratings commented (in addition to 59 percent of respondents who gave low ratings and 45 percent of those who gave high ratings). These comments are a rich, often underutilized resource for health care institutions to better understand how they can improve patient satisfaction.
Myth #4: Patient satisfaction is primarily a popularity contest. Patient satisfaction and quality are not related. Patients can’t evaluate the quality of care that is being delivered. There is a fair amount of controversy about this area of discussion in the health care literature. Some research questions whether patient satisfaction correlates with quality. A 2012 article in the Archives of Internal Medicine, for example, reported that higher patient satisfaction was associated with lower emergency room use, but with higher levels of inpatient care, expenditure on drugs, and rates of mortality [11]. Despite this, a number of studies support the idea that, while patients may not understand the technical details of care, their perceptions of quality from what they see, hear, and feel can be remarkably accurate [12, 13]. Patients seem to be able to distinguish reasonably well between friendliness and competence. Is friendliness something that patients’ value? Yes, but they see it as only part of the optimal patient experience.
A study reported in Circulation: Cardiovascular Quality and Outcomes in 2010 found that higher patient (and patient family) satisfaction was associated with lower risk-adjusted inpatient mortality rates for acute myocardial infarction, even after controlling for hospital performance on the core process measures for treating acute myocardial infarction [14]. The study authors conclude that “higher patient satisfaction is associated with improved [hospital] guideline adherence and lower inpatient mortality rates, suggesting that patients are good discriminators of the type of care they receive” [15]. Similarly, a 2011 article in the American Journal of Managed Care reported that higher patient satisfaction was associated with lower 30-day readmission rates for heart failure, heart attack, and pneumonia patients [12]. Additional studies have shown that organizations with higher patient satisfaction ratings tend to have fewer patient lawsuits and stronger financial performance [16, 17].
A 2013 systematic review of 55 studies in BMJ Open concluded that “the data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare” [13]. At the end of the day, patients’ perception of their care matters from both service and quality perspectives.
Myth #5: You can’t improve patient satisfaction scores significantly in any reasonable timeframe. It is clearly not easy to improve patient satisfaction scores dramatically over a relatively short period of time. It requires a true commitment throughout the organization, constant attention to results, and usually a big change in the organization’s culture. Yet, organizations have demonstrated that it can be done.
The Cleveland Clinic is a prime example. As a major academic medical center, it has a long-standing reputation for clinical excellence, consistently being ranked at the top of such surveys as that of the U.S. News and World Report. But until recently, it had not distinguished NEWS | February 13, 2012
Patient satisfaction linked to higher health-care expenses and mortality
Doctors may agree to patient requests for services to increase patient satisfaction
Editor's note:
Read this press release [en español]
1K
(SACRAMENTO, Calif.) —
A team of UC Davis researchers found that people who are the most satisfied with their doctors are more likely to be hospitalized, accumulate more health-care and drug expenditures, and have higher death rates than patients who are less satisfied with their care.
Published today in the Archives of Internal Medicine, the national study is believed to be the first to suggest that an overemphasis on patient satisfaction could
đang được dịch, vui lòng đợi..
Các ngôn ngữ khác
Hỗ trợ công cụ dịch thuật: Albania, Amharic, Anh, Armenia, Azerbaijan, Ba Lan, Ba Tư, Bantu, Basque, Belarus, Bengal, Bosnia, Bulgaria, Bồ Đào Nha, Catalan, Cebuano, Chichewa, Corsi, Creole (Haiti), Croatia, Do Thái, Estonia, Filipino, Frisia, Gael Scotland, Galicia, George, Gujarat, Hausa, Hawaii, Hindi, Hmong, Hungary, Hy Lạp, Hà Lan, Hà Lan (Nam Phi), Hàn, Iceland, Igbo, Ireland, Java, Kannada, Kazakh, Khmer, Kinyarwanda, Klingon, Kurd, Kyrgyz, Latinh, Latvia, Litva, Luxembourg, Lào, Macedonia, Malagasy, Malayalam, Malta, Maori, Marathi, Myanmar, Mã Lai, Mông Cổ, Na Uy, Nepal, Nga, Nhật, Odia (Oriya), Pashto, Pháp, Phát hiện ngôn ngữ, Phần Lan, Punjab, Quốc tế ngữ, Rumani, Samoa, Serbia, Sesotho, Shona, Sindhi, Sinhala, Slovak, Slovenia, Somali, Sunda, Swahili, Séc, Tajik, Tamil, Tatar, Telugu, Thái, Thổ Nhĩ Kỳ, Thụy Điển, Tiếng Indonesia, Tiếng Ý, Trung, Trung (Phồn thể), Turkmen, Tây Ban Nha, Ukraina, Urdu, Uyghur, Uzbek, Việt, Xứ Wales, Yiddish, Yoruba, Zulu, Đan Mạch, Đức, Ả Rập, dịch ngôn ngữ.
- Nếu trả lời sai, số tiền sẽ được giữ ngu
- nuoc cam
- Nếu trả lời sai, số tiền sẽ được giữ ngu
- Acquiring new customers can be costly. I
- has been awarded this certificate for co
- LIGHTING IN PLANT - 8321 LIGHTING POLE
- tôi thích nhất là phòng ngủ của tôi vì ở
- Improve the birth rate, hatching rate an
- giá thành
- How many points you Korean?
- Rashi advises Ranvir to move on in life.
- nuoc trai cay
- Prominent licenses
- tôi sẽ nộp cho công an
- Rủi ro tỷ giá: Công ty thực hiện một số
- Nếu trả lời sai, số tiền sẽ được giữ ngu
- Program 4.3: MATLAB Codes to Generate PS
- Improve the birth rate, hatching rate an
- sấy taoj kiểu
- 株式株式会社ムラタ メガネのプリンスです。このたびは弊社の採用試験にご応募いただ
- đánh số trang bị lệch
- Japanese scrap booked to Taiwan after pr
- Rectum
- Monitored pay or adjustments salary
