I am always trying to be healthier. Like a good improver, I know that I can’t do this without a “how much, by when” aim. The problem is health is hard to measure, so I’ve settled on weight since it’s readily available, easy to track, and simple to calculate.
But since I measure weight, I sometimes forget that my goal is better health (not weight loss) and I end up using the wrong strategies. (Think fad diets instead of altering long-term habits and behaviors.)
This situation is analogous to what happens to health care organizations when they rely too heavily on patient satisfaction scores.
Move from Satisfaction to Engagement
When teams set out to improve care, it’s essential to set a numerical aim. The problem is when organizations try to evaluate patient engagement — the patient's active participation in the management of their own health — they almost always default to measuring patient satisfaction instead. It’s difficult to figure out how to quantify patient engagement; it’s much easier to use the data they’re already collecting through HCAHPS surveys and other patient experience instruments.
But easy isn’t necessarily right. In the past year, there have been several articles describing the risks inherent in efforts to “satisfy” patients. In fact, one study from UC Davis found a correlation between high patient satisfaction scores and higher mortality rates and costs.
These publications raise important questions about the risks of focusing on patient satisfaction. Digging a layer deeper, is “patient satisfaction” even the right metric? Do we want to satisfy patients or do we want to engage them in their own care and the processes of improvement? Do we want to please patients or do we want to provide care that contributes to optimal functioning and quality of life?
Like my never-ending quest to improve my health, organizations set out to engage patients and families, but they settle for patient satisfaction as a measure because it’s required, reimbursed, and available. When satisfaction becomes the measure, it also becomes the aim. When satisfaction becomes the aim, the high-leverage strategies to improve it become superficial and possibly wasteful. For example:
- It is easier to hire a gourmet chef and improve the menu than to develop empathy in a workforce suffering from burnout.
- It’s simpler to consider adding private rooms than to improve the quality and cultural competence of communication between patients and clinicians.
- It takes less effort and thought to over-order diagnostic tests than to redesign care in partnership with patients and families.
Avoid the Pitfalls of Measuring Patient Satisfaction
Although there’s no silver bullet, there are ways to avoid the pitfalls of measuring patient satisfaction:
- Don’t let satisfaction be your only measure. Consider adding patient-reported measures of health or engagement or qualitative measures that allow patients and families to provide feedback about their experience.
- Make sure your leaders and staff understand and communicate the difference between engagement and satisfaction. Paint a picture of how care (and patient’s experience of care) would be different when the goal is to partner with patients.
- Build a theory for patient engagement. Are your current activities the highest-leverage strategies for engagement? Bring staff and patients together to develop a driver diagram that identifies the most effective ways to engage patients. For example, one driver may be shared care goals described in the words of patients.
- Reward providers who are doing the right thing. Highlight and recognize providers who are truly engaging patients. For example, raise the profile of providers who are using shared decision making to discuss whether an antibiotic is the right choice or sharing non-prescription alternatives for symptom relief.
- Monitor balancing measures. Make sure providers aren’t getting high satisfaction scores just because they comply with all their patients’ requests. For example, I have heard numerous stories of increases in satisfaction scores because providers assent to requests for prescription refills or diagnostic tests without meaningful discussion.
- Learn from bright spots. What useful information can you find in letters of praise from patients and families? In most cases, if someone took the time to write, they’re not just satisfied customers; they likely received care that moved or touched them. These bright spots can drive the identification of engagement levers for your health system.
These strategies are not the easy path to take, but getting the right aims and measures can make all the difference.
How are you measuring true engagement of patients and families? Let us know in the comments below.
Christina Gunther-Murphy, MBA, is an Executive Director at the Institute for Healthcare Improvement (IHI) and oversees IHI’s Person- and Family-Centered Care Focus Area.