The Science of Patient Satisfaction

Lisa Harris, MD, is assistant professor of medicine at IUSM. She also is chief of medicine at Wishard Health Services, chief medical officer for IU Medical Group-Primary Care and research scientist with Regenstrief Institute.

Concern with patient satisfaction was not part of the curriculum in the 1980s when I was a student. But today the IU School of Medicine and many other medical schools are teaching doctors to listen and learn from their patients.

I became interested in patient satisfaction as a means of improving health care while working on my first research project in 1993. As part of a study on slowing disease progression, I found a relationship between patient satisfaction, compliance with medications, and lower blood pressure. This led me to speculate that patients' experiences with care might be related to both processes and outcomes.

According to the Wishard Hospital patients we have surveyed, their single most important area of concern is communication: among staff members, between staff and patient, and as it affects the transition from hospital to home. Based on these responses, we have developed an intervention which utilizes and expands the Regenstrief Medical Records System (RMRS). The RMRS is a centralized electronic medical database that ensures that critical patient data are always legible, up to date, and accessible to authorized health care providers.

Our research focuses on providing computer notebooks and hardware that enable nurses to enter information vital to nurses, social workers, dietitians, pharmacists and physicians who must work together to care for a patient. It aims to include such things as the notes containing contact numbers for the patient's relatives, information related to the patient's functional status and social support with vital signs and other information in the patient's centralized record. It also triggers requests for consultations that may be needed based on the patient's profile without a physician's request, freeing up the physician to concentrate on the patient's acute problems while ensuring that the appropriate care provider is engaged to address the patient's other critical needs.

Is this approach as useful as we think it is? We defer to scientific analysis for the verdict and have undertaken a one-year trial to determine whether this intervention actually improves care from the patient's perspective. The trial is also designed to determine whether the intervention better prepares patients to deal with chronic health problems after discharge; i.e. does it reduce hospital readmission rates? We hope to have our answers later this spring.

One thing we already have learned is that even when patient responses to structured survey items reflected satisfaction with care, thirty percent of the same patients responded negatively when questions about their care were open ended. Since these verbatim (or open-ended) responses seemed to add important information, we developed a way to code them. In order to study whether including this qualitative data will make a difference in the health care provider's ability to improve patient care, we have submitted a proposal to test the importance and value of the extra effort needed to analyze and use these data.

The objective of both of these studies is to focus on patient satisfaction as a science as well as an art. We need to determine whether, given the right tools, we can look to our patients themselves to help us improve care in a measurable way.