Is Patient Satisfaction a Misplaced Priority?

A recent article in Atlantic magazine online caught my eye. Titled "The Problem With Satisfied Patients," it charges that elements of the Affordable Care Act that reward healthcare providers for increasing patient satisfaction scores may have serious—in fact, deadly—consequences by prioritizing the patient experience over actual clinical results. Here's the money quote:

"...a national study revealed that patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. Worse, the most satisfied patients were significantly more likely to die in the next four years." (Emphasis added.)

Granted, most of of the criticism falls on areas other than dining. The major culprit seems to be a healthcare version of the grade inflation that has already allegedly infiltrated colleges. But instead of professors being encouraged to give higher grades in order to promote "customer satisfaction" among students (and, crucially, their parents) at the expense of rigorous academics, the criticism is that doctors and nurses are becoming so concerned with raising patient satisfaction scores that they are less inclined to deliver hard truths (you're too fat!) and more inclined to go along with treatments requested or preferred by the patient in order to boost satisfaction scores.

On the food front, the accusation is that hospitals are putting more emphasis (and dollars) toward areas that superficially promote satisfaction—like room service meals and fancier menus—rather than on areas that actually promote healing.

Is it a valid point?

Well, it's true that the Affordable Care Act was written in a way that incentivizes a push for higher patient satisfaction scores by tying them to monetary rewards in the form of increased reimbursements. I can see how something like that might impact how the clinical staff, which often has to deliver bad news, interacts with patients, though I have a hard time seeing a doctor foregoing necessary procedures because the patient might not like it, not with legions of personal injury lawyers standing by with itchy trigger fingers ready to pounce at any sign of medical malpractice.

It's also true that more and more healthcare dining operations are being pushed to raise patient satisfaction scores regarding meal service, which supposedly has an outsized effect on how a patient feels about the total hospital experience. This push has also (somewhat) loosened the purse strings in some institutions to invest in upgraded meal production and delivery services, especially room service dining.

However, the notion that this is drawing needed resources away from the clinical end is pretty laughable. Dining directors in hospitals know (and mostly accept) that their departments are near the end of the line when investment dollars are allocated, patient satisfactions scores be damned, and that they have to fight tooth and nail for every penny. In even the most extreme cases, the amount allocated toward foodservice facilities pales in comparison to what is spent on the clinical side. If there are any exceptions to this out there, I'd love to hear about them.

In any case, the quality of dining services has no bearing one way or the other on the quality of the clinical care, but my worry is that if there is a backlash against the alleged overprioritization of patient satisfaction scores, dining operations in healthcare facilities may become caught in the crossfire, demonized as prominent examples of an institution's supposedly misplaced priorities.

In any case, this is something to keep an eye on...

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