Are patient satisfaction scores doing more harm than good?

By Naveed Saleh, MD, MS
Published October 28, 2021

Key Takeaways

In medicine, objective, evidence-based data guide treatment plans. However, not all aspects of patient care are objective. Patient satisfaction, for example, is mostly subjective and relies on patient perception vs expectation.

Patient satisfaction is hard to define and measure, which can be frustrating to a physician intent on excelling in all realms of practice. Good doctors want their patients to be treated with dignity and want to know that hospital personnel are doing everything to ensure safe and medically advantageous efforts to heal. 

Of course, hospitals are concerned with patient-satisfaction scores, too. They not only want their patients to be satisfied with their health care and associated outcomes, but they also want them to be satisfied with the non-clinical aspects of their stays. Moreover, the better their patient satisfaction scores, the more they are reimbursed by CMS.

Despite its nebulous nature, there are concrete steps that can be taken to improve patient satisfaction. Let’s take a closer look at the nuances.

What exactly is patient satisfaction?

In 2018, the NEJM Catalyst published an analysis of patient satisfaction. They cited research that describes three aspects of patient satisfaction including, "the delivery of essential medical care; treatments sought by patients and their families (which may or may not be favorable to good health); and ­the provider activities and behaviors that comprise compassionate care and the safeguarding of human dignity."

So how do you measure these seeming intangibles? With a survey, of course!

Patient satisfaction surveys aim to translate subjective results into meaningful, quantifiable, and actionable findings. Keys to a good survey include determining which aspects of patient satisfaction to measure, formulating reliable and valid questions, randomly sampling patients from the hospital population, and leveraging a variety of delivery methods, including mail surveys, telephone surveys, or face-to-face interviews.


Today, patient satisfaction surveys are everywhere. Their mundane nature can, in part, be traced to the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) created by the CMS in partnership with the Agency for Healthcare Research and Quality AHRQ. 

CMS notes on its website that although many hospitals have collected information on patient satisfaction for internal use in the past, there was no national standard for collecting and publicly reporting information about patient care experiences that permitted comparisons among hospitals on a local, regional, and national level until HCAHPS was developed. This survey was first administered in 2006, with CMS then starting to publish results in 2008.

The HCAHPS has three general goals:

  1. Generate data concerning patient perspectives of care that allow for meaningful comparisons among hospitals with regard to criteria that are important to all consumers 

  2. Publicly report data to incentivize quality-of-care improvements by hospitals 

  3. Publicly report data to promote transparency and accountability of hospital care provided by public institutions 

For hospitals, HCAHPS scores serve as a key financial concern. Hospital reimbursement is tied to patient satisfaction, with higher HCAHPS scores bringing in more money via the Hospital Value-Based Purchasing program. In 2016, $1.5 billion was available to hospitals through the program. Moreover, hospitals with exceptionally low scores were financially penalized. 

Do patient satisfaction surveys work?

There’s no question that various stakeholders have poured tons of resources into patient satisfaction surveys. Moreover, patient satisfaction can be measured in a plethora of ways, including responsiveness of staff, clinician communication, technical skill, and hospital environment.

Does measuring with these various yardsticks of the patient experience reflect actual care? The answers are surprising.

According to the NEJM Catalyst article, emerging research on the topic is mixed. Here are some points made:

  • More satisfied respondents to the HCAHPS were less likely to go to the emergency department but more likely to become inpatients. These satisfied consumers were also more likely to have higher healthcare costs, as well as increased mortality rates.

  • Another study puzzlingly indicated that satisfied patients are at a higher likelihood of opioid dependence. Although causality wasn’t determined, CMS removed questions from HCAHPS to address this concern.

  • Disconcertingly, researchers hypothesize that physicians with salaries that are tied to patient satisfaction are more likely to buckle when patients want a treatment that is unnecessary or even dangerous.

  • In an equally alarming finding, physicians may be less inclined to tell patients to lose weight or quit smoking, which are typically things patients don’t want to hear. 

Improving patient satisfaction

As an individual clinician, you are limited in what you can do to improve all aspects of patient care. Some factors depend on the hospital and other staff. There are, however, steps that can be taken to improve patient satisfaction with your own service, including practicing patient-centered care. These steps are mentioned in an article published by Commonwealth Fund.

Key foci of patient-centered care that the physician should consider include the following:

  • Educating and sharing knowledge with the patient

  • Remaining sensitive to nonmedical and spiritual aspects of care

  • Respecting the patient’s needs/preferences

  • Encouraging the free flow of information

  • Involving family and friends in care

Other tips about how to improve patient satisfaction can be gleaned from the actions of Rush University Medical Center. 

More than 10 years ago, hospitalist-patient communication scores on HCAHPS at this institution were among the worst in the nation. In 7 years, they turned things around and rose 59 national percentage points on the survey.

Some steps they took included:

  • Handing out “face cards” to patients to help them identify and converse with providers on the team

  • Using checklists to update care plans

  • Utilizing in-board whiteboard to facilitate team communication

  • Undertaking afternoon visits to update care plans/results

  • Engaging in bedside interviews

  • Participating in annual education sessions centering on effective communication, checklists, and HCAHPS.

Bottom line

Although research on the impact of patient satisfaction scores on care is emerging and mixed, it’s clear that patient satisfaction matters to hospitals and physicians alike. 

Although the topic is thorny, there are steps that can be taken to improve patient satisfaction on a granular level. As a clinician, for example, you can promote patient-centered care and focus on communication skills.

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