The outsized and misplaced importance of patient satisfaction scores is a perfect embodiment of Goodhart’s law, well-paraphrased as “when a measure becomes a target, it ceases to be a good measure.”
If you make patient satisfaction scores a critical target—and they are—you will see consequent mismanagement. This is so blatantly apparent when it comes to urgent care and pain management that, if anything, high satisfaction scores are likely a more meaningful signal of poor care.
If a patient comes to an urgent care for a URI and wants antibiotics, they will be most “satisfied” when they receive the prescription they didn’t need. And all that over-treatment is not without risk.
Even outside of quality metrics, you need patients to make money, and the “customer” is always right.
A study published in JAMA is a great example of the obvious negative externalities of prioritizing patient satisfaction scores. It analyzed a large number of telemedicine visits for URI:
72 percent of patients gave 5-star ratings after visits with no resulting prescriptions, 86 percent gave 5 stars when they got a prescription for something other than an antibiotic, and 90 percent gave 5 stars when they received an antibiotic prescription.
In fact, no other factor was as strongly associated with patient satisfaction as to whether they received a prescription for an antibiotic.
Higher costs and more prescriptions
Another study out of UC Davis analyzed a >50,000 person national Medical Expenditure Panel Survey and found that patients who were most satisfied had greater chances of being admitted to the hospital, had ~9% higher total health-care costs, and 9% higher prescription drug expenditures. Of course, if you’re a for-profit entity (and most “non-profit” hospitals certainly are), higher costs and more prescriptions often just mean more profit. A win-win-win.