Patient satisfaction and quality of care

July 6, 2018 Nursing

The quality of health care remains an ongoing concern for consumers, payers, and policy makers. There are a number of national initiatives to measure quality and drive improvements in care. One initiative that has received significant attention is an effort by a group of purchasers known as the Leapfrog Group. (Sultz and Young) Founded in 2000, the Leapfrog coalition includes more than 65 employers and agencies that together purchase care for more than 34 million people. The Leapfrog Group has focused on measuring and reporting hospitals’ adoption of evidence based practices to improve patient safety.

Through annual surveys, the program measures whether hospitals have adopted these practices and make the data publicly available on the Leapfrog Group Web site (http://www.leapfroggroup.org). One goal of the program is to direct consumers to hospitals that have adopted Leapfrog’s patient safety practices. Overall, I think it is useful for the public to have this information available. If you look at the website: http://www.hospitalcompare.hhs.gov/.It reports such statistics as percentage of hospital-acquired infections like line infections; hospital readmissions, surgical complications, etc…

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However, a lot of it seems irrelevant and puts too much power on the patients. For example, if you put Mayo Clinic’s two hospitals in Rochester, MN on their regarding Patient Survey answers, they score below average than average Minnesota hospitals and national average regarding patient satisfaction categories. Yet, Mayo is ranked #1 in US News as far as top hospitals in the nation are concerned. I think the public is not always ready to know what those numbers reflect: ie infection rates, length of hospitalization.

The last time I saw such data in the newspaper, the best hospitals in Illinois were small hospitals in small towns. None of the Academic Institutions were rated very high… I may change my decision on a provider that I don’t know if he or she is reported as having a very high rate of complaints and lawsuits. However I will not change my decision on a hospital that I know personally or that has been recommended by physicians that I trust and/or respect. So if a patient saw those survey results of Mayo Clinic shown in link below, would those survey results deter them from going to Mayo Clinic or not?

http://www.medicare.gov/hospitalcompare/profile.html#profTab=1&ID=240010&loc=ROCHESTER%2C%20MN&lat=44.0216306&lng=-92.4698992&AspxAutoDetectCookieSupport=1

I think such things as patient complications like hospital-acquired infections, timely and effective care, surgical complications, hospital-acquired conditions, etc are things that are important to know for patients especially if there is a large discrepancy between various hospitals. Readmissions category I think is useless because a lot of the readmission rate is due to patient non-compliance and that is obviously not included in the statistical analysis of this.

Overall, regarding patient readiness with these statistics–> I have a feeling they may put higher weight on patient survey results which can be heavily biased because good patient satisfaction can a lot of times be independent and not correlated with patient care… For example: in pain management, the patient satisfaction scores are a lot of times unfair because “tough love” is needed a lot in this field.

Like if a patient comes to you with complaints of back pain but has a normal MRI, very inconclusive physical examination, and a history that does not make sense and they continue to ask for strong narcotics without good or adequate reasons and don’t want to even consider trying more conservative measures and have no records with them; and you decide that narcotics are not the best treatment plan at this time and don’t prescribe the narcotics like the patient wants you to, of course they are going to be mad and write you a very poor survey.

Does that make you a bad doctor/hospital/clinic, etc? –>>> NO

I think patients would more heavily jump to conclusions based on survey results etc. Also, some patients may not comprehend the medical jargon in the results of other statistics and may misinterpret the results as well into a biased or misguided judgment on a hospital. With all this said, there are some valid points made in those results that are most important for preventative medicine dealing with prevention of hospital-acquire infections, surgical complications, hospital-acquired conditions (like the category of “objects accidentally left in body after surgery”, etc).

I think this can influence your public health and social work practice by
helping you create more Quality Improvement Projects and ideas to help prevent these types of hospital-related complications in the future.

For example, hospitals have quality improvement projects that focused on prevention of line infections, PEG tube displacement, decubitus ulcers, etc by getting Chest radiographs on every new patient admission with any type of line and measured the length from the inferior vena cava to the end so we could see if there was line displacement. Also, the case managers of each unit would do a “line check” every night before change of nursing shifts change to determine what lines are necessary to remain to be in place and which should be taken out and staff would discontinue as many lines as possible to prevent line infection if it was warranted. Also, the staff would do weekly skin checks of the inpatients to make sure if they did have sacral decubitus ulcers or other skin ulcers, and also that the nurses are turning them in bed frequently.

The reason these were implemented is due to prior hospital-related complications that were recorded. Public reporting of health care quality information is more likely to change behaviors in health care providers than it does consumers’ choice of providers. The researchers also found that quality measures that are publicly reported tend to improve over time. In addition, the number of studies on potential harms from public reporting was limited and those that did examine the issue do not confirm potential harm Americans are most likely to trust the recommendations of nurses’ organizations and patient rights groups when it comes to getting advice on health care policy. Other groups trusted by a majority: doctors, seniors’ citizens, hospitals, small business groups and consumer groups. On the other side of the spectrum,

Americans place least trust in the health policy recommendations of pharmaceutical companies, big business, health insurance companies and labor unions. (Brodie). AHRQ is continuing to further its mission to improve the quality, safety, efficiency and effectiveness of health care for all Americans, in addition to its work to eliminate healthcare-associated infections, promote health IT, and provide data and information for decision making.

The evidence developed through AHRQ-sponsored research and analyses helps everyone involved in patient care make more informed decisions about what treatments work for whom, when and, at what point in their care. AHRQ will continue to invest in successful programs that develop and translate into evidence, knowledge and tools that can be used to make measurable improvements in health care in America by using a variety of tools to help stimulate and support improvements in the quality of care delivered by hospitals.

The intent is to help improve hospitals’ quality of care by distributing objective, easy to understand data on hospital performance, and quality information from consumer perspectives through improved quality of care and patient outcomes.One can use Hospital Compare to find hospitals and compare the quality of their care. The information on Hospital Compare can help one make decisions about where one gets your health care, and encourages hospitals to improve the quality of care they provide. Like health insurance, the safety net contributes to improving access to care.

There are challenges in making direct comparisons of the impact of each approach, but the evidence would tend to suggest that health insurance improves access to care to a greater degree than the direct investment in the safety net alone. However, the provision of health insurance is also a more costly strategy for improving access. (Bindman) So overall, I think as mentioned above, certain categories mentioned in these reports are crucial for prevention and improvement in complication rates in hospitals but it should be curtailed to prevent a biased judgment rather than an objective judgment made by future patients who read these websites.

Even though, I don’t agree with some of these patient survey questions and results, I would use these questions and results to influence how our nursing staff and physicians approach patient care and what most patients feel are important for providing “quality care”. They do not influence my practice as a neonatologist.

Sultz, H. A. & Young, K. M. (2014). Health Care USA: Understanding Its Organization and Delivery, Eighth Edition. Boston: Jones and Bartlett Publishers Mollyann Brodie, Ph.D. The Public and Health Care Reform : Kaiser Family Foundation, March 2009 Andrew Bindman, M.D. America’s Health Care Safety Net University of California, San Francisco, December 2008

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