Are patients really satisfied?

Yesterday, my new paper — Bias in patient satisfaction surveys: a threat to measuring healthcare quality — was published at BMJ Global Health. It’s co-authored with Felipe Dunsch, Mario Macis, and Qiao Wang.

Here’s a quick rundown of what we learned.

Many health systems use patient satisfaction surveys to gauge one key element of health services: the patient experience. As part of evaluating an intervention to improve health care management in Nigeria, we piloted patient satisfaction questionnaires.

A common way to measure patient satisfaction is to give patients a series of statements and to ask if they agree or disagree: “The clinic was clean.” “Staff explained your condition well.” That kind of thing. We noticed that people seemed to be agreeing with everything.

Was that because the quality of care was good, or because saying yes is just easier?

So we randomly assigned some patients to get the standard statements, and others to get negatively framed statements. “The clinic was dirty.” “Staff were rude.” “Staff explained your condition poorly.”

Reframing the questions negatively led to significantly lower reports of patient satisfaction on almost every item.

Sometimes the drops were big, as high as 12 percentage points and 19 percentage points.

Our work was in Nigeria, but a lot of patient satisfaction questionnaires that we reviewed from a lot of countries use this positive framing.

But that likely gives a falsely optimistic view of the patient experience.

Patient satisfaction questionnaires that either mix positive and negative framing, or that avoid agree/disagree formats can do better.

Of course, the quality of care is much more than patient satisfaction. But good health care systems can and should offer a positive patient experience.

Check out the paper!