ICBioethics Blog 

How Relevant are Patient Experience Surveys?

Written by: Aimee Zellers

This week the New England Journal of Medicine published a piece on the relationship between patient experience and health outcomes, and whether patient experience reports reflect an accurate picture of quality of care. The authors conducted a survey of studies focused on patient experiences and health outcomes. There are two basic views. First, some argue that the studies show that measuring patient experience has no relation to the quality of care the patient received. Second, a number of studies have shown that good patient experiences are associated with better health outcomes. So, which conclusion is accurate? [Spoiler Alert: I don’t know.]


Those who believe the relationship to be highly suspect argue three main points. First, most patients lack any formal medical training; therefore, they are not credible to provide feedback on quality of care. Second, patient experiences or patient satisfaction brings in some aspect of emotion, whether it is happiness or frustration, and emotions can be easily influenced by many different things that are unrelated to care. There are also other outside factors that could impact the patient’s perception of care and satisfaction that are not actually related to clinical adherence to care. These external factors are very difficult to measure objectively if at all. The final concern is that patients may base their satisfaction on whether they get what they want, regardless of the benefit. For example, a patient may request a certain test or drug that is not beneficial or relevant to his or her condition. When denied it will likely impact satisfaction. In sum, the critics argue that these studies yield no useful information.

Despite these challenges, studies that suggest that there is a correlation between satisfied patients and quality care cannot be simply ignored. Manary, et al, suggest a number of things to consider if we are going to take reports of patient experience seriously.

1. It must be determined whether the individual is reflecting on one event, visit, or treatment, or if they are reflecting on care over the course of particular period of time.

2. Surveys should focus questions on the patient-health provider interaction and patient-care team interactions.

3. Surveys should be completed in a timely fashion to avoid any recall or memory lapses or biases.

4. Surveys should be risk-adjusted.

5. A common language and methodology for analyzing patient experience and satisfaction needs to be developed. Currently, different measurement scales are being used and the terminology is not consistent. This makes it incredibly difficult to compare results and reach sound conclusions.

It’s clear that there is going to be controversy for some time regarding how this type of information should be procured, analyzed, and used. It’s quite likely that the information gathered from these surveys, if done consistently and with the appropriate questions, could produce a useful measure of quality. These efforts should not be abandoned as some critics might have us believe.

Questions for health providers:

How legitimate is a patient’s reported experience in quality assessment?

To check out the NEJM article click here

A few of the studies on patient experiences:

Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. American Journal of Managed Care 2011; 17 :41-8.

Glickman SW, Boulding W, Manary M, et al. Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes 2010; 3: 188-95.

Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the United States. New England Journal of Medicine 2008; 359: 1921-31.

Mitch GennusoComment