Patient Satisfaction

Measurement

A direct assessment of patient satisfaction with care can be obtained by asking for an overall evaluation, such as “How satisfied are you with the care you have received during the past 6 months?” (response options: Very satisfied, Somewhat satisfied, Somewhat dissatisfied, Very dissatisfied). This direct approach is an efficient way to find out the bottom-line perception of a healthcare consumer, but it provides no specific information about the basis for the perception. Similarly, one could use the approach used in the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys of asking patients to rate the care received on a 0-to-10 response scale, where 0 is the worst possible care and 10 represents the best possible care. The CAHPS option elicits evaluations of care rather than satisfaction per se. But satisfaction and global ratings of care are very highly correlated and provide similar information.

Patient satisfaction is driven by the collective experience with aspects of care (e.g., my doctor listens carefully) weighted by the value or perceived importance of those aspects of care (e.g., it is very important that my doctor listen carefully to me). Most work elicits patient reports about care but does not assess value or importance of the domains of care because of response burden and the relative homogeneity in the importance ratings (i.e., domains assessed on standardized surveys tend to all be rated as important by consumers of healthcare). Reports about care are best elicited by asking how often positive and negative aspects of care occurred—for example, “How often did this doctor spend enough time with you?” or “How often did the clerks and receptionists at this doctor's office treat you with courtesy and respect?”

Eliciting reports about whether and how often patients have specific experiences with care requires more items, but reports are less subjective and are easier to interpret and more useful for healthcare providers than satisfaction ratings or evaluations.

Core Reports of Care Domains

Healthcare is multidimensional, and evaluations of care need to capture the relevant dimensions. Patient assessment of technical quality of care should be avoided because patients are typically not a good source of this information. It is more appropriate to assess technical quality of care using expert consensus, such as the RAND-UCLA appropriateness method. Although the important domains of care for which patients are a good source of information can vary depending on the setting, the core elements across settings include access to care, how well providers communicate with patients, and courtesy and respect from office staff.

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