One reads everywhere, even in these pages, that satisfied patients have better outcomes. Indeed, health care leaders are hearing from all kinds of vendors and consultants how they need to improve patient satisfaction.
But is it really true that “satisfied with treatment” means “in better health”? Certainly there is plausibility in such a link: how we feel affects the body as well as the mind.
There is an analogy, too, in organizational development, the so-called “contented cows” theory. And there is considerable research evidence that employee engagement improves organizational outcomes, although that is not the whole story. (Then again the claim that contented cows give better milk is perhaps no more than an advertising slogan.)
Likewise, there are many studies showing that patient satisfaction leads to better outcomes. But there are others that demonstrate the opposite. For example, a 2012 JAMA Internal Medicine article (“The Cost of Satisfaction”) reports that “in a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.”
Many have questioned how well patients can evaluate their own care. A Johns Hopkins report is entitled “Patient Satisfaction With Hospital Stay Does Not Reflect Quality Of Surgical Care.”
Moreover there is much evidence that, just as teachers are concentrating on improving test scores rather than real learning, doctors are becoming more attentive to Press Ganey ratings than patient’s actual needs. As one doctor has noted, “Practicing physicians have learned — from reimbursement systems, the medical liability environment, and clinical performance scorekeepers — that they will be rewarded for excess and penalized if they risk not doing enough.” When it comes to our health, we are all inclined to think that nothing less than the best will do and no amount of tests and care is too much.
Another JAMA article puts it this way: patient satisfaction and patient care are necessary but not equal. It explains research showing why more satisfied patients were actually worse off medically as the result of doctors and hospitals treating patients as consumers.
Our increasingly money-oriented healthcare system tends to produce happy patients who are like customers who are happy about their store purchase whether it was actually in their best interest or not. Make customers happy and they will come back more. The result can be a preference in spending on hospital television sets over, say, nurse staffing.
We have suggested that the quest for an ideal healthcare organization should start with questions: Maybe the first one to ask should be, “Are we in this for health or for the money?” We invite workers in the field to ask that question in their organization and report to us what answers they get.
–Jim Murphy has a solo consulting practice called Management 3000, focusing on organizational development and change management. Formerly he led the Massachusetts Bay Organizational Development Learning Group, was Human Resources Director for the City of Boston Assessing Department, and served as a consultant with the Boston Management Consortium. His consulting practice includes management coaching as well as research and writing on employee relationships, leadership, healthcare and collaborative practices. Having produced newsletters for several organizations and being a frequent content writer for the”Confident Voices in Healthcare” blog, he is interested in writing and research opportunities, as we all consulting and coaching. www.manage2001.com firstname.lastname@example.org