Considerations for Patient Satisfaction

There is debate whether patient satisfaction scores are an accurate measure of a hospital’s ability to provide optimal care. Satisfaction surveys can help guide quality improvement measures, but they are often too subjective — patient’s perceptions may not always equate to good care. In their quest to increase patient satisfaction scores, some hospitals have added hotel-like amenities.

Some healthcare experts believe adding more nurses to hospitals is the key to patient satisfaction because nurses are the group that most influences patient satisfaction. The online RN to BSN program at California State University-San Marcos prepares students to provide patients with optimal care — the most important measure of patient satisfaction.

What Are Patient Satisfaction Scores?

If you have ever been a hospital patient, you may have received a randomly distributed survey following your discharge. Sometimes hospitals design these surveys, and sometimes they simply use a 32-question standardized survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Distributed by the Centers for Medicare and Medicaid Services (CMS) — the federal agency that administers Medicare and Medicaid — the HCAHPS asks patients to rate factors related to their stays. For instance: “During this hospital stay, how often was the area around your room quiet at night?” and “Would you recommend this hospital to your friends and family?”

According to The Problem with Satisfied Patients, the Department of Health and Human Services bases 30 percent of a hospital’s Medicare reimbursement on patient satisfaction and survey scores. An Affordable Care Act policy originating in 2012 states that Medicare will withhold one percent of total reimbursements to hospitals if patient satisfaction scores are not high enough. In addition to high patient satisfaction scores, hospitals must also demonstrate specific basic care standards to release these reimbursements. Top performers in these categories receive bonus funds.

Is There Too Much Focus on Patient Satisfaction Scores?

According to an article in Patient Preference and Adherence, a patient’s experience is the most essential component of patient-centered care. Patient satisfaction surveys can show healthcare facilities how they can better meet patients’ needs. An article in HealthAffairs reveals that patient satisfaction rates correlate with quality of hospital care. Patient satisfaction also correlates to reduced readmission rates and inpatient mortality rates. While this research demonstrates that patients are good judges of the care they receive, not everyone shares this view.

Although surveys can be beneficial, some experts say that overemphasizing subjective data can be harmful. A patient’s idea of good healthcare is not always in the patient’s best interest. HealthAffairs provides the example of a doctor who refuses to fill a prescription for narcotics but instead recommends alternative pain relief solutions.

According to “The Problem with Satisfied Patients,” patients may complain about any number of frivolous things, such as a hospital not carrying Splenda. A quadruple-bypass surgery patient, for example, may complain because he did not receive enough pastrami on his sandwich.

Even though the nurses and doctors are using best practices, a patient may not feel satisfied. This patient may then later express their dissatisfaction on the hospital survey, giving an inadequate portrait of a hospital’s (or clinician’s) ability to provide quality care.

Patient satisfaction scores are not necessarily a true indicator of a practitioner’s ability to provide quality care, but some hospitals are now using them to calculate nurses’ and physicians’ salaries. Per the article, a practitioner or hospital can have excellent patient satisfaction scores but fail to provide optimal care. Others might have low scores but provide excellent care. Providers motivated by scores that secure more money are not practicing patient-centered care.

Focusing too intently on patient perception has led some hospitals to create environments that resemble hotels or spas. A New York Times article reports that some facilities are adding amenities such as uniformed valets, professional greeters, on-demand patient meals and in-room massages. To justify these amenities, they point to the healing power of happy patients. Of course, they know that luxury amenities improve patient satisfaction ratings and increase referrals. This, according to the article, can help decrease costs and increase revenue.

Nurses are the Key to Patient Satisfaction

Catering to patients’ requests does not contribute to optimal healthcare. According to The Problem With Satisfied Patients, data shows that hiring more nurses and treating them as valued employees determines patient satisfaction.

Failure to invest in nurses can lead to lower patient satisfaction scores, which can have dire repercussions. For instance, according to MLive, more than 20 percent of Michigan nurses polled reported that they knew of patients who died due to understaffing. According to the Michigan Nurses Association, a survey of 401 registered nurses revealed a high rate of preventable harm. The majority of nurses surveyed said patient care is suffering because they have to care for too many patients. Adding more nurses to hospitals can potentially alleviate this problem.

Are Hospitals Spending Enough on Nurses?

In another New York Times article arguing for more nursing staff, the author says too many hospitals are investing their resources on amenities instead of hiring more nurses. The author refers to a psychiatric nurse forced to care for 12 patients — double the standard patient load. When one of her patients became suicidal, her doctor ordered focused care, but due to the hospital’s budgetary constraints, the only other available nurse was sent home early. Yet, this same hospital spent money on monogrammed towels, a pool, espresso machines and a patio for smoke breaks. The hospital also requests nurses to deliver non-alcoholic champagne toasts to new mothers.

Patient satisfaction scores are subjective, and they do not necessarily indicate a hospital’s level of care. One of the reasons hospitals must maintain high scores is to avoid financial penalties. Amenities such as pools and espresso machines may have some therapeutic value, and they may increase satisfaction scores, but investing in nurses is the best way to achieve true patient satisfaction and positive health outcomes.

Learn more about the CSUSM online RN to BSN program.


(n.d.). CMS covers 100 million people. Centers for Medicare &Medicaid Services

(n.d.). HCAHPS Survey. Hospital Consumer Assessment of Healthcare Providers and Systems

Robbins, A. (2015, April 17). The Problem With Satisfied Patients. The Atlantic

Zgierska, A., Rabago, D., & Miller, M.M. (2014). Impact of patient satisfaction ratings on physicians and clinical care. US National Library of Medicine National Institutes of Health

Weed, J. (2016, August 1). With Room Service and More, Hospitals Borrow From Hotels. The New York Times

Ellison, G. (2016, March 24). Michigan nurses poll links patient deaths to hospital understaffing. MLive

Robbins, A. (2016, August 22). Skip the Fancy Towels, and Hire More Nurses. The New York Times: Hospitals That Feel Like Hotels

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