The Intersection of Quality, Safety, and Satisfaction
Rahul K. Shah, MD George Washington University School of Medicine; Children’s National Medical Center, Washington, DC We are all familiar with the Institute of Medicine’s landmark clarion call to improve the safety and quality of care delivery in the United States healthcare system. This report, released almost 15 years ago, served as a catalyst for the modern patient safety and quality improvement efforts and successes. As the last decade and a half has progressed, the role of the consumer (i.e., patient) of healthcare has emerged. The power of the consumer in the healthcare transaction has grown tremendously. Hospitals actively compete for patients to provide care for some services that have high margins and are lucrative for the hospital. How do the hospitals compete for these patients? Of course they must all have excellent outcomes. For example, perhaps a couple of decades prior, we would have been able to compare three hospitals and see disparate results in terms of outcomes—i.e., one would be at 30 percent, another at 50 percent, and the best at 80 percent. Metrics at present are so narrowly defined and the quality of care has improved so significantly that when comparing institutions and providers, quality scores are within a range of a few single digits; for example, these three institutions may now score 98.7 percent, 98.9 percent, and 90.9 percent. What do these numbers mean for the consumer? How is the consumer going to be able to choose where to take their care? They are probably not going to base their decision on these outcome or quality metrics. Satisfaction Surveys Enter the patient satisfaction movement/craze to which physicians are beginning to have to pay attention. There are myriad healthcare satisfaction and experience surveys. These are nothing new; however, they were not widely popular until the past couple of years. Indeed, some otolaryngology practices are piloting the HCAHPS (hospital consumer assessment of healthcare providers and systems) survey for their outpatient practices. These surveys are a “measure” of the “experience” of the consumer. There is variability in such patient satisfaction and experience metrics that perhaps the consumer will be able to discern and select the best institution from these measures. Providers continue to be squeezed in a schizophrenic environment where there are competing demands, unfunded mandates, and outright financial deductions for not adhering to or meeting certain metrics. As I often say, I could easily have the highest patient satisfaction scores in the hospital: I would only see one patient every week. Of course, this extreme is not sustainable on many levels. I have been fortunate to have spent time with and heard a few talks from James Merlino, MD, the chief experience officer of the Office of Patient Experience at the Cleveland Clinic, when he discussed the intersection of patient safety, quality improvement, and patient satisfaction. He has come up with an excellent example of how they intertwine. He uses the airline industry as an example and paints the following story: our first priority when choosing an airline is to ensure we get to where we need to be safely, without crashing (patient safety); once we understand that we are safe, we then want to ensure that we arrive on time and leave on time within reason (quality); once this is established, only then do we consider the inflight amenities and overall comfort (patient satisfaction). Dr. Merlino’s analogy captures eloquently how we should think about patient safety, quality, and patient satisfaction in healthcare delivery. As there will inevitably be many competing priorities and many ideas du jour, it is imperative that Academy members have the ability to rise above the fray and see the proverbial forest for the trees. The analogy further helps us understand the intersection between patient safety/quality improvement and patient satisfaction by prioritizing each one and putting them in a linear perspective. The connectedness is much tighter than we appreciate at first glance, and the relationship is perhaps also much more symbiotic than we appreciate. The study of patient satisfaction is an emerging frontier in the care delivery cycle and one that Academy members need to be versed in. Our own Academy member, Emily F. Boss, MD, MPH, has published several peer-reviewed articles on this topic and explains in her excellent articles the relationship between patient satisfaction, disparities in care, and improvement opportunities. Suffice it to say, the next couple of years will be interesting as providers learn how to navigate these intersecting priorities. We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.
Rahul K. Shah, MD
George Washington University School of Medicine;
Children’s National Medical Center, Washington, DC
We are all familiar with the Institute of Medicine’s landmark clarion call to improve the safety and quality of care delivery in the United States healthcare system. This report, released almost 15 years ago, served as a catalyst for the modern patient safety and quality improvement efforts and successes.
As the last decade and a half has progressed, the role of the consumer (i.e., patient) of healthcare has emerged. The power of the consumer in the healthcare transaction has grown tremendously. Hospitals actively compete for patients to provide care for some services that have high margins and are lucrative for the hospital.
How do the hospitals compete for these patients? Of course they must all have excellent outcomes. For example, perhaps a couple of decades prior, we would have been able to compare three hospitals and see disparate results in terms of outcomes—i.e., one would be at 30 percent, another at 50 percent, and the best at 80 percent. Metrics at present are so narrowly defined and the quality of care has improved so significantly that when comparing institutions and providers, quality scores are within a range of a few single digits; for example, these three institutions may now score 98.7 percent, 98.9 percent, and 90.9 percent. What do these numbers mean for the consumer? How is the consumer going to be able to choose where to take their care? They are probably not going to base their decision on these outcome or quality metrics.
Satisfaction Surveys
Enter the patient satisfaction movement/craze to which physicians are beginning to have to pay attention. There are myriad healthcare satisfaction and experience surveys. These are nothing new; however, they were not widely popular until the past couple of years. Indeed, some otolaryngology practices are piloting the HCAHPS (hospital consumer assessment of healthcare providers and systems) survey for their outpatient practices. These surveys are a “measure” of the “experience” of the consumer. There is variability in such patient satisfaction and experience metrics that perhaps the consumer will be able to discern and select the best institution from these measures.
Providers continue to be squeezed in a schizophrenic environment where there are competing demands, unfunded mandates, and outright financial deductions for not adhering to or meeting certain metrics. As I often say, I could easily have the highest patient satisfaction scores in the hospital: I would only see one patient every week. Of course, this extreme is not sustainable on many levels.
I have been fortunate to have spent time with and heard a few talks from James Merlino, MD, the chief experience officer of the Office of Patient Experience at the Cleveland Clinic, when he discussed the intersection of patient safety, quality improvement, and patient satisfaction. He has come up with an excellent example of how they intertwine. He uses the airline industry as an example and paints the following story: our first priority when choosing an airline is to ensure we get to where we need to be safely, without crashing (patient safety); once we understand that we are safe, we then want to ensure that we arrive on time and leave on time within reason (quality); once this is established, only then do we consider the inflight amenities and overall comfort (patient satisfaction). Dr. Merlino’s analogy captures eloquently how we should think about patient safety, quality, and patient satisfaction in healthcare delivery.
As there will inevitably be many competing priorities and many ideas du jour, it is imperative that Academy members have the ability to rise above the fray and see the proverbial forest for the trees. The analogy further helps us understand the intersection between patient safety/quality improvement and patient satisfaction by prioritizing each one and putting them in a linear perspective. The connectedness is much tighter than we appreciate at first glance, and the relationship is perhaps also much more symbiotic than we appreciate.
The study of patient satisfaction is an emerging frontier in the care delivery cycle and one that Academy members need to be versed in. Our own Academy member, Emily F. Boss, MD, MPH, has published several peer-reviewed articles on this topic and explains in her excellent articles the relationship between patient satisfaction, disparities in care, and improvement opportunities. Suffice it to say, the next couple of years will be interesting as providers learn how to navigate these intersecting priorities.
We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.
