Only 1 in 10 physicians asks patients what they expect from care

Even as satisfaction scores are increasingly used to determine pay, failing to inquire about expectations constitutes a "blind spot," a study says.

By Kevin B. O’Reilly — Posted Nov. 11, 2011

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Eighty-five percent of physicians say it is important to know what patients expect from a hospital stay to ensure high-quality care, yet only one in 10 doctors asks about patient expectations.

Nurses are likelier to quiz patients about their expectations, with 20% doing so, according to a survey of more than 1,000 physicians and nurses in the U.S. and three other countries published in November's BMJ Quality and Safety (link). Forty-seven percent of respondents were physicians and 53% were nurses.

The gap between physicians' recognition that patient expectations are important and their failure to ask about them constitutes a "blind spot," the study says.

"Expectations are definitely an important component of patient satisfaction, which is the congruence between the patient's expectations and his perceptions at the end of treatment," said Ronen Rozenblum, PhD, MPH, director of the unit for innovative health care practice and technology in the Brigham and Women's Hospital Center for Patient Safety Research and Practice in Boston.

More than 60% of health care organizations are using patient satisfaction scores to determine physician incentive payments, according to a report released in October by the Hay Group, a Philadelphia management consultancy. Medicare also plans to link 1% of pay to hospitals' performance on quality metrics, with 30% of that total based on patient satisfaction ratings.

But patient satisfaction is about more than money, Rozenblum said.

"In the past, patient satisfaction was just a marketing thing, because you want the patient to come back to the hospital," he said. "Now we are going to the second step by recognizing that patient satisfaction is part of the quality of care."

For example, higher patient satisfaction scores were linked to better guideline adherence and lower mortality rates among more than 3,500 heart attack patients in a March 2010 study in Circulation: Cardiovascular Quality and Outcomes (link).

Reacting to patient concerns

"A lot of people think that the main things affecting patient satisfaction are external things like the lobby, the food, the yard or what the room is like," Rozenblum said. "But the main determinants are related to the patient-clinician interaction, mainly if the clinicians react to the concerns and needs of the patients."

It is impossible to address patients' concerns without understanding what they are, Rozenblum said.

"You have to get information on patients' expectations," he said. "Sometimes those expectations are unrealistic, but what are the chances that you're going to address an expectation that you've never asked about?"

Hospitals need a structured way to ask about and document patients' expectations, Rozenblum said. Many patient concerns can be addressed by providing more information or offering empathetic responses when the expectation cannot be met, he said.

While 16% of U.S. health professionals said they routinely ask patients about their care expectations, 13% of their British counterparts did so. Only 7% of Israeli physicians and nurses asked about patient expectations. Danish health professionals were likeliest to ask, with 31% doing so. Patients in Denmark have been regularly surveyed about their care experiences since 2000, with poorly rated hospitals pushed to improve, the study said.

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