Quality Care and Patient Satisfaction

What makes a good hospital? Is it the number of quality healthcare awards it earns or its annual score on patient satisfaction surveys? Don’t the two go hand in hand? Surely if a hospital is ranked as one of the best in quality care, its patients are going to enjoy the caring experience there, right? The answer, according to researchers at CareChex, is not really. In fact, facilities in most states across the country succeed in one area, but don’t fare so well in the other.

The findings are a result of two studies released last fall by CareChex, a medical quality rating service of South Carolina-based Delta Group, a privately-held healthcare information service company. CareChex researchers specialize in rating the quality of hospital and physician care. And the results of these studies should raise a few eyebrows among members of the hospital C-suite, said Thane Forthman, DHA, managing principal of The Delta Group, of which CareChex is a division.

“I think the big takeaway from this research is that within a hospital there are two simultaneous but not always integrated campaigns,” he explained.

“One is to improve the clinical quality of care, such as patient mortality rates, and patient safety rates. The other involves the marketing and public relations issues involving overall patient satisfaction. If I’m on the C-suite, what I would take note of is that I can’t use one as a proxy for the other. If I’m not looking at that information in an integrated fashion collectively, I’m not going to get a real good view of how stakeholders view my hospitals.”

Deep disparities

How wide are the disparities? Consider this: hospitals in Ohio ranked #1 in overall quality of care (with a 98 percent ranking). However, when it came to patient satisfaction, facilities in the Buckeye State finished near the bottom, ranking 34 overall (33 percent of satisfied patients) in the nation.

Ohio wasn’t alone in failing to bridge the gap between quality care and patient satisfaction. Nearly 40 states reported substantially different rankings in these two areas. Vermont hospitals, for instance, scored tops in patient satisfaction (98 percent) but finished 30th among hospitals in overall care (42 percent). Florida facilities recorded the largest discrepancy, tallying an 84.3 rating in overall quality of care (8th in the nation); yet finishing nearly last in patient satisfaction with a 3.9 rating (ranking 49th in the U.S).

Dr. Forthman believes one of the reasons for these gaps in patient care is the lack of research combining the two factors. “To my knowledge, a study like this hasn’t been performed before now,” he said. “It was something that in the years of looking at quality of care, we had an interest in determining if there was a correlation or disconnect between what patients perceived to being good quality care versus the actual technical aspects of the clinical protocols that the medical field would expect to be the best for that particular case type.”

The absence of “customer-oriented” care can often lead to patient dissatisfaction despite excellence in clinical quality, said Andrew Webber, president & CEO, National Business Coalition on Health (NBCH), a national membership organization of purchaser-led healthcare coalitions representing more than 7,000 employers and approximately 25 million employees and their dependents.

“This finding underscores the need for hospitals to engage in regular patient satisfaction surveys rather than assume patients are satisfied with their medical care simply because a hospital meets a particular standard of clinical quality,” he said “From the perspective of employers and purchaser-based coalitions, employee satisfaction with the care they receive is an important part of the hospital’s overall value equation – there’s simply no reason why we shouldn’t expect quality care to be provided along with a positive patient experience.”

Behind the Numbers

The first CareChex study, “2010 CareChex Quality of Care by U.S. Geographic Area,” provides insight into the relative quality of care and the broad disparities in care delivered across different states and major metropolitan areas. The data also helps explain the growing trend toward U.S. “medical tourism,” where patients travel outside their local market to receive higher quality care at a better price.

The second study, “2010 CareChex Patient Satisfaction by U.S. Geographic Area,” identifies the relative patient satisfaction with hospital care among states and major metropolitan areas and gives a macro view of which locations offer the best customer-centric care. With the rise of consumerism in healthcare, the hospital industry has realized that cost and quality alone are insufficient competitive differentiators in the minds of customers – service excellence also plays a vital role in determining value, Dr. Forthman said.

CareChex looked across all key components of quality available for comparison – process, outcomes, and patient satisfaction – to form a single composite percentile score and attendant quality ranking. A total of 118 university hospitals were evaluated using the Delta Group’s National Quality Rating Database (NQRD), which includes virtually all general, acute, nonfederal U.S. hospitals. The NQRD includes statistics from various hospital information sources, including the Hospital Quality Alliance, CMS’s Hospital Consumer Assessment of Healthcare Providers and Systems Database, and CMS’s Medicare Provider Assessment and Review (MedPAR).

Other key findings are as follows:

  • The nation’s capital (District of Columbia) has the lowest quality of overall hospital care and the lowest patient satisfaction score when compared to the rest of the country.
  • With one of the highest levels of HMO managed care penetration in the country, California had one of the lowest “quality of care” scores. While more research is needed to determine why this may be, a link to aggressive ancillary cost reduction and shorter hospital stays may be adversely affecting quality of care.
  • The three states with the highest patient satisfaction scores are all from the Northeast region of the U.S. (Vermont, Maine, and New Hampshire).
  • Five of 10 states with the highest quality of overall hospital care are in the Midwest region (Ohio, Michigan, Indiana, Wisconsin, and North Dakota).
  • Six of 10 states with the lowest quality of overall hospital care are in the Western region (California, Wyoming, New Mexico, Nevada, Hawaii, and Alaska).


While the findings should provide a wake-up call for facilities across the country, Dr. Forthman believes the numbers should also serve as a reminder to healthcare executives of how to satisfy the key stakeholders in their facilities.

“Physicians take pride in the quality results a hospital achieves, so as far as recruitment, that’s one stakeholder hospitals will want to promote positives results to,” he said. “Another stakeholder who will look at quality is payors. However, the patient themselves becomes a very important stakeholder who gets missed as ultimate consumer if technical quality is the only thing that’s being looked at.”

Full quality rankings and percentile scores by state and metropolitan areas for overall hospital care and for patient satisfaction are available at www.carechex.com/media/studies.aspx

Tom Kerr is a frequent contributor to ADVANCE.