It's happening everywhere in OECD nations and even in emerging health markets. And if it's not happening in your jurisdiction, it's sure to happen soon. The 'it' is the tying of a portion of healthcare funding to patient satisfaction.

The problems with this new 'movement' are obvious and lengthy. What are we measuring? Is it defined the same way by patients everywhere? Is there a standardised perspective for calculating and grading patient satisfaction? Are providers and patients both on the same page with respect to patient satisfaction goals?

In Europe and North America, we are talking big numbers. Nearly $1bn in payments to hospitals in the US alone over the next few years will be based in part on patient satisfaction, determined by a 27-question government survey administered to patients. Hospitals with high scores will get a bonus payment. Those with low ones will lose money. In the UK up to 10% of the payments to NHS trusts are dependent on adequate levels of patient satisfaction. In Canada, the government of the most populous province (Ontario) has instituted a mandatory patient satisfaction survey and patient complaints process as part of the new funding mechanism. And the list goes on.

Survey questions in the US include: “How often did doctors treat you with courtesy and respect?” and “How often were your room and bathroom kept clean?” It asks patients to rate their stay on a scale of zero to 10. A senior nurse at a 953-bed facility in the US, cites a patient who had a haemorrhagic stroke and recovered swiftly enough to walk out of the hospital about a week later. On the survey the patient complained that meals were served cold and gave the hospital low scores.

What really matters?
Are we interested in better outcomes or 'hotel factors'? The temperature of the food, the cleanliness of the rooms, proximity to elevators and noise in the hallways are all part of the patient experience. No argument. To what extent do these hotel factors contribute to better outcomes? What is the difference across these factors in an acute care vs. chronic care facility? Is there a difference in satisfaction scores between primary care and specialty care? What expectations do patients have anyway? And do first-time hospital visitors rate hospitals higher because they have no measuring stick against which to gauge? Are patients even qualified to be able to distinguish between high-value and low-value healthcare? Do they even know what it looks like - or more precisely, do they even know what to look for? How many ratings are absent and free of the influence of the caregiver (child visits the parent in the hospital and is appalled at the treatment and fills out the satisfaction survey for the parent)?

We've all heard the arguments: we need to hold providers and hospital systems accountable. Or the private sector (banks, airlines, fast-food chains, etc) is obsessive about customer satisfaction - why shouldn't the public sector be the same way? And I agree.

Are we interested in better outcomes or 'hotel factors'? And what expectations do patients have anyway?

Satifying patients
We do need to hold providers accountable and we do need some degree of the 'voice of the customer' as part of the solution in this accountability push. But this way is not working in my view. And, yes, the private sector has some great ideas. Actually we don't need to look at banks and airlines for our answers. There is private healthcare. There are procedures and treatments that are offered outside the 'public' system. The plastic surgeries, the dermatology centres (Botox), the laser-vision correction centres are all excellent analogs for policymakers to look at for a real-world litmus test of what patient satisfaction looks like in an environment where the threshold is presumably much higher because no private or public payer is footing the bill - in other words, a really tough audience to please.

Or instead of worrying about the noblesse of getting the right answers and results (happier patients), we should focus on asking the right questions. Or, if we're going to ask the wrong people the wrong questions, perhaps, not even asking the questions at all.