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Patient Satisfaction and Quality of Surgical Care in US Hospitals

Tsai, Thomas C. MD, MPH*,†; Orav, E. John PhD‡,§; Jha, Ashish K. MD, MPH*,§,¶

doi: 10.1097/SLA.0000000000000765

Objective: The relationship between patient satisfaction and surgical quality is unclear for US hospitals. Using national data, we examined if hospitals with high patient satisfaction have lower levels of performance on accepted measures of the quality and efficiency of surgical care.

Background: Federal policymakers have made patient satisfaction a core measure for the way hospitals are evaluated and paid through the value-based purchasing program. There is broad concern that performance on patient satisfaction may have little or even a negative correlation with the quality of surgical care, leading to potential trade-offs in efforts to improve patient experience with other surgical quality measures.

Methods: We used the Hospital Consumer Assessment of Healthcare Providers and Systems survey data from 2010 and 2011 to assess performance on patient experience. We used national Medicare data on 6 common surgical procedures to calculate measures of surgical efficiency and quality: risk-adjusted length of stay, process score, risk-adjusted mortality rate, risk-adjusted readmission rate, and a composite z score across all 4 metrics. Multivariate models adjusting for hospital characteristics were used to assess the independent relationships between patient satisfaction and measures of surgical efficiency and quality.

Results: Of the 2953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5% (interquartile range, 63%–75.5%). Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P < 0.001). Adjusting for procedural volume and structural characteristics, institutions in the highest quartile of patient satisfaction had the higher process of care performance (96.5 vs 95.5, P < 0.001), lower readmission rates (12.3% vs 13.6%, P < 0.001), and lower mortality (3.1% vs 3.6%) than those in the lowest quartile. Hospitals with high patient satisfaction also had a higher composite score for quality across all measures (P < 0.001).

Conclusions: Among US hospitals that perform major surgical procedures, hospitals with high patient satisfaction provided more efficient care and were associated with higher surgical quality. Our findings suggest there need not be a trade-off between good quality of care for surgical patients and ensuring a positive patient experience.

Supplemental Digital Content is Available in the Text.It is unknown whether patient experience is related to efficiency and quality of hospital surgical care. Using the Hospital Consumer Assessment of Healthcare Providers and Systems survey and national Medicare claims, we show that hospitals with higher patient satisfaction had shorter lengths of stay, higher process scores, lower mortality, and lower readmission rates.

Department of *Health Policy and Management, Harvard School of Public Health, Boston, MA

Department of Surgery, Brigham and Women's Hospital, Boston, MA

Department of Biostatistics, Harvard School of Public Health, Boston, MA

§Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA; and

VA Boston Healthcare System, Boston, MA.

Reprints: Thomas C. Tsai, MD, MPH, Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115. E-mail:

Disclosure: Supported by grant R25CA92203 (for Dr Tsai) from the National Cancer Institute. The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2015 by Lippincott Williams & Wilkins.