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Do hospitals that do the right thing have more satisfied patients?

Tajeu, Gabriel S.; Kazley, Abby Swanson; Menachemi, Nir

doi: 10.1097/HMR.0000000000000034

Background: Hospital incentive payments are increasingly becoming tied to quality. However, the U.S. health care system continues to face rising health care costs and scarce workforce resources, making improving quality a challenge. Patient satisfaction and process quality are two areas of quality tied to reimbursement. Both are associated with positive health outcomes, but little is known about the relationship between the two.

Purposes: The purpose of this study is to determine if there is an association between process quality and patient satisfaction in a representative sample of U.S. hospitals.

Methodology/Approach: We utilize a pooled cross-sectional study design with year fixed effects from 2009 to 2011. We linked the Hospital Compare data set and the American Hospital Association Annual Survey of Hospitals (AHA) data set. We use a method prescribed by the Joint Commission to determine hospital-level process quality in three areas: heart failure, acute myocardial infarction, and pneumonia treatment. We then use regression models to measure the relationship between process quality and two measures of overall hospital patient satisfaction.

Findings: After we control for hospital-level characteristics and year, we find that patient satisfaction is positively associated with all three areas of hospital process quality (p < .01). For example, acute myocardial infarction process quality was positively associated with whether patients “would definitely recommend the hospital” (B = 0.75, p < .01). Process quality areas were moderately and positively correlated (p < .01), and on average, patient satisfaction scores have increased over time (p < .01).

Practice Implications: Our findings of an association between process quality and patient satisfaction suggest that focusing on process quality does not have negative implications for patient satisfaction. As performance in different process quality areas is only moderately correlated, managers should continually monitor all areas. The trend of increased patient satisfaction over time, perhaps because of industry pressures, should be investigated further.

Gabriel S. Tajeu, MPH, is Doctoral Candidate and Graduate Fellow, Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. E-mail:

Abby Swanson Kazley, PhD, is Associate Professor and MHA Division Director, Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston.

Nir Menachemi, PhD, MPH, is Professor and Director of Doctoral Program in Public Health, Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham.

The opinions expressed are those of the authors and not necessarily any organization with which they are affiliated.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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