Becker's Clinical Quality & Infection Control

14 Quality Improvement T hough the intention of patient satisfac- tion surveys may be altruistic, the focus on patient satisfaction and the surveys designed to measure it could actually lead to a decrease in care quality and an increase in costs, according to a report from The Hastings Center. The Hastings Center is a nonpartisan research insti- tution dedicated to bioethics and the public interest. "Patient satisfaction is an important, valuable ele- ment of good healthcare, yet some uses and con- sequences of patient satisfaction surveys may be problematic," the authors wrote. The report lists the following unintended conse- quences that patient satisfaction surveys could cause: 1. Providers giving unnecessary or inappropri- ate care. "An emphasis on patient satisfaction as an indicator of healthcare quality may lead to an excessive emphasis on patients' perspectives and wishes," the authors wrote, and could cause healthcare professionals to cater to those wishes, even if it's not medically necessary. 2. Clinicians telling patients what they want to hear. The authors cited a study that "suggests that the threat of low patient satisfaction scores may lead providers to permit, or even encourage, false beliefs among their patients" because patients tend to rate physicians more poorly if they deliver bad news. 3. "Teaching to the test." This phenomenon hap- pens when hospitals strive to meet high patient satisfaction scores and put processes in place to "manipulate" patient responses on the HCAHPS survey. The authors say this practice "raises the question of whether higher HCAHPS scores truly represent higher patient care." 4. An ultimate decrease in healthcare quality and increase in costs. The report cites a 2012 study in the Archives of Internal Medicine that directly ties high satisfaction scores to higher overall health- care costs. "Ultimately, patient satisfaction surveys may lead healthcare astray, undermining the provision of optimum care for all," the authors conclude. n Are Patient Satisfaction Surveys Doing More Harm Than Good? By Heather Punke Quality Improvement Efforts Reduce Malpractice Claims, Researchers Find By Shannon Barnet I mproving care quality inside a hospital may prevent malpractice lawsuits just as effectively as laws that limit patients' ability to win multimillion- dollar judgments for pain and suffering, according to a study published in the American Journal of Medical Quality. The purpose of the study was to determine the effect of tort reform and qual- ity improvement measures on medical liability claims in two groups of hospi- tals within the same multihospital organization. One of the groups of hospitals was located in Texas, which implemented medical liability tort reform caps on noneconomic damages in 2003, and the other was in Louisiana, which did not undergo significant tort reform during the same time period. The study revealed a significant reduction in medical liability claims per quar- ter in Texas after tort reform implementation, from roughly 7.27 claims per quarter to 1.4 per quarter. Meanwhile, in Louisiana, a considerable correlation was found between the increase in mean CMS hospital performance scores and the decrease in the frequency of claims, despite the lack of tort reform. Although tort reform caps on noneconomic damages in Texas caused the largest initial decrease, increasing quality improvement measures without in- creasing financial burden also decreased liability claims in Louisiana. According to lead author Khaled J. Saleh, MD, the study is the first to dem- onstrate a quantifiable link between increasing patient quality and decreasing medical liability claims. n New Online Benchmarking Engine Allows Hospitals to Compare Themselves to Peers By Heather Punke A recently launched online benchmarking engine pulls pub- lic data for 4,813 hospitals from CMS' Hospital Compare website and allows for comparison of hospitals against their peers. The tool, called OnlyBoth, uses artificial intelligence software that reviews the data and reports the findings in English sentences. It de- scribes hospitals by 84 attributes. People can enter any U.S. hospital into the engine and get answers to the following three questions: 1. How are we doing? 2. Where could we improve? 3. Which similar peers do best? "[OnlyBoth] starts with business data, discovers insights, and writes them up for people to act on," said Oren Etzioni, CEO of the Allen Institute for Artificial Intelligence in Seattle. Go to http://hospitals.onlyboth.com to benchmark a hospital. n

• Cover