It's Not Medical Outcomes That Drive Patients' Hospital Reviews
Rave online reviews about a hospital stay may not mean much about the actual medical care there, if a new study is any indication.
Researchers found that across U.S. hospitals, patient-satisfaction scores were more dependent on "hospitality" factors -- like friendly nurses, quiet rooms and good food -- than on hard measures of health care quality.
At hospitals with the lowest death rates, patient satisfaction tended to be higher, but only by a small amount, the study found. Instead, quiet, comfort and friendly staff were much stronger influences.
It's not exactly surprising: Patients know whether their food is palatable, their room is comfortable or hospital staffers are responsive, noted Cristobal Young, the lead researcher.
"Those front-stage factors are visible to them," said Young, an associate professor of sociology at Cornell University in Ithaca, N.Y.
The "backstage" happenings, meanwhile, are critical, but not necessarily apparent. "The steps a hospital takes to control infection, for example, are very important," Young said. "But they're not visible to us."
And if patient satisfaction ratings do not capture those variables, people should take Yelp reviews with a grain of salt, according to Young.
The study, published recently in the journal Social Forces, conflicts with some past research that found high patient-satisfaction ratings do correlate with the quality of a hospital's medical care.
But the fact that medical care affects patient satisfaction tells only part of the story, according to Young. The new findings, he said, suggest that while that's true, "hospitality" is a much stronger influence.
For the study, Young's team analyzed government data on medical care quality and patient satisfaction for more than 3,100 U.S. hospitals, collected between 2007 and 2010.
Health care quality was measured through such factors as a hospital's 30-day death rate among older patients treated for heart disease or pneumonia; and how well the staff adhered to standards of care for heart disease, pneumonia and surgeries.
Patient satisfaction was gauged through a standard survey that asked about issues like nurses' communication, pain relief, and the comfort and quiet of hospital rooms.
In general, Young said, patient satisfaction was only slightly higher at hospitals with the lowest death rates than those with the highest -- a difference of about 2 percentage points.
On the other hand, a clean and quiet room made a bigger difference in patient ratings. Nurses, meanwhile, had the greatest impact. At hospitals where nurses' communication skills were rated in the top 10%, patients were happier -- with more than 75% giving high satisfaction ratings to their overall care.
In contrast, at hospitals where nurses' communication was in the bottom 10%, only about half of patients were highly satisfied, the investigators found.
That yardstick, however, misses the importance of nurses' technical know-how in caring for patients, Young said.
A key question is whether nurses' communication skills can really be considered a nonmedical factor. And the American Hospital Association (AHA) says the answer is "no."
"The study authors characterize the nursing-communication questions as a 'hospitality' measure. But those questions also reflect much deeper quality-related issues -- like whether nurses listened carefully to patients and explained care," said Akin Demehin, director of policy for the AHA.
Beyond that, he said, additional questions on the survey "reflect patient perspectives on other important quality issues -- like staff responsiveness, medication management and the clarity of discharge orders."
Demehin added: "We are concerned that this study's findings reflect a misconception of how patient experience relates to quality."
It might seem logical that, even if a rave online review focuses on the pleasant aesthetics of the hospital room, the hospital would likely provide good care, too.
According to Young, "Just by virtue of the hospital having more resources to throw around, you might think they'd provide better care. But the actual correlation is weak."
He suggested that people turn to the Medicare program's Hospital Compare website. It provides information on factors such as surgery complications, infections and whether a hospital meets various standards of care.
"The Yelp reviews don't tell you the most important things you need to know," Young said.
For more on the quality of your local hospitals, visit Medicare's Hospital Compare.
SOURCES: Cristobal Young, Ph.D., M.A., associate professor of sociology, Cornell University, Ithaca, N.Y.; Akin Demehin, M.P.H., director of policy, American Hospital Association, Washington, D.C.; Feb. 13, 2020, Social Forces, online