Controversy has arisen, however, regarding the validity of "patient satisfaction" as a useful yardstick. Two articles from the literature illustrating this recently caught my eye.
JAMA Surgery in April 2013 published a much cited article that evaluated the relationship between patient satisfaction scores and hospital compliance with Surgical Care Improvement Project (SCIP) metrics. Interestingly, in a study of 31 hospitals, patient satisfaction was found to be independent of the extent to which hospitals followed standard guidelines to help reduce post operative infectious complications.
A couple of months ago, Annals of Surgery studied 171 hospitals over 11 years, looking for a correlation between patient satisfaction and surgical outcomes. The findings of the study certainly raised some eyebrows. The only surgical outcome indicator associated with high patient satisfaction scores was a low mortality rate. (Let us hope that no one is surprised by this particularity.) More confounding was that complications and higher readmission rates after surgery had no statistical effect on a patient's reported satisfaction experience. The only variables associated with high satisfaction scores, other than low mortality, were larger hospitals (in square footage, I guess) and hospitals with a high surgical volume.
These papers highlight the concern many of us in the trenches have with using subjective, highly capricious metrics like HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores as a reliable measure of quality. You end up in an upside down world where patients with horrible surgical complications effusively praise their doctors and nurses for being so "compassionate and caring during a difficult time" and, on the other hand, where patients who sail through difficult major colon resections give a hospital a bad score because their TV only had three working channels and the newspaper delivery volunteer was rude every morning.
Quality is a metric that cannot be measured via proxies. We need to start being more honest about it. Using HCAHPS and patient satisfaction scores is just a fancy way of equivocating on transparency. We have a perfectly fine, already available method of measuring quality: simply open up the drapes and let some light into the world of surgical outcomes. If you want to let the public know how well a hospital or surgeon is performing, don't think you are providing a valid answer by instead publishing bullshit like "patient satisfaction is very high!". Publish the actual outcomes. If a hospital performs 1,000 hernia repairs every year, then maybe the public has a right to know recurrence rates, infectious complications, mortality rates, etc. Same thing with abdominal procedures and orthopedic interventions. We have been doing the exact same thing in the realm of cardiothoracic surgery for years. Open up the books. May the best man win.