Hidden consequences of patient satisfaction: A survey of pediatric surgeons

Belinda Li; Anne G Dudley; Chelsea J Lauderdale; Chevis N Shannon; John C Pope

doi:10.1016/j.jpedsurg.2021.03.010

Hidden consequences of patient satisfaction: A survey of pediatric surgeons

J Pediatr Surg. 2021 Sep;56(9):1524-1527. doi: 10.1016/j.jpedsurg.2021.03.010. Epub 2021 Mar 18.

Authors

Belinda Li¹, Anne G Dudley², Chelsea J Lauderdale³, Chevis N Shannon³, John C Pope⁴

Affiliations

¹ Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. Electronic address: belinda.li@vumc.org.
² Division of Pediatric Urology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT, USA.
³ Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
⁴ Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.

PMID: 33773798
DOI: 10.1016/j.jpedsurg.2021.03.010

Abstract

Background: Patient satisfaction surveys are increasingly utilized to assess patients' perceptions of their health care. Recently, these scores have been linked to payment, potentially incentivizing practices to meet certain metrics. We hypothesize that increasing pressures to receive positive reviews have led physicians to alter the delivery of their care to accommodate patient expectations over standards of care.

Methods: An 11-question REDCap™ survey was developed and emailed anonymously to all sixty-two surgeons across all surgical subspecialties at our children's hospital. Multiple-choice and open-ended questions were included. A modified Delphi method was used to acquire general consensus.

Results: Survey response rate for analysis was 41/62 (66%). 23 (56%) stated that they have changed their clinical practice patterns due to concerns regarding patient dissatisfaction. Examples of such changes included: requesting imaging tests or laboratory studies, performing invasive procedures, referring for second opinions, and prescribing medications. Only 2% felt that these interventions led to any significant change in outcome of a patient's condition. Several respondents expressed concerns that factors outside their control (scheduling, parking, wait times) contributed to patient dissatisfaction and affected providers' ratings, while others expressed concerns about inherent biases driving survey participants.

Conclusions: As a result of patient satisfaction surveys, a significant number of surgeons reported altering their clinical practice beyond standard care to meet patient expectations. Some of these modifications included performing unnecessary interventions. Reliance on these surveys may be at odds with reducing health care costs and avoiding physician burnout. These and other unintended consequences of patient satisfaction surveys warrant further study before they are widely accepted as appropriate quality metrics.

Level of evidence: Level IV, questionnaire.

Keywords: Health care quality; Outcomes; Patient satisfaction.

MeSH terms

Burnout, Professional*
Child
Humans
Patient Satisfaction
Practice Patterns, Physicians'
Surgeons*
Surveys and Questionnaires