March 14, 2019
2 min read

Patient satisfaction needs a team approach

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Patient satisfaction assessment has become critical to determine quality and value in medical care. The patient’s perspective is important to understand and assess so improvements are patient-centric. The movement toward patient satisfaction assessment is not new, but its importance in health care has escalated as it is now tethered to reimbursement and other financial incentives.

Patient satisfaction is challenging. Some have suggested survey results represent a true objective outcomes measure that can be affected by specific processes of care. However, this is a highly subjective-based measurement tool, influenced by patients’ socioeconomic factors, health care status, severity of illness and the influence of community opinions on the provider or health care system.

Anthony A. Romeo, MD
Anthony A. Romeo

Quality, value of health care

Patient satisfaction is closely tied to patient expectations of ideal care. If patients make an appointment to see an expert, they may not care if they have an extended wait time in the office or about the communication style, when they get answers to their questions. However, when a patient expects to be evaluated in an efficient manner, an extended wait, completing excessive paperwork and assessments by clinical staff before seeing the surgeon may result in less satisfaction despite high-quality care.

Responses form a basis for improved care. For example, a driving factor for outpatient surgical care to be delivered in an ASC is patient satisfaction is greater when compared with other environments. As the flow of care away from the institutional, hospital-based environment increases, the hospital systems have responded by developing outpatient ASCs that are often managed differently than their inpatient facilities, providing care with similar patient satisfaction scores, even if the cost mimics typical hospital care as opposed to less expensive ASC care.

Patients see health care delivery as a team approach. In the hospital setting, nurses’ attentiveness and ability to listen and access to care are powerful drivers of satisfaction. In the outpatient setting, ease of making an appointment, courtesy of staff and method for payment affect patient satisfaction. Institutions have created committees to ensure all stakeholders are aware of their impact on patients and the significant consequences of misbehavior.

Influence positive change

Patient satisfaction questionnaires are often variable and biased based on the developer of the scale. Most questionnaires reflect general health care delivery and institutional assessment and may not identify areas of value to surgical subspecialties. There are ceiling effects to many instruments, whereby higher scores are more easily achieved, so they fail to provide the granularity and specificity to compare different systems and make valuable changes.


Future questionnaires should be more standardized and reflect issues important to specialization. We should work toward a system that influences positive change — not one where every patient scores 90% or above on satisfaction.

Patient satisfaction is important to orthopedic surgeons. We are reminded of this when we become patients, which leads to improved awareness of where significant changes can provide better experiences. Patient satisfaction is a valuable concept and an opportunity to continually improve how we practice. We should be more involved in the instruments and methods used so these accurately reflect our practice and provide the best information to improve patient care.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.