Are patient satisfaction surveys doing more harm than good?

Though the intention of patient satisfaction 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 recent report from The Hastings Center.

The Hastings Center is a nonpartisan research institution dedicated to bioethics and the public interest.

"Patient satisfaction is an important, valuable element of good healthcare, yet some uses and consequences of patient satisfaction surveys may be problematic," the authors wrote.

The report lists the following unintended consequences that patient satisfaction surveys could cause:

  1. Providers giving unnecessary or inappropriate 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 happens 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 healthcare costs.

"Ultimately, patient satisfaction surveys may lead healthcare astray, undermining the provision of optimum care for all," the authors conclude.

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