{"id":258,"date":"2016-08-29T20:30:24","date_gmt":"2016-08-30T03:30:24","guid":{"rendered":"https:\/\/blog.sprucehealth.com\/?p=258"},"modified":"2023-10-26T06:22:15","modified_gmt":"2023-10-26T13:22:15","slug":"five-evidence-based-ways-increase-patient-satisfaction","status":"publish","type":"post","link":"https:\/\/sprucehealth.com\/blog\/five-evidence-based-ways-increase-patient-satisfaction\/","title":{"rendered":"Five Evidence-Based Ways to Increase Patient Satisfaction"},"content":{"rendered":"

Ask any doctor for their opinion on patient satisfaction, and you’re likely to hear\u00a0an impressively heated response.\u00a0Doctors, in general,\u00a0want their patients to be happy and to get better, but this does not necessarily equate to a love for the modern concept of patient satisfaction. While this\u00a0may seem paradoxical, in many cases, physicians are simply\u00a0concerned that some of the things that make patients happy might\u00a0actually make them less healthy. One recent landmark study, for instance, found higher rates of hospitalization and death among patients who were more satisfied, even after controlling for health status.[1]<\/p>\n

Other studies\u00a0have found the opposite, though, showing better\u00a0health outcomes in patients with higher satisfaction.[2]\u00a0Since, all else being equal, doctors would prefer their patients to be satisfied,\u00a0it would be useful to have an explanation that reconciled these disparate\u00a0conclusions. How can patient satisfaction be healthy in one case and dangerous in another? Perhaps the simplest possible theory is that not all patient-satisfying behaviors are created equal. Unnecessary imaging for low back pain and antibiotics for respiratory illness, for example, have been shown to be excellent at increasing patient satisfaction, but they also unfortunately increase iatrogenic harm and cost.[1] Empathic communication, on the other hand,\u00a0engenders higher satisfaction while also improving\u00a0clinical outcomes in diseases ranging from diabetes to the common\u00a0cold.[3]<\/p>\n

With this possible\u00a0reality in mind, here are five evidence-based things you can do to increase\u00a0patient satisfaction that don’t seem likely to decrease\u00a0patient health. Primum non nocere<\/em>, and awayyy we go:<\/p>\n

1)\u00a0Get Creative With\u00a0the Wait<\/h1>\n

People hate waiting. Patients hate waiting. You have probably already optimized your patient wait times\u00a0as much as you can, so maybe you think there’s nothing else you can do. But there might be!<\/p>\n

It turns out that most of what people\u00a0actually hate is feeling<\/em> like they’re waiting or, worse, feeling like they’re waiting longer than they expected to. This is a subtle but critical difference, and you can capitalize on it\u00a0to make your\u00a0patients happier without having to take on the nearly impossible task of changing actual wait times.<\/p>\n

In\u00a0one study, actual wait time to see a physician (PWT) did not predict patient satisfaction, but the wait time being\u00a0longer or shorter than expected had a huge impact:[4]<\/p>\n

\"Expectation<\/p>\n

So what can you do to decrease perceived wait time? There’s not as much good evidence on this, but there is\u00a0some decent guidance. One study, for instance, found satisfaction to more than double when the waiting room was viewed as “comfortable and pleasant” by patients with the same perceived length of wait.[5]<\/p>\n

Research and thinking from outside of medicine\u00a0may also be useful, and a set of business guidelines from 30 years ago is often cited on this topic:[6]<\/p>\n

\n
\n
\n
    \n
  • Unoccupied wait times feel longer than occupied wait times<\/strong>
    \nGive your patients valuable things to do when waiting. Make the waiting space attractive and pleasant, despite how much we seem to love a good sepia-tone dystopia in medical design.<\/li>\n
  • Preprocess waits feel longer than in-process waits<\/strong>
    \nGet patients moving through check-in flows and other steps of their visit, even as they wait to get to you.<\/li>\n
  • Anxiety makes waits seem longer<\/strong>
    \nSee if you can find ways to identify patients with urgent concerns and provide reassurance, if possible,\u00a0while they’re still waiting.<\/li>\n
  • Uncertain waits are longer than known,\u00a0finite waits<\/strong>
    \nGIVE SOME GUIDANCE ON EXPECTED WAIT TIME. UPDATE AS NECESSARY.<\/li>\n
  • Unexplained waits are longer than explained waits<\/strong>
    \nSomething going wrong in clinic? Keep the waiting room updated. See the point above this one.<\/li>\n
  • Unfair waits are longer than equitable waits<\/strong>
    \nSometimes we triage, depending on medical environment. Find a way to explain wait differences\u00a0that seem unfair.<\/li>\n
  • The more valuable the service, the longer people will wait<\/strong>
    \nProvide tons of value when you do finally see the patient. Research suggests that great visits make up for bad waits (more on this later).<\/li>\n
  • Solo waits are longer than group waits<\/strong>
    \nEncourage patients to bring friends or family to visits; decreased wait time perceptions will be a side benefit.<\/li>\n<\/ul>\n

    Then, after their wait is finally over, make sure that you…<\/p>\n<\/div>\n<\/div>\n<\/div>\n

    2) Spend Time With Patients<\/h1>\n

    I hear you; don’t groan yet! Of course we would all\u00a0spend more time with patients if\u00a0we could, so how is this useful advice? Because perception of visit time, just like wait time, is different than\u00a0actual<\/em> time.<\/p>\n

    In one study, patients were more\u00a0likely to rate their visit at the highest satisfaction level as perceived visit length increased:[7]<\/p>\n

    \"Satisfaction<\/p>\n

    The researchers did not report whether this effect was independent of actual visit length, which is unfortunate, but they did note that there was only fair to moderate agreement (kappa 0.41) between actual times\u00a0and patients’ estimates, so it is possible that the entire effect depends\u00a0on perception.<\/p>\n

    In support of the importance\u00a0of perception, the same authors also found that\u00a0a patient’s expectation of visit length predicted\u00a0their satisfaction:<\/p>\n

    \"Satisfaction<\/p>\n

    If patients were expecting\u00a0a visit to be shorter than it actually ended up feeling, they were pleased. Similarly, if they thought it was going to be longer\u00a0than it was,\u00a0they were less likely to be happy. Understanding your patients’ expectations of a visit will help you set\u00a0and then exceed them, producing tons of satisfaction without requiring you\u00a0to change the impossible (available minutes in the day).<\/p>\n

    Bonus power-up tip:\u00a0Longer perceived visits make up for bad\u00a0wait times!
    \n<\/strong>This is the greatest. Decent evidence shows that patients who perceive their visits to be longer are likely to be satisfied even when they have abominable wait times:[8]<\/p>\n

    \"Mean<\/p>\n

    In that graph, patients with short wait times were\u00a0generally happy no matter what, but\u00a0things started to get ugly\u00a0as wait times crept\u00a0up. The magic, though, is that happiness could still be salvaged if the visit was perceived to be longer (and probably “better” in general).<\/p>\n

    So how can you make visits seem longer and more generally valuable for your patients? Well, you could make them actually longer, or you could…<\/p>\n

    3) Sit Down<\/h1>\n

    This one’s easy, and you might have heard it before. When asked, patients say\u00a0that they want their doctor to be seated\u00a0when possible: one study observed\u00a0a 52% patient preference for this versus only 8% for standing (40%\u00a0didn’t care either way).[9]<\/p>\n

    Furthermore, when this\u00a0preference for seated posture\u00a0is tested in a controlled\u00a0way, it turns out that it likely\u00a0is real.\u00a0In an emergency medicine\u00a0study,\u00a0patients perceived physician encounters to be nearly 25% longer when their doctor was sitting instead of standing.[10] Other studies have reinforced this finding, while also observing that seated physicians are typically\u00a0perceived to be more compassionate than their standing colleagues, as well as better at\u00a0listening carefully and explaining things.[9,11,12]<\/p>\n

    Direct measures of satisfaction in posture\u00a0studies are not as clear, but given that patient perception of visit length appears clearly linked to satisfaction, and seated posture seems like a slam dunk to increase perceived visit length, the dots mostly connect themselves. Anyway, wouldn’t you rather sit down from time to time? The evidence basically demands that you do it.<\/p>\n

    Interestingly, some of the posture researchers were also extremely\u00a0thorough documenters (or realized too late that they didn’t have enough figures for their paper):[11]<\/p>\n

    \"Chair<\/p>\n

    Definitely a\u00a0vital Figure 1. Now, before you take that compassionate and evidence-based seat, make sure to…<\/p>\n

    4) Dress Like a Boss<\/h1>\n

    How you look affects many things in life, and it’s likely that patient satisfaction is on that list. To be fair, there is some conflicting evidence on this topic, so don’t throw your hospital wardrobe out just yet. In general, what we know is that patients will tell you that they\u00a0favor\u00a0doctors who are dressed the part (white coats, no jeans, etc.), and this finding has been reproduced many times,\u00a0both in studies that directly\u00a0surveyed patients\u00a0on their preferences and in those that were obviously geared to investigate\u00a0physician appearance (e.g., patient judgments were\u00a0based solely on photographs).[13,14]<\/p>\n

    Things get murkier, however, when you control physician appearance and then measure patient satisfaction in actual\u00a0care settings. One emergency department study\u00a0found no difference between scrubs and formal attire, for instance, but a post-hoc analysis on the same data revealed\u00a0a significant\u00a0positive effect for wearing\u00a0a white coat.[15] In an obstetrics and gynecology clinic, no satisfaction difference was found when comparing business clothing with casual attire or scrubs, but the “casual” category was still fairly formal (e.g., no jeans allowed, and some doctors were wearing white coats).[16]<\/p>\n

    Perhaps the best summation of this topic comes from a recent review of clothing for healthcare personnel, which concluded that “patients express preferences for certain types of attire, with most studies indicating a predilection for formal attire, including a white coat, but these partialities had a limited overall impact on patient satisfaction and confidence in practitioners.”[17] So you might be able to dress\u00a0down a bit without sacrificing\u00a0satisfaction, but with that said, here is the number of studies that support you wearing 10-year-old jeans\u00a0and a battered fleece jacket during patient care: zero. Dressing the part, within reason, is a definite\u00a0easy victory.<\/p>\n

    For visceral impact, here’s an actual picture of a doctor in “casual” dress\u00a0from one of the survey studies, with\u00a0patients preferring\u00a0this\u00a0~40 times less<\/strong>\u00a0than when he\u00a0was wearing\u00a0“professional” attire:[13]<\/p>\n

    \"Casual<\/p>\n

    Don’t be that guy. Instead, dress like you mean it and…<\/p>\n

    5) Be an Expert Communicator<\/h1>\n

    You don’t always have control over the course of a patient’s disease or their eventual outcome, but the way you build the doctor-patient relationship can have an important impact on how satisfied\u00a0that patient is with your care and how they feel about their illness. There are endless possible ways to communicate well or poorly with a given patient, of course, but studies have identified several concrete\u00a0communication topics that seem to reliably affect patient perception of care:[18]<\/p>\n

      \n
    • Unmet expectations
      \n<\/strong>It’s not just expectations that are important but also whether they are\u00a0met. Try to identify why exactly your patient has come to see you, and then do your best to meet those needs. If you spot\u00a0a gap between expectation and likely\u00a0reality, find a tactful way to address it and hopefully recalibrate your patient’s goals (or a way to connect\u00a0them with care that can meet their expectations).<\/li>\n
    • Likely length of symptoms
      \n<\/strong>If it is possible to give responsible\u00a0guidance on likely symptom course, you should definitely do so. The natural history of bronchitis\u00a0or a kidney stone may be old news to you, but your\u00a0patients will derive a huge mental benefit from being given\u00a0a clear timeline\u00a0on such things. We all like tracking numbers on our packages so that we know when to expect them; help your patients know when to expect the arrival of their\u00a0first symptom-free day.<\/li>\n
    • Explanation\u00a0of symptoms
      \n<\/strong>Your patients are coming to you for relief, yes, but they are also coming for answers. Don’t underestimate the positive effect you can have simply\u00a0by explaining what is happening (and what isn’t!) If you can explain to your patient why their cough is likely to be a self-limited virus and not a bacterial pneumonia, you might have already provided a good deal of what they wanted when they walked in your door.<\/li>\n<\/ul>\n

      Unfortunately, much of the work on the role of communication in patient satisfaction relies on surveys instead of controlled experimentation, so it is difficult to say precisely which practices\u00a0best establish a good doctor-patient relationship. For what it’s worth, many studies have identified likely roles\u00a0for a variety of\u00a0behaviors,\u00a0including giving patients ample time for questions, utilizing\u00a0shared decision-making, conveying\u00a0a positive attitude, and using normal human nonverbal communication strategies (eye contact, handshakes, appropriate humor).[19,20] If these findings are unsurprising, maybe that’s because it’s obvious that communication is\u00a0critical\u00a0to human satisfaction in every arena,\u00a0and we can’t afford to ignore that when the white coats go on.<\/p>\n

      Second bonus power-up tip: Good communication also improves health outcomes and reduces lawsuits!
      \n<\/strong>You thought we were done, but this is too good not to mention. Being an expert communicator with your patients will make them more satisfied, yes, but the evidence also suggests that it will make them\u00a0healthier. And you’ll get sued less. Maybe we’re simply measuring\u00a0the placebo effect, but meta-analysis of studies on the\u00a0doctor-patient relationship has indicated\u00a0that its quality has a small but\u00a0statistically significant effect on healthcare outcomes.[21] Individual studies on the topic are interesting, too: one showed reductions in symptom length and severity\u00a0among patients with the common cold when they felt their clinician was maximally empathetic.[19]<\/p>\n

      As for lawsuits, a large study found that 75% of patient complaints were\u00a0related to “communication” problems\u00a0rather than “care” issues, noting also a 6% increase in complaint rate for each 1-point drop in satisfaction score (on a scale of 5).[22] The same authors then correlated satisfaction scores to eventual risk management cases and found that each 1-point decrement in satisfaction was also associated with a 5% increase in the probability\u00a0of a risk management episode. Do you want to find out how much bad communication it takes to drop a few points of satisfaction? Probably not. Here’s a simple bar graph of risk management episodes among the top third, middle third, and bottom third of physicians by patient satisfaction score:<\/p>\n

      \"Risk<\/p>\n

      \n

      So there you have it: five evidence-based ways to increase patient satisfaction that aren’t likely to decrease\u00a0patient health. Let us know if you put any of these to work\u00a0and notice any differences, or if you’re already using some of them successfully!<\/p>\n

      \n

      References:<\/p>\n

        \n
      1. Fenton, J. J., Jerant, A. F., Bertakis, K. D. & Franks, P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch. Intern. Med.<\/i> 172,<\/b> 405\u2013411 (2012).<\/li>\n
      2. Glickman, S. W. et al.<\/i> Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circ. Cardiovasc. Qual. Outcomes<\/i> 3,<\/b> 188\u2013195 (2010).<\/li>\n
      3. Finset, A. 50 years of research on the effect of physician communication behavior on health outcomes. Patient Educ. Couns.<\/i> 96,<\/b> 1\u20132 (2014).<\/li>\n
      4. Thompson, D. A., Yarnold, P. R., Williams, D. R. & Adams, S. L. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann. Emerg. Med.<\/i> 28,<\/b> 657\u2013665 (1996).<\/li>\n
      5. Leddy, K. M., Kaldenberg, D. O. & Becker, B. W. Timeliness in Ambulatory Care Treatment: An Examination of Patient Satisfaction and Wait Times in Medical Practices and Outpatient Test and Treatment Facilities. J. Ambul. Care Manage.<\/i> 26,<\/b> 138 (2003).<\/li>\n
      6. Maister, D. H. The psychology of waiting lines<\/i>. (www.davidmaister.com, 1985).<\/li>\n
      7. Lin, C. T. et al.<\/i> Is patients\u2019 perception of time spent with the physician a determinant of ambulatory patient satisfaction? Arch. Intern. Med.<\/i> 161,<\/b> 1437\u20131442 (2001).<\/li>\n
      8. Camacho, F., Anderson, R., Safrit, A., Jones, A. S. & Hoffmann, P. The relationship between patient\u2019s perceived waiting time and office-based practice satisfaction. N. C. Med. J.<\/i> 67,<\/b> 409\u2013413 (2006).<\/li>\n
      9. Bruera, E. et al.<\/i> A randomized, controlled trial of physician postures when breaking bad news to cancer patients. Palliat. Med.<\/i> 21,<\/b> 501\u2013505 (2007).<\/li>\n
      10. Johnson, R. L., Sadosty, A. T., Weaver, A. L. & Goyal, D. G. To sit or not to sit? Ann. Emerg. Med.<\/i> 51,<\/b> 188\u201393, 193.e1\u20132 (2008).<\/li>\n
      11. Merel, S. E., McKinney, C. M., Ufkes, P., Kwan, A. C. & White, A. A. Sitting at patients\u2019 bedsides may improve patients’ perceptions of physician communication skills. J. Hosp. Med.<\/i> (2016). doi:10.1002\/jhm.2634<\/li>\n
      12. Swayden, K. J. et al.<\/i> Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Educ. Couns.<\/i> 86,<\/b> 166\u2013171 (2012).<\/li>\n
      13. Rehman, S. U., Nietert, P. J., Cope, D. W. & Kilpatrick, A. O. What to wear today? Effect of doctor\u2019s attire on the trust and confidence of patients. Am. J. Med.<\/i> 118,<\/b> 1279\u20131286 (2005).<\/li>\n
      14. Lill, M. M. & Wilkinson, T. J. Judging a book by its cover: descriptive survey of patients\u2019 preferences for doctors’ appearance and mode of address. BMJ<\/i> 331,<\/b> 1524\u20131527 (2005).<\/li>\n
      15. Baevsky, R. H., Fisher, A. L., Smithline, H. A. & Salzberg, M. R. The influence of physician attire on patient satisfaction. Acad. Emerg. Med.<\/i> 5,<\/b> 82\u201384 (1998).<\/li>\n
      16. Fischer, R. L., Hansen, C. E., Hunter, R. L. & Veloski, J. J. Does physician attire influence patient satisfaction in an outpatient obstetrics and gynecology setting? Am. J. Obstet. Gynecol.<\/i> 196,<\/b> 186.e1\u20135 (2007).<\/li>\n
      17. Bearman, G. et al.<\/i> Healthcare personnel attire in non-operating-room settings. Infect. Control Hosp. Epidemiol.<\/i> 35,<\/b> 107\u2013121 (2014).<\/li>\n
      18. Jackson, J. L., Chamberlin, J. & Kroenke, K. Predictors of patient satisfaction. Soc. Sci. Med.<\/i> 52,<\/b> 609\u2013620 (2001).<\/li>\n
      19. Rakel, D. et al.<\/i> Perception of empathy in the therapeutic encounter: effects on the common cold. Patient Educ. Couns.<\/i> 85,<\/b> 390\u2013397 (2011).<\/li>\n
      20. Zachariae, R. et al.<\/i> Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br. J. Cancer<\/i> 88,<\/b> 658\u2013665 (2003).<\/li>\n
      21. Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J. & Riess, H. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One<\/i> 9,<\/b> e94207 (2014).<\/li>\n
      22. Stelfox, H. T., Gandhi, T. K., Orav, E. J. & Gustafson, M. L. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am. J. Med.<\/i> 118,<\/b> 1126\u20131133 (2005).<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

        Ask any doctor for their opinion on patient satisfaction, and you’re likely to hear\u00a0an impressively heated response.\u00a0Doctors, in general,\u00a0want their patients to be happy and to get better, but this does not necessarily equate to a love for the modern concept of patient satisfaction. While this\u00a0may seem paradoxical, in many cases, physicians are simply\u00a0concerned that some of the things that make patients happy might\u00a0actually make them less healthy. One recent landmark study, for instance, found higher rates of hospitalization and death among patients who were more satisfied, even after controlling for health status.[1]<\/p>\n","protected":false},"author":1,"featured_media":464,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"slim_seo":{"title":"Five Evidence-Based Ways to Increase Patient Satisfaction - Spruce Blog","description":"Ask any doctor for their opinion on patient satisfaction, and you're likely to hear\u00a0an impressively heated response.\u00a0Doctors, in general,\u00a0want their patients to"},"footnotes":""},"categories":[17],"tags":[13],"different-template":[],"class_list":["post-258","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-practice-improvement","tag-literature"],"acf":[],"_links":{"self":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/posts\/258","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/comments?post=258"}],"version-history":[{"count":0,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/posts\/258\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/media\/464"}],"wp:attachment":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/media?parent=258"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/categories?post=258"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/tags?post=258"},{"taxonomy":"different-template","embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/different-template?post=258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}