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Pitfalls of Patient Satisfaction Surveys and How to Avoid Them

David Evans's picture

A child has a fever. Her father rushes to his community’s clinic, his daughter in his arms. He waits. A nurse asks him questions and examines his child. She gives him advice and perhaps a prescription to get filled at a pharmacy. He leaves.

How do we measure the quality of care that this father and his daughter received? There are many ingredients: Was the clinic open? Was a nurse present? Was the patient attended to swiftly? Did the nurse know what she was talking about? Did she have access to needed equipment and supplies?

Both health systems and researchers have made efforts to measure the quality of each of these ingredients, with a range of tools. Interviewers pose hypothetical situations to doctors and nurses to test their knowledge. Inspectors examine the cleanliness and organization of the facility, or they make surprise visits to measure health worker attendance. Actors posing as patients test both the knowledge and the effort of health workers.

But – you might say – that all seems quite costly (it is) and complicated (it is). Why not just ask the patients about their experience? Enter the “patient satisfaction survey,” which goes back at least to the 1980s in a clearly recognizable form. (I’m sure someone has been asking about patient satisfaction in some form for as long as there have been medical providers.) Patient satisfaction surveys have pros and cons. On the pro side, health care is a service, and a better delivered service should result in higher patient satisfaction. If this is true, then patient satisfaction could be a useful summary measure, capturing an array of elements of the service – were you treated with respect? did you have to wait too long? On the con side, patients may not be able to gauge key elements of the service (is the health professional giving good advice?), or they may value services that are not medically recommended (just give me a shot, nurse!).

Two recently published studies in Nigeria provide evidence that both gives pause to our use of patient satisfaction surveys and points to better ways forward. Here is what we’ve learned: