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Hospitality Trumps Clinical Outcomes When It Comes To Patient Satisfaction

Analysis  |  By Jennifer Thew RN  
   February 27, 2020

Patients' ratings of hospitals have almost no correlation to the quality of care, new research finds. 

Your friend tells you she needs a knee replacement. There are two hospitals in town. One that has rooms with amazing views and delectable food. The other has a rate of zero hospital-acquired conditions. She asks which one you would choose.

Of course, you'd pick the one with better clinical outcomes. Who wouldn't?

Yet, according to new research from Cornell University, patients’ ratings of hospitals and their willingness to recommend them have almost no correlation to the quality of care.

“The No. 1 thing that ultimately matters to patients – are you going to survive your operation? Can they fix you? – does not really factor into patient satisfaction scores,” says Cristobal Young, associate professor of sociology in the College of Arts and Sciences at Cornell University in a news release.

As lead author of  "Patients as Consumers in the Market for Medicine: The Halo Effect of Hospitality," Young and colleagues analyzed Centers for Medicaid and Medicare Services data on patient satisfaction, mortality, and technical medical quality for more than 3,000 general and acute-care hospitals in the United States between 2007 and 2010.

The study found patient satisfaction scores at hospitals with the lowest death rates were only 2 percentage points higher than hospitals with the highest death rates.

A far bigger factor in patient satisfaction, with scores varying by nearly 27 percentage points, was interpersonal communication by nurses, including their responsiveness and compassion.  

Additionally, the tidiness and quietness of rooms had a larger influence on patient satisfaction than death rates or medical quality.

Young says the fundamental problem is that patients generally can only see and understand a hospital’s “front stage” room-and-board presentation.

“They know when the food is cold and tasteless, when their room is loud and overcrowded, when the nurses are too busy to tend to their pains and frustrations,” the study authors write.

Patients have little insight into the “backstage” operations where critical medical care happens, and as a result, the study concludes, front stage room-and-board care creates a “halo effect” of patient goodwill while the backstage delivery of excellent care does not.

While many hospitals have invested in hotel-like amenities including atriums with waterfalls, private rooms with patios and scenic views, gourmet food, and premium TV channels, those investments, Young cautions, represent a distraction and a shifting of resources from what should be an organization's core mission – providing excellent healthcare.

“No one would object to nurses being friendly or to patients having private rooms and great food and manicured gardens,” Young says. “But none of those things are medical treatment. They won’t fix your health problem. And hospitals have limited resources and razor-thin margins.”

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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