Patient Satisfaction: Can Academic Medical Centers Compete?

Otolaryngologists practicing in academic medical centers score lower than those practicing in a community setting on a number of key patient satisfaction measures, especially in categories that involve access and convenience, such as “promptness in returning phone calls” and “time spent waiting before going to an exam room,” according to an analysis of Press Ganey Medical Practice surveys completed by otolaryngology patients and published earlier this year (Laryngoscope. 2012;122(10):2304-2310).

Despite this gap, academic otolaryngologists rated higher than those in community practice on questions relating to loyalty, such as confidence in the care provider and willingness to recommend the practice or care provider to others.

This study, the first to broadly quantify and assess patient satisfaction scores in the otolaryngology outpatient setting, as well as the first to explore the impact of the teaching setting on patient satisfaction with otolaryngology, has a clear message for otolaryngologists regardless of practice setting: “Physician behaviors were those most likely to correlate with whether or not a person decides to come back to a practice,” said Emily Boss, MD, MPH, the study’s lead author and an assistant professor of otolaryngology-head and neck surgery at Johns Hopkins University School of Medicine in Baltimore.

Small Differences May Be Significant

The Press Ganey survey analyzed 29 Likert-scaled questions grouped into six service domains—access to care, moving through the visit, nursing, care provider, personal issues and overall assessment. On many questions within each of the six domains, the difference in mean Press Ganey scores between the community setting and the academic medical setting did not rise to the level of statistical significance.

And, even in those areas where there was a significant difference, both types of providers scored fairly high. One example is “ease of scheduling appointment,” in which non-teaching otolaryngologists scored 89.1 and teaching otolaryngologists scored 90.2. “That’s like saying, ‘Statistically speaking, Michael Phelps swims faster than Ryan Lochte,’” said C.W. David Chang, MD, assistant professor of clinical otolaryngology at the University of Missouri School of Medicine in Columbia. “The difference is miniscule.”

Dr. Boss sees the statistics differently. “Actually, this small difference is much more significant than it may seem,” she said. Scores received on a satisfaction survey are right-skewed and typically have a very small range for each question, she added. The majority of patients give physicians or practices scores of 4 (“good”) or 5 (“very good”/“great”). The individual survey scores, typically ranging from 75 to 100, are averaged and then benchmarked against all other otolaryngology practices, so that each practice receives a national percentile rank of 1 to 100. Depending on the question, a difference of approximately 0.7 in mean score may mean a difference of more than 10 percentiles nationally, she said, and added that small differences perceived in the mean score are actually quite significant.