In today’s market, where patients have greater access to information and higher expectations for the quality of care they receive, the issue of patient satisfaction has received a great deal of attention.
When you hear the words “patient satisfaction,” what images come to mind? Do you view patients as consumers? Are you happy to increase the chances that your patients will feel satisfied with the care they receive from your practice? Or do you feel irritated by the notion of “catering” to your patients? Does your employer tie bonuses and salary increases to your patient satisfaction scores? Is that ethical?
Many articles have been written about patient satisfaction as it relates to the healthcare profession: “How Patient Satisfaction Can Kill,” “Patient Satisfaction Doesn’t Mean the Best Medical Care,” and “Why Linking Patient Satisfaction with Dollars is Misguided.” After all, we’re not in retail where the “customer is always right.” We are called upon to provide not what the patient wants, but what the patient needs. These are often very different things.
I have spoken with many therapists and orthopedic surgeons, regarding how they assess the level of satisfaction patients have with their care. Many clinicians ask patients to fill out a satisfaction survey on their final appointment. Some use plug-and-play survey tools like surveygizmo or SurveyMonkey, while others have made up their own. Regardless of survey type, I believe that the key to having a useful survey is to ask the right questions. And the key to increasing patient satisfaction is to choose the appropriate treatment while educating the patient on why you’re doing what you’re doing.
Although the care of patients involves many different activities, the two main aspects of care are the technical and the interpersonal. As the physical therapy industry continues to push for evidence-based practice, we as therapists are doing a better job of providing technically improved care. We are taking a hard look at the way we have always done things and asking if the evidence really supports the continued use of certain modalities and techniques in practice. This is vital to advancing our profession. The trick is to continue to focus on the other aspect of care, the interpersonal, at the same time.
Evidence suggests that by encouraging patients to take an active role in their health care we can increase the effectiveness of their therapeutic activities. This article from 1985 presents an idea that I believe is still relevant to this discussion. The title says it all: “Building an effective doctor-patient relationship: from patient satisfaction to patient participation.” The article states that “physicians are urged to involve patients in an informed decision making process by eliciting and including patient preferences in a health program that incorporates an active patient role.” This quote truly gets to the heart of the matter: In order for our evidence-based treatments to actually be effective (and therefore lead to patient satisfaction scores that are truly representative of the quality of care), we need to get the patient to “buy-in” first.
The best way to get buy-in is to involve patients in the decision-making process and educate them about the treatment plan. How many times do we conduct a technically perfect initial evaluation and then give the patient the “correct” home exercise program, only to have them come back for the next appointment stating that they haven’t tried the home exercises? We then feel frustrated and often blame the patient for non-compliance, when the real problem is that the patient never bought into the plan in the first place. Thus begins a negative cycle of patient non-compliance and therapist frustration that ultimately leads to poor patient satisfaction scores.
I propose that we involve patients in the healing process from the moment we meet them. In the initial evaluation, we need to ask our patients “How can I help you?” and “What can’t you do that you want to do?” From there, we need to educate them about our findings from the assessment and tie those findings into the goals we are setting in the treatment plan. During treatment sessions, we need to explain how a specific exercise or technique will assist them in reaching their goals, and then we need to hold them accountable for doing their part in the process. We must emphasize the importance of the patient’s active participation in the success of the treatment plan.
It is also important to determine what might be standing in the way of the patient’s compliance with attending appointments and/or performing home exercises. Is it difficult to find parking at your facility? (It is at my office, where only street parking is available, so I tell patients this when they schedule their first appointment). Is the patient caring for small children and an aging parent? (Then perhaps their home exercise program should consist of one to two very focused exercises they perform several times a day as time allows). In short, we need to set our patients up for success, not blame them for failure.
As therapists, we are in the unique position of spending a substantial amount of time with our patients each week. By developing a mutually respectful relationship and educating our patients about the treatment process, we can increase our overall success with each patient. And that’s what patient satisfaction is all about: the experience of technical and interpersonal success.