Measuring patient satisfaction with hospitalists: Survey development and initial findings

The field of hospital medicine is undergoing a period of rapid growth, and hospitalists are becoming an essential aspect of hospital environments. This growth is driven by the reduced presence of family/general practitioners and internists in hospitals. The broad view of care taken by hospitalists, and their role as a link to hospitalized patients' primary care providers, will become key in the continued wellness of hospitalized patients. At the same time, patient satisfaction measurement has become a key quality indicator in many health care arenas. This point was made clear with the onset of the Hospital Consumer Assessment of Healthcare Providers and Systems H-CAHPS survey—a standardized tool for measuring patients' perspectives of hospital care. Not surprisingly, many have called for a new patient satisfaction instrument tailored to the hospitalist role and better suited to meet the needs of this field than present tools. Focus groups were conducted with providers and administrators to identify the current issues in the field, examine potential items, and determine reporting needs. Primary issues included time with the patient, concern for patients, clarity/timeliness of explanations, interactions with family, and discharge preparation. Also critical was the ability to include photos on the survey (as hospitalists typically have no prior relationship with the patient), the ability for the patient to rate multiple hospitalists, and provider-level reporting. A pilot-test was conducted with five hospitals using items identified in the focus groups. Measures of central tendency and variance were examined for all questions. Response frequencies and patient comments were evaluated for patterns of missing data and question-wording problems. Inter-item correlations were examined to identify item redundancy. A factor analysis confirmed the scale's construct validity. A multiple regression revealed that the survey items predict the likelihood of patients' recommending the hospital, confirming the scale's predictive validity. Corrected item-scale and item-non-scale correlations confirmed the scale's convergent/discriminant validities. Cronbach's alpha (.967) suggested a high degree of reliability. According to the Flesch-Kincaid Index the final survey tests at a ninth-grade reading level. Poor performing items were eliminated during the process resulting in final scale comprised of eight items. The survey was launched nationally in 2011, providing additional data for psychometric analyses, and a national examination of patient's satisfaction with these providers. Future research on the national database and through case studies will identify best practices regarding specific hospitalist functions, interactions with patients, interactions with other hospital staff, and relationships with clinical/operational/financial metrics.