Patient assessments in surgery: Variables which contribute most to increase satisfaction

Background: Patient assessments are increasingly seen as important outcome measures and are used by many health care providers for internal evaluations of their own performance. In the context of the Affordable Care Act, patient evaluations became even more relevant since satisfaction ratings have been linked to Medicare reimbursement. For this reason, it is important to understand whether factors associated with patients' assessments are alterable by allocation of resources or whether variables than cannot be modified are the most influential determinants of satisfaction. We conducted a multisite study of surgical patients who responded to a validated survey to assess which aspects of the hospital stay contribute most to increase satisfaction. Methods: The study data were obtained from 55 hospitals from the statistical metropolitan area of Dresden, Germany. The eligible study sample included 4.276 randomly selected surgical patients aged 18 years and older who were discharged in 2012. Patient assessments and socio-demographic characteristics were measured using a 43-item questionnaire. Bivariate (chi-square test, Mann-Whitney-U test) and multivariate (logistic regression analysis) techniques were used to reveal relations between overall satisfaction and assessed variables. All associations were considered to be statistically significant at p<0.05-level. Results: The analysis revealed seven major determinants of satisfaction of surgical patients. Determinants were variables primarily reflecting the interaction between hospital staff and patients followed by service and organizational aspects such as accommodation (OR: 1.71, 95% CI: 1.32-2.23) and the organization of admittance (OR: 1.37, 95% CI: 1.10-1.71). Interpersonal manner of nurses (OR: 1.81, 95% CI: 1.30-2.52) and service staff (OR: 1.89, 95% CI: 1.17-3.03) were more important to patients than communication with physicians (OR: 1.49, 95% CI: 1.16-1.90). Variables reflecting information receiving such as the quality of instructions given to the patients (e.g., regarding operation and anesthesia) were not associated with satisfaction ratings. Conclusion: This research suggests that interpersonal aspects of care – particularly the interaction with nurses, service personal and patients – are strong drivers of satisfaction and are more important to patients in surgery than technical aspects of care. Found determinants of satisfaction are modifiable by health care professionals. Therefore, emphasis should be put on these factors to enhance patient satisfaction and, at the same time, increase the likelihood that patients will return to their provider for additional care.