Uncovering the blind spot of patient satisfaction and patient expectations: An international survey

Patient satisfaction is increasingly recognized as an important component of quality of care. To achieve a high level of patient satisfaction, providers need to identify and address patients' expectations. However, a new international survey conducted by researchers from Brigham and Women's Hospital (BWH) and Harvard Medical School reveals that while clinicians think it is important to ask patients about their expectations, they often fail to do so and consequently may not respond adequately. This research is published in the November issue of the British Medical Journal: Quality and Safety and was selected as the Editor's choice, making it available online in full text at no cost.

"Although nearly all clinicians we surveyed indicated that it was important to ask patients about their expectations, only a few reported actually asking. This appears to uncover a in clinicians' approach when attempting to address patient expectations and improve ," said Ronen Rozenblum, PhD, MPH, lead author of the paper and a researcher in the Department of Medicine at BWH. "Despite emphasis on Patient-Centered Care by many groups these findings raise concerns regarding the of clinicians towards the subjective needs and expressed preferences of individual patients," Rozenblum said.

Researchers surveyed 1004 clinicians, both physicians and , from four in Denmark, the United States, Israel and the UK. The survey included questions that focused on clinicians' awareness, , competence and performance with respect to patient expectations. Researchers report that almost nine in ten clinicians felt their awareness of patient expectations was inadequate. They also discovered that while 89.4 percent of clinicians believed it was important to ask patients about expectations, only 16.1 percent reported actually asking. This result varies by country with Denmark having the highest percentage of clinicians routinely asking, followed by the United States, then the United Kingdom and Israel. Additionally, only 19.6 percent of clinicians felt they had adequate training to handle patients' expectations and only 6.9 percent stated that their department had a structured plan for addressing patient expectations.

According to Rozenblum, the study findings not only highlight the problem but also identify the main causes of clinician's blind spot. The researchers discovered that the level of awareness and adequate training were the major determinants of clinicians' approach to addressing patient expectations. These findings reveal that clinicians with greater awareness and/or adequate training were more likely to ask patients about their expectations.

"These data suggest that healthcare organizations should take a more active role in increasing clinicians 'awareness. Conducting training to cope with patient expectations and initiating structured programs for addressing patient expectations might in turn improve outcomes," concluded David Bates, MD, Senior Vice President for Quality and Safety at BWH and senior author on the paper.

Based on the study findings, Dr. Rozenblum and Dr. Bates have developed a conceptual model of patient satisfaction (PatientSatisfactive Model™) as a dynamic entity that incorporates providers' efforts to address patients' expectations of care. The PatientSatisfactive Model™ includes elements designed to empower patients to express their expectations and to engage clinicians in dialogue about those expectations throughout the hospitalization. The model has already been tested in a pilot study and the researchers are now taking the next steps to test the model in a multi-center study.

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