Patients Give U.S. Hospitals So-So Marks

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The nation's hospitals received mediocre grades from U.S. patients in the first national survey of its kind, according to an analysis published Oct. 30 in the New England Journal of Medicine (NEJM).

Although most surveyed patients said they were satisfied with their hospital care overall, the data show that respondents weren't equally pleased with every aspect of care. Nearly 80% of patients said they felt their doctors always communicated well with them, for example. But less than three quarters said nursing services were always good, or that their rooms were always clean. Noisiness was an issue: Barely half of the surveyed patients said their rooms were always quiet.

"I really see this as a sea change in the way we think about health care and health-care quality," says Ashish Jha, assistant professor of health policy at the Harvard School of Public Health and lead author on the NEJM paper that analyzed the survey data. "For a $2.1 trillion health-care system, it's shocking we don't pay more attention to what patients think."

The new survey, called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), was created by a public-private partnership including the Centers for Medicare and Medicaid Services and the federal government's Agency for Healthcare Research and Quality. It was conducted in about 60% of all U.S. hospitals between July 2006 and June 2007 and designed to help administrators establish appropriate hospital policies while arming health consumers with the tools to pick the best care providers.

Some national data on hospital performance exists already. But doctors say that certain aspects of care can't be assessed without input from the patient: treatment of pain, for instance. (About a third of HCAHPS surveyed patients said their pain was not always treated adequately.) Doctors also want to make sure that patient-doctor communication is up to par. Patients who fully understand care instructions when they leave the hospital, for example, are more likely to stay out of the emergency room down the line. In total, the HCAHPS survey asked 27 questions about patients' demographic characteristics and eight areas of patient perceptions: communication with doctors, communication with nurses, quality of nursing services, communication about medications, pain control, information received when leaving hospital, and whether hospital rooms were clean and quiet. About 80% of surveyed patients felt they got good information at discharge. Only 60% said they always had good information about medications administered to them in the hospital.

Jha's analysis of the data found that patients liked not-for-profit hospitals more, on average, than for-profit hospitals. Institutions with more nurses per patient were also more popular than those with fewer. And, on the whole, the hospitals that scored better according to the survey were also those that performed better on more traditional measures of clinical performance, such as providing the appropriate emergency treatment for heart attack or correctly following procedures designed to reduce risk of medical error.

Results from the HCAHPS survey are public. Interested patients can compare scores from hospitals across the U.S. at; visitors can search by institution name or by location and view the performance of each hospital on several measures of clinical success, including the patient survey. Although roughly 40% of hospitals did not report any survey data this year (on average, hospitals that did report patient-survey results also scored better on traditional quality measures), consumers can expect a more complete data set next year. Soon, reporting patient-perception data, like reporting of other hospital-performance data, will be linked to Medicare funding, Jha says.

Perhaps now that hospitals know what patients are thinking, they can work to improve. Despite general patient satisfaction, the HCAHPS survey suggests that basic components of care can make or break the patient experience — things like how patients interact with hospital staff. "We should be in the upper 90s [in percentage of approval] on these things," Jha says. "It strikes me that we have a long way to go."

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The Rankings
Call it Southern hospitality. Patients in the South and the Midwest gave higher hospital satisfaction scores than Americans in the rest of the country. Of the 40 largest hospital-referral regions in the country, here are the best and worst, according to the proportion of patients in each region who gave their hospitals a score of 9 or 10, out of 10.


Percent rating
hospital 9 or higher

Birmingham, AL

Knoxville, TN

Charlotte, NC

Milwaukee, WI

Indianapolis, IN

Orlando, FL

Chicago, IL

New York, NY

Fort Lauderdale, FL

East Long Island, NY