Quality of care through the patient's eyes

Satisfaction surveys are just the start of an emerging science

As techniques to measure the quality of health care proliferate and improve, health professionals are beginning to understand that patients and their families hold unique vantage points as expert witnesses to care. For some time, hoteliers, bankers, car manufacturers, and politicians have been enthralled by information about the public's view of their services, including anecdotes, insights offered by focus groups, and data gathered from large scale surveys. Slow to turn to new fashions, health professionals are now learning that those they serve can make important suggestions as individuals, generate worthy hypotheses in small groups, and provide aggregate data through surveys that describe what is and is not going well and that can document the impact of efforts to improve.

Unfortunately, “satisfaction surveys” are fraught with hazards. As Cohen and colleagues show (p 841), surveys may produce widely varying data depending on how questions are framed and when and how they are asked.1 Moreover, uncertainty is compounded when one problematic set of data is compared to another obtained with even slightly differing …