What’s Driving Patient Satisfaction in Inpatient Hospitals?

Patient satisfaction is widely recognized as a central indicator of service quality and care received by patients.1,2 Thus, patient satisfaction surveys are often used for benchmarking purposes at hospital, state, and national levels.3,4

In conjunction with other measures, health care organizations commonly use patient satisfaction outcome data to justify the implementation of quality improvement programs.2 At state, national and international levels, patient satisfaction data are gradually influencing major shifts in health care policy and quality of care reforms in medical and psychiatric settings.3,4

As a subjective quality indicator, patient satisfaction reflects “the extent to which services gratify the patient’s wants, wishes or desires for treatment,” 5 from the patient’s perspective. Thus, patient satisfaction data places patients’ personal treatment needs and perspectives in the foreground with objective indices of successful treatment outcome, for example, symptom improvement.2,4,6  

To those concerned with improving mental health care quality, patient satisfaction –– as a focus of research, a patient-reported clinical outcome,7 and a predictor of good prognosis8–– should be of great interest. It seems likely that patient satisfaction will be an important measure in research aimed at improving the quality of mental health care. Yet, among providers of psychiatric inpatient care, skeptical opinions about the validity, reliability, and utility of inpatient satisfaction data are widespread.

Skepticism About Inpatient Satisfaction

Psychiatric health care providers frequently presuppose that inpatient satisfaction data, especially when gathered from inpatients with psychotic disorders, are unreliable and invalid due to poor insight, a characteristic feature of the illness.7 Ostensibly this perspective is plausible: A patient who lacks awareness of his or her mental illness would have difficulty grasping the purpose and necessity of psychiatric treatment and accurately self-assessing treatment effects.9 In this way, poor insight complicates the measurement of patient satisfaction.7

However, although poor insight complicates the measurement of inpatient satisfaction, it doesn’t invalidate it.3,7,9 In fact, there is good evidence to the contrary. Psychiatric hospitals that have implemented satisfaction surveys are finding that psychiatric inpatients can tell them if and to what extent they are satisfied. Poor insight, though, may frequently prevent inpatients from identifying why they are satisfied, or articulating a coherent rationale for their satisfaction ratings.9

Further complicating the measurement of satisfaction is that it may depend as much on the characteristics of staff and quality services delivered as on the illness and personality characteristics of the patients receiving care.5,8 Provide any ten psychiatric inpatients the same quality services from the same staff, and self-reported satisfaction scores may vary from one extreme to the other.

High variance between and within study findings on inpatient satisfaction6 has been frequently reported and seems to have left many researchers and inpatient clinicians unsatisfied with just knowing if and to what extent inpatients are satisfied; they want to know why. To understand the determinants of inpatient satisfaction, researchers have found they must look beyond satisfaction surveys to explore the underlying patient, illness, and treatment related variables linked to patient satisfaction.7

Identifying and Understanding the Determinants of Inpatient Satisfaction

Identifying and understanding the relationships between patient, illness, and treatment variables and patient satisfaction may, in some settings, be a prohibitively costly and time-consuming endeavor. Yet currently, at John George Psychiatric Hospital in San Leandro, Calif., clinical psychology doctoral students are undertaking research in this area as part of their clinical training.