“Time to Get Serious About Patient Satisfaction” by Paul Keckley in H&HN Daily, July 7

Avedas Donabedian, M.D., the father of the structure, process and outcomes approach to health care quality, got it right when he said, “Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked. Generally speaking, one can assume that the quality of care is, actually, worse than surveys of patient satisfaction would seem to show.”

The reality is that HCAHPS and similar instruments aren’t really getting at what patients really think about care. Take a look at the physician-patient communication literature and you will find that it is poor physician communication skills in the exam room that are at the root of inaccurate diagnoses, medical errors and mistreatment/undertreatment of patients. Sir William Osler said more than 100 years ago: Listen to the patients and they will tell you the diagnosis. The problem is that physicians today don’t ask, and when they do, they often don’t listen.

If providers are serious about providing high-quality care at a good value, they need to look beyond HCAHPS at the real indices of good, patient-centered communications, e.,g., patient nonadherence rates by provider, medical error rates by provider, percentage of patients who leave the doctor’s office not understanding what they were told to do, number of missed opportunities for engaging patients in teachable moments, etc.

The same patients who give physicians and hospitals 95 percent “good–very good” scores on HCAHPS for clinician communications are walking out of the doctor’s office misdiagnosed, not allowed to ask any questions and not told how to take a new medication.

— Steve Wilkins, MPH
Mind the Gap Academy
Founder, Adopt One! Challenge

A Critical Distinction

I am disappointed that many of the writers, including Dr. Keckley, use the terms “patient experience” and “patient satisfaction” interchangeably. They are different concepts. Using them without regard to their meaning only confuses readers and the general public. Isn’t HCAHPS an experience measure, not a satisfaction measure? Meaning it looks at whether something happened. It does not look at how happy I am with what happened. Tools to measure both experience and satisfaction have their value. Using one does not rule out the other.

— alanhp

Always Waiting for the Prod

Perhaps my greatest disappointment in our industry is that it always seems to be reactionary to the winds of the next payment method, the next IHI report, the next penalty for lacking quality. We in the business should be demanding more of ourselves, leading the change.

— Marty Gutkin

Find the Right Fit or Fail

“Culture Critical to any Health Care Partnership” by Marty Stempniak in July 14

Every organization has a one-of-a-kind set of competencies, a performance profile that makes it unique, with a potential unlike any other enterprise. These core competencies are really the heartbeat, the very nature of an enterprise. But it takes continuous informed observation and careful analysis to find them. Leaders have to dig diligently and deeply to detect those special capabilities that distinguish their enterprise from its competitors and that give it an unmatched advantage. It’s the essence of what we have come to label as its culture.

When contemplating a merger, managers at both companies should list all areas of cultural dissonance between the two [including] those ... where employees may resist executing post-integration plans. Never forget that culture eats strategy (for lunch) everyday.

— James Z. Daniels


An article in July’s InBox section, “The Keys to Making Executive Rounding a Success,” incorrectly identified the organization that “has worked to try to perfect the art of executive rounding through its hospital engagement network.” It is Joint Commission Resources.