Removing some of the randomness of online reviews helped Sentara Healthcare to jump to the front of the local search-engine line.

Sentara, a 12-hospital system stretching across Virginia and North Carolina, has done so by surveying its own urgent care patients and posting their aggregated opinions online. Working with Lincoln, Neb.-based National Research Corp. the past year, they gathered more than 10,000 responses from urgent care patients, who gave Sentara’s centers an average ranking of 4.7 out of five.

Urgent care traffic is driven more by online search results, geography, wait times and availability than traditional health care delivery, says Andrew Ibbotson, vice president of the research group. A typical search puts Sentara’s local clinic at the top of the ratings list, based on surveys from more than 1,000 patients treated in the past six months. In comparison, a typical Yelp ranking may come from four or five reviews, some of which may be several years old.

Online hospital and physician reviews are an accepted part of health care’s transformation, and a recent analysis in Health Affairs found that Yelp reviews do contain information that’s not asked for on the HCAHPS survey.

Issues covered by Yelp but not HCAHPS include cost, ease of payment and compassion of clinicians. Plus, the information is delivered in narrative form, making it easier for consumers to understand, says health policy researcher and lead author Benjamin Ranard, M.D. But Yelp rankings also may not come from patients, he notes; often, relatives of older patients who were a witness to the care write reviews.

“There is space for both a systematically collected survey and organically generated online reviews like Yelp,” Ranard says. “Both can be useful.”

Sentara’s survey incorporates both HCAHPS questions and a narrative. The system prepared clinicians by training them with simulated patients to better understand the consumers’ point of view, says Mark Weisman, M.D., medical director for the Sentara Medical Group in Norfolk, Va.

“These survey results exist not just to ‘score’ a provider, but are crucial to providing an exceptional patient experience,” says Weisman, who has a perfect five-star rating from 106 reviews. “Survey results alert us to what is working well and what needs to be improved.”

There is concern, however, that bending to patient desires does occur and bad outcomes can result.

Nancy Foster, American Hospital Association vice president for quality and patient safety policy, says she admires organizations like Sentara for making use of survey data to help patients, but she has general concerns about the quality of patient-satisfaction measures. Patients and their families are an integral part of the care team, however, so their feedback is important, Foster says.

“It’s nice if it’s not just ‘This hospital is terrible,’ or words to that effect,” she says. “It’s also nice when you're told you’re doing something right because then you can replicate it.”

Foster predicts that hospital quality measures will evolve and become more useful in helping patients make health care decisions. In the meantime, there is much room for improvement and, as far as the HCAHPS survey is concerned, she says “a total refresh would be in order.”