Background: Patient surveys are frequently utilized to assess patient satisfaction with physician performance. These surveys often impact provider evaluations and may even effect reimbursement and employment. Patient satisfaction surveys often have several questions designed to assess distinct aspects of physician performance. Institutions may select specific questions for their individual performance measures rather than all results. The purpose of our study was to assess the variability across individual questions on a patient satisfaction survey and the impact of this variability on patient satisfaction scores of individual physicians.

Methods: We completed this prospective observational study at a suburban voluntary hospital that has 318 inpatient beds. All patients admitted to the telemetry floor were eligible. We excluded patients who were unable or refused to answer the questionnaire. The anonymous questionnaire was administered over a 4-month period by a team of trained research assistants who asked the patient to identify their physician by name as well as answer 5 additional questions designed to assess: physician communication, concern, introduction to the patient, answering patient questions and whether the patient would recommend the physician. Patient satisfaction was rated on 3-point scale.

Results: During the 3-month period of the study 158 patients evaluated 15 hospitalists yielding an average of 9.9 evaluations per hospitalist. Hospitalists who did not have at least 5 evaluations were excluded for the analysis. A question specific top box score and percentile rank were calculated for each hospitalist. The top box score across all questions and physicians ranged from a low score of 46% to a high of 100%. We found that there were large variations in the physician’s percentile rank based on the question selected for ranking. One physician had a percentile rank of zero on one question and 86th percentile rank on another.

Conclusions: There are large variations in hospitalist percentile ranking across questions on a patient satisfaction survey. Eliminating specific questions should be considered carefully due to this potential impact. A cumulative score across all patient satisfaction questions may eliminate the impact of these question specific effects.

IMAGE 1: A comparison of question specific physician ranks between top box and percentile ranking scoring methods.