• Heather Lyu, Elizabeth C Wick, Michael Housman, Julie Ann Freischlag, and Martin A Makary.
• Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
• JAMA Surg. 2013 Apr 1;148(4):362-7.

ImportanceIn 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care.ObjectiveTo determine whether patient satisfaction is independent from surgical process measures and hospital safety.DesignWe compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire.SettingThirty-one US hospitals. PARTICIPANTS Patients and hospital employees.InterventionsThere were no interventions for this study.Main Outcomes And MeasuresHospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey.ResultsPatient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = -0.216 [P = .24]; appropriate hair removal, R = -0.012 [P = .95]; Foley catheter removal, R = -0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = -0.462 [P = .008]).Conclusions And RelevancePatient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.

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