Patient satisfaction and patient-centered care: necessary but not equal.

IN 2001, THE INSTITUTE OF MEDICINE (IOM) TARGETED 6 goals for improving health care. One of these was patient-centered care, which was subsequently adopted by the Institute for Healthcare Improvement’s Triple Aim initiative. According to the IOM report, patientcenteredness is defined as “providing care that is respectful of and representative to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This aim strives to improve health outcomes by closing the gap between patient desires as a consumer and their medical needs. Dimensions of patientcentered care include improving health literacy through information and education; coordination and integration of care; physical comfort; emotional support; and personalized care, which encompasses the concept of shared decision making. In this context of personalized care, patients and physicians work together to use available evidence to select between various diagnostic and therapeutic options. For example, a patient may be averse to surgical therapies and choose to undergo coronary angioplasty and stenting rather than surgical revascularization even though the chances of requiring a repeat procedure are higher. The concept of shared decision making implies that patients’ preferences and cultural values will have a bearing on clinical decisions. Shared decision making is demanding and often timeconsuming, and sometimes requires the integration of the views of generalists and specialists, who might have competing interests, especially when it involves highly compensated procedures. In these circumstances, elevating the values, preferences, and needs of patients over those of physicians or the health care organization is absolutely necessary. Patient satisfaction, on the other hand, is a different concept, which has its roots in consumer marketing, and is a measure of how services or products of a company meet or exceed the anticipated expectations of the customer. Since the early 1980s, marketing researchers have used disconfirmation theory to define customer satisfaction. In this regard, the quality of the service encounter is measured against the customer’s expectations. For example, if the service experience approximates the expectations, the customer tends to be indifferent with respect to service quality and satisfaction. On the other hand, if expectations are not met (disconfirmed), the customer judges service quality as low. Corporate interest in customer satisfaction has focused on improving corporate profits through the satisfaction-profit chain by creating customer retention, loyalty, and repeat business. Although quality of service is correlated with satisfaction, the dynamics of this relationship are complex and not fully understood. Because consumers are not always equipped to evaluate technical competency, they tend to rely on peripheral elements of the encounter such as friendliness and the quality of personal interactions. In this regard, customer and patient satisfaction are similar because both value the process by which services are delivered. Patient satisfaction is important because it means the physician has provided comfort, emotional support, education, and considered the patient’s perspective in the synthesis of the clinical decision-making process. However, patient satisfaction and patient-centered care differ in that physicians are not obligated to satisfy all demands by patients in a patientcentered practice. Compelling evidence of the effectiveness of the satisfactionprofit chain has driven the commercialization of monitoring patient satisfaction. Commercial providers of patient satisfaction surveys claim that there is a direct link to quality by pointing to reductions in malpractice claims and by noting that perceptions of quality can actually be healing through the placebo effect. However, the science of integrating quality and outcome metrics into patient satisfaction surveys is far from fully developed. Despite this knowledge gap, patient satisfaction surveys are increasingly used to monitor quality. Although the desire to improve quality by increasing satisfaction seems altruistic, it can be self-serving because hospital administrators are driven by financial performance. Hospitals and health care delivery organizations spend considerable money, time, and effort to track patient satisfaction not only across departments, but also for