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The Problems with Patient Satisfaction Surveys

The world of consumer healthcare is currently experiencing a vital shift.

Just like in retail, automotive, hospitality, financial services, and nearly every business sector and industry, the old fee-for-service and fix-what’s-broken approach is no longer enough. According to patient satisfaction surveys, healthcare consumers want more options, greater convenience, fairer prices, and better interactions throughout the entire patient experience, across the continuum of care.

The gap between patient expectations and provider perceptions

Unfortunately, not all healthcare providers are able to respond to these needs and expectations. If your organization doesn’t want to get left behind, you have to close the gap.

What patients think: 81 percent of healthcare consumers are dissatisfied with their patient experience.

What providers think: 63 percent of providers believe they deliver high-quality patient experience to consumers.

What patients think: In terms of factors that influence patient satisfaction levels, healthcare consumers care more about customer service and bedside manner than level of medical skill.

What providers think: On the list of top issues confronting the healthcare C-suite, patient satisfaction does not make the top five.

What patients think: 68 percent of healthcare consumers turn to online reviews, social media, and health research sites to find a new doctor, make a decision about hospitals, and read information about quality of care.

What providers think: Only 5 percent of providers identify as digital-first organizations. 43 percent admit to lacking digital marketing capability because of unsuitable organizational structure.

Majority of providers don’t know how to manage online reputation

One operational aspect that healthcare providers can focus on is online reputation management. After all, a strong online reputation fuels patient retention and patient satisfaction.

What patients think

A survey by found that a positive online presence and reputation emerged as the top factor affecting patient loyalty.


  • 80 percent of patients use the Internet to make a healthcare-related search. 63 percent will choose one provider over another because of a strong online presence. And 60 percent will choose one provider over another based on a positive online reputation.
  • 81 percent of patients read online reviews, and 60 percent choose a provider over another because of positive online reviews. 90 percent, meanwhile, will change their mind about a referral if they see poor or negative online reviews, defined as those with ratings of three stars (out of 5) or less.

What providers are doing

Another recently released report describes how providers currently manage their online reputation, what types of risks are preventing them from building a strong reputation, what kind of impact failing to address online reviews has, and what resources and tools organizations can use moving forward.

Here are some of the most interesting findings from the healthcare report:

  • Approximately 80 percent of providers agree that a strong online reputation is extremely or very important. Majority (55 percent), however, don’t know how to positively impact or manage their own reputation.
  • A staggering 88 percent of providers have at least some level of concern about negative online reviews posted by patients. But only 18.4 percent have a process in place for responding to negative reviews and following up with patients who write these reviews. And 1 in 4 do not even respond at all to negative feedback given by patients in their reviews.

“Patients depend on online sources of information more so than ever, and are using all of the digital tools available to inform themselves and make healthcare decisions,” said CEO Andrei Zimiles in a statement.

“While it is paramount for healthcare organizations to provide quality care, they must also focus on building a strong online presence and a seamless customer journey. It’s what today’s patients expect.”

Adopting a patient-centric approach and building a stronger reputation

To respond to consumer expectations, build a strong online reputation, and drive growth, providers must adopt a customer-centric approach aimed at expanding the ways in which care is delivered.

Truly understand consumers. Winners and losers will be determined by their ability to achieve a more complete and accurate view of the customer, as well as manage high-impact trends and issues affecting the patient experience.

Before influencing consumer behavior, providers must first understand it: from initial contact, through the process of engagement, to post-transactional interactions and long-term relationships, with special attention to patient feedback as voiced in online reviews.

Optimize the patient experience. As the clout of healthcare consumers grows, so do their options. To encourage preference and inspire loyalty, providers must foster trust-based relationships with customers, promptly respond to online reviews and patient feedback, and consistently deliver experiences that captivate and go beyond achieving better health outcomes.

Invest in digital. The use of top technology and data can help providers improve patient access, boost patient acquisition, manage feedback, and enhance brand reputation. In an industry ripe for disruption, technology can also transform entire organizations (not just marketing departments) and exert bottom line impact through reduced costs, increased operational efficiencies, and improved processes.

Online Reviews and Patient Satisfaction Surveys

Online reviews continue to make a big impact on service-based businesses across multiple sectors and industries. Consumers are checking reviews not merely to find restaurants and hotels; they’re also checking reviews to find doctors and make major decisions involving their health and well-being.

Findings from a new patient satisfaction survey by marketing firm Digital Assent reaffirm once again the increasing reliance of consumers on online reviews. According to survey results, a staggering 72 percent of patients say that negative reviews will likely prevent them from choosing a particular doctor. Moreover, 42 percent say that it takes only two to five bad reviews out of a hundred to discourage them from seeing a particular healthcare/medical professional.

The study, from Digital Assent’s first annual “Online Patient Review” survey, was released just shortly after another report – this time by the American Osteopathic Association – showed that approximately 33 percent use doctor ratings and consumer review sites as a main tool for finding physicians.

Popular review sites for doctors and hospitals today include Yelp, Vitals, HealthGrades,, and Dr. Oogle.

According to the new study, 50 percent of patients believe that positive online reviews and high ratings on any of these sites could convince them to choose a particular doctor. Only 18 percent of respondents say that reviews have no influence at all.

What does this mean for doctors, hospitals, and other health/medical professionals and institutions? The survey results imply that it is more critical than ever to build and strengthen a healthy online reputation.

You can’t argue with the data. Not only do reviews and ratings provide a reflection of actual patient satisfaction levels; they also serve as a major factor for patients’ decisions to choose – or to avoid – your practice.

Patient surveys like HCAHPS will remain important — but hospitals and healthcare marketers will have to make sure online reviews are on their radar.

The Challenge with Patient Satisfaction Surveys

Robert Anthony Andrews is a physician in the North Shore-LIJ Health System at Lenox Hill Hospital in Manhattan. The 15 “patient comments” posted on North Shore-LIJ’s website are all positive, which is not surprising, with one reviewer describing Dr. Andrews as “amazing.”

Another reviewer writes, “Dr. Andrews is a consummate pro who shows genuine care for his patients.”

On yet another page, a profile for Dr. Christopher LaPorta, a comment describes him as “excellent doctor.” Like with Dr. Andrews, all of Dr. LaPorta’s reviews are positive, and his “overall patient satisfaction score” is 4.8 stars (out of five).

“It’s not a random sample” 

The reviews on North Shore-LIJ’s website, which will change its name to Northwell Health beginning in January, come from surveys administered by Press Ganey, an independent patient satisfaction company founded about 30 years ago by Irwin Press, Ph.D, and Rod Ganey, Ph.D. According to its website, Press Ganey also provides comparative databases for health care facilities.

This calls into question the validity of surveys from companies like Press Ganey and whether or not patients should trust the survey data when making healthcare decisions.

Lee Hargraves, managing researcher at American Institutes for Research, said, “(With surveys), that question always is – is that a random sample of patients or is that people who like filling out questionnaires? It’s not a random sample.”

He added that one of the most crucial aspects of conducting patient surveys is the ability to have a random sample of patients as well as the ability to follow up (at least two to three times) in order to have an acceptable response rate.

“Of course, what does the word ‘acceptable’ mean?” he said. “The problem with surveys these days is they’re everywhere and it’s harder to survey people now than it was 25 years ago.”

In addition, a Press Ganey analysis by writers at Emergency Physicians Monthly reinforces the problems with not surveying a random sample of patients.

“Failing to fully randomize data can adversely impact even a large survey’s conclusions to the point that those conclusions become invalid,” they write.

According to a release, North Shore-LIJ began displaying reviews from Press Ganey in August 2015 in an effort to do what the health system describes as promoting greater transparency in customer feedback. North Shore-LIJ, which is one of the largest healthcare providers in the U.S., has accumulated more than 500,000 patient satisfaction surveys.

“The health system’s program (patient satisfaction review program) delivers straight truth to consumers, screening only for patient privacy and unsuitable language, if necessary,” according to a release.

Hargraves, who works on a health care program to develop standardized questions for patients, said Press Ganey was created because a market emerged for the need to understand what happens when someone leaves the hospital.

“They developed a survey – that’s one of my criticisms is that they developed the survey,” he said. “Basically (they) just put it together and started to build a business around hospitals, and then, of course, expanded in all the arenas where patients are being seen – physician offices, emergency rooms, all kinds of places.”

Hargraves added, “A lot of the surveys (Press Ganey uses) now are hybrids of some of their own questions and then questions that come from the Agency for Healthcare Research and Quality through what’s called the CAHPS (Consumer Assessment of Healthcare Providers and Systems) project.”

The CAHPS program was started by the federal government in an effort to provide people with information when they are making choices regarding health care, with survey questions based on a scientific method. Hargraves said Press Ganey is a vendor that uses the CAHPS survey in combination with their own questions. The CAHPS project started about 20 years ago.

“A lot of what is done – for example going back to Press Ganey – is their clients are trying to get feedback from their consumers, patients, about the experience they had and try to improve that experience,” Hargraves said. “That’s one of the fundamentals of the survey – is it’s used for quality improvement. It’s used for service. It’s not used so much for marketing – although it can be.”

“Organizations use the information for many things, Hargraves said. “I think using for public is just beginning in some ways. On the other hand, if someone is in Medicare, there are many tools on the Medicare website to get information about consumers and their experiences.”

North Shore-LIJ is not the only health system to use Press Ganey surveys. More than 10,000 health care providers – like The University of Utah Health Care – use the survey to measure patient satisfaction.

The university writes they are “committed to posting positive and negative feedback” from the survey comments. North Shore-LIJ writes they will post positive and negative reviews, too, but North Shore-LIJ will not post all reviews on their website. The patients have to complete a “reliable number of patient surveys” in order for reviews to be posted on a doctor’s profile.

More problems with surveys 

A report by the Hastings Center finds more problems with patient satisfaction surveys.

“The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost,” writes Dr. Stuart Youngner, a professor of bioethics and psychiatry at the Case Western Reserve University and Alexandra Junewicz, resident in psychiatry at New York University School of Medicine.

Narrowing in on patient satisfaction surveys as independent has caused the surveys to be “ripe for commercialization,” triggering an increase in profit-making businesses, according to the authors.

Youngner and Junewicz added, “Patient satisfaction surveys can call attention to the importance of treating patients with dignity and respect, but good ratings depend more on manipulable patient perceptions than on good medicine.”

North Shore-LIJ did not return a request for comment.

Kevin Kent

Kevin is the Director of Finance and Operations at ReviewTrackers. Every day he finds creative ways to solve business owners' problems and identifies key issues to help them achieve top results.


  1. California Urgent Care

    It is really a nice post Kevin Kent. This article sounds meaning. Not surprising to me that medical care is so hard to measure. Medical practice is an art, not a science. Politicians, planners, regulators and PhDs do not know it.