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The Problems 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.