Does a bad outcome = poor patient satisfaction?

In our previous blog, we discussed how a good clinical outcome does not guarantee high patient satisfaction. How about in times of a poor clinical outcome? Is it possible that these patients could still be “satisfied” with their overall care and experience? In orthopaedic surgery, a poor surgical outcome has a wide range of consequences from prolonged pain to multiple reoperations. But when these outcomes occur, how does the patient perceive the situation, and how tight are the clinical outcomes bound to their satisfaction?

I want to introduce you to 2 patients. Mary and John.

Mary was an incredibly active mother of 5 despite left knee pain that troubled her for years. When she finally decided to undergo a left total knee arthroplasty, she was hopeful that this would allow her to “live her life” again. She loved the surgeon and his entire staff. The surgery was uneventful, and she felt immediate improvement from her previous pain in just a few days after surgery. However, 3 weeks later, she noticed new swelling, redness, and pain in that left knee, and she was diagnosed with an infection. She would subsequently undergo multiple re-operations and now has some chronic discomfort in her knee. But, when I caught up with Mary recently, she had nothing but positive things to say about her health-care teams and experience.

John was an ironman. On a Friday afternoon after a light jog, he found his right leg pinned up against a light pole by a swerving car operated by a drunk driver. He was rushed to the nearest hospital, and subsequently to the operating room. Now 5 years removed from that initial injury and 7 surgeries later, we met at a coffee shop to catch up. Yes, somewhere deep inside he was disappointed that he could no longer conquer Kona as he did in previous years, but he was incredibly grateful for all the hours, sweat, and energy poured out by all the providers who had been caring for him. As complications piled over the years, the healthcare team continued to be transparent, encouraging, and available. John appeared physically damaged, but remained encouraged, energetic, and gracious.

How can it be that, despite the poor outcomes, Mary and John appear upbeat, optimistic, and highly satisfied with the care they have received? Just as good outcomes are not always tightly intertwined with high patient satisfaction, a poor outcome may not be directly related to poor patient satisfaction. And recent literature could now be supporting this notion. In fact, surveys performed at 171 hospitals and found that the presence of complications or increased rate of readmission were not found to affect patient satisfaction (1).

What does this mean? Patient outcomes may not be the main driver of patient satisfaction or, at the very least, the outcome is one of many variables that play an integral part of understanding the patient’s satisfaction.

So what, then, are other drivers of patient satisfaction? Stay tuned!

(1) Kennedy, G. D., Tevis, S. E., & Kent, K. C. (2014). Is there a relationship between patient satisfaction and favorable outcomes?. Annals of surgery, 260(4), 592.