Can Looks Be Deceiving? (Or….what’s up with that hospital survey?)

When I walked into the hospital lobby to visit my friend, I wasn’t sure that I hadn’t arrived in a posh hotel. The marble floors gleamed, and the atrium was filled with plants that made it feel like I’d wandered into a specialty greenhouse. Her room was decorated in matched and muted colors, the hospital staff came in twice while I was visiting to empty trash and check the bathroom. And no doubt she would get a survey asking about her care after she was discharged.


Obviously the amenities made her stay more comfortable. But this experience made me wonder about the actual quality of the care she got in the hospital. Did my friend get the right medicines at the right time? Did the staff wash their hands before they came in the room? Were the orders for her care followed correctly and the results monitored by her physician?


And what about that survey that would show up in the mail after she got home?  A recent article in the Washington Post calls attention to a study published in the Journal of the American Medical Association that suggests those surveys after you get home might be more important than you think. Does the fact that some insurers pay more when hospitals have good customer ratings somehow factor in to what hospitals focus on?


Medicare is one of many insurers that pays hospitals more when their consumer ratings of a hospital are high. Hmm. Could this explain why hospitals are hiring from the hospitality industry to create amazing lobbies and teach staff about the kind of attention that generates higher ratings? We may feel that we’re getting good care if our room is clean, the nurses are compassionate and not rushed, and no one bothers us during the night, but the JAMA study showed that a higher percentage of patients who rated their hospital stay highly actually had worse outcomes over time. It’s possible those patients might have been paying attention to the wrong things.


Just what *is* quality?


A long ago report from the Institute of Medicine1 found that when they asked insurers, doctors, and patients how they define quality in healthcare, they got 3 very different sets of answers.


Insurers focused on cost effectiveness – the right care for the right cost. Doctors focused on the accuracy of diagnoses and the health outcomes of the patient. Patients though, experienced quality very differently. Things like interpersonal communication, attention to patient preferences and needs, and involvement of family members and friends rated highly. In short, the kinds of things that influence how we feel about the experience, not the care itself.


Does a beautiful lobby, tastefully decorated room, attentive house-keeping staff, and well-prepared meals contribute to that high-quality feeling when you complete that survey after you get home? Apparently it does. But does that mean the clinical care you’re receiving is high quality? The two simply may not be related.


If you’re someone who likes to check consumer ratings as you make decisions about your healthcare, keep in mind that the rating you give may directly influence how much a hospital gets paid by your insurer for your care. While a hospital and its staff are certainly providing a “service” it’s important to remember that a hospital isn’t a hotel. It’s the quality of the actual care, not the plants in the atrium we need to pay attention to.


There’s no question that if you have to be in the hospital, the beautiful lobby and great meals can make a stay more bearable. But before you assume that a beautiful building, lots of amenities, and pleasant staff mean you’re in good hands, get an impartial review of your hospital’s ability to deliver high quality care by checking them out on the non-profit, non-partisan The Leapfrog Group. And bear that mantra, “Looks can be deceiving”  when you complete that customer satisfaction survey.


1 Michael J. Barry, M.D., and Susan Edgman-Levitan, P.A., Shared Decision Making: The Pinnacle of Patient-Centered Care, N Engl J Med 2012; 366:780-781March 1, 2012



Scroll to Top