The Problem With Patient Satisfaction Scores


Scoring of individual physicians is becoming more widespread. Here's how to improve the process.

Fam Pract Manag. 2016 Jan-Feb;23(1):23-27.

Author disclosure: no relevant financial affiliations disclosed.

Patient satisfaction has gained greater attention in recent years, partly because of the emphasis on patient-centered care but also because of the increasing number of family physicians leaving small group practices and entering large organizations, many of which systematically use patient surveys to measure patient satisfaction with multiple aspects of their health care. The results are used to calculate scores that enable comparisons among physicians and other providers and with benchmarks.

As the impact of patient satisfaction scores has increased in recent years, so has the importance of correctly calculating and applying them. When scores are posted on the Internet, physicians' reputations are affected. Some clinics also use the scores to help identify physicians whose scores suggest they might need additional training or some other form of administrative intervention. For example, at a meeting last year, clinicians were told that those with patient satisfaction scores in the bottom 25 percent would meet with a human service representative to work on improving their deficiencies. Patient satisfaction scores are a factor in compensation formulas as well.

Valid patient satisfaction scores, appropriately used, may help to improve quality of care and service, but they can have unintended consequences as well, such as diminished physician satisfaction. Seventy-eight percent of clinicians in one study said patient satisfaction scores moderately or severely affected their job satisfaction negatively, and 28 percent said the scores made them consider quitting.1

Even those outside the medical field have begun scrutinizing the downside of patient satisfaction scores.2,3 The purpose of this article is to identify potential problems with patient satisfaction scores and suggest some ways of making them more useful.


Dr. Bachman describes the problem with patient satisfaction scores.

Samples are not simple

Understanding the potential problems with patient satisfaction scores begins with understanding how the data are gathered, how the scores are calculated, and how this can affect comparability.

Patient satisfaction scores are usually derived from surveys, which are constructed and administered in different ways. How and when questions are asked can affect results. For example, phone surveys tend to glean different results than written surveys. A survey completed at the end of a patient visit provides different information than a survey sent out and completed a few weeks after the visit.

Many surveys ask a series of questions about one area. For instance, a typical patient satisfaction survey may ask 13 questions

About the Author

Dr. Bachman is a practicing family physician and professor in the Department of Family Medicine at the Mayo Clinic, Rochester, Minn., and a member of the Family Practice Management Editorial Advisory Board.

Author disclosure: no relevant financial affiliations disclosed.



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2. Falkenberg K. Why rating your doctor is bad for your health. Forbes. Jan. 21, 2013. Accessed Nov. 12, 2015.

3. Robbins A. The problem with satisfied patients. The Atlantic. April 17, 2015. Accessed Nov. 12, 2015.

4. MNHealthScores. Detailed report – patient experiences: providers with a “most positive” rating. 2014. Accessed Nov. 12, 2015.

5. Balestracci D Jr. Data Sanity: A Quantum Leap to Unprecedented Results. 1st ed. Englewood, CO: Medical Group Management Association; 2009.

6. Ford RC, Bach SA, Fottler MD. Methods of measuring patient satisfaction in health care organizations. Health Care Manage Rev. 1997;22(2):74–89.

7. Anhang Price R, Elliott MN, Zaslavsky AM, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(5):522–554.

8. Kahneman D. Regression to the mean. In: Thinking, Fast and Slow. New York, NY: Farrar, Straus and Giroux; 2011: 175–184.

9. Latzko WJ, Saunders DM. Four Days With Dr. Deming: A Strategy for Modern Methods of Management. 1st ed. Reading, MA: Addison-Wesley Publishing Company; 1995.

10. Bickell NA, Neuman J, Fei K, Franco R, Joseph KA. Quality of breast cancer care: perception versus practice. J Clin Oncol. 2012;30(15):1791–1795.

11. Think improvement, not inspection. Institute for Healthcare Improvement website. 2015. Accessed Nov. 12, 2015.

12. Walton M. The Deming Management Method. New York, NY: Perigee Books;1986:138–139.


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