Proliance Director of Clinical Outcomes puts patient satisfaction scores in perspective


AHC Media spoke with William Fletcher, Director of Clinical Outcomes at Proliance Surgeons, about patient satisfaction scores in the article "Patient Satisfaction vs. Quality Scores: What They Really Mean." AHC Media provides current and unbiased content regarding clinical practice, scientific research, and healthcare management best practices. See below for an excerpt.

For more information on Proliance Surgeons' outcomes, check out the Spine Outcomes information pages (see clinical and patient-reported outcomes).

What Do Satisfaction Scores Really Mean?

Sometimes patient satisfaction scores are not even an accurate measure of how patients perceive the hospital [or clinic], says William Fletcher, Director of Clinical Outcomes with Proliance Surgeons, a system of surgical practices based in Seattle. Unlike objective measures, a patient satisfaction score can be influenced easily, and usually in a negative way.

“We have found over and over again that the entire list of 25 questions on a patient satisfaction survey can be ruined if a patient has to wait 45 minutes in the waiting room,” Fletcher says. “To that patient, everything was miserable. The doctor was awful, the front office was awful, the back office was awful. Everything was awful because they had to wait 45 minutes.”

A long wait time is a valid complaint and has a place in measuring satisfaction, Fletcher says, but a problem like that can unreasonably affect the rest of the survey. The hospital needs to know that the patient was unhappy with the wait time, but it will be misled if the patient answered the other questions in a negative way out of anger.

“We have surgeons with the highest satisfaction scores I’ve ever seen, but their outcomes are not better than our other surgeons, at least not to any degree that the score would suggest,” Fletcher says. “And we have other surgeons who, for whatever reason, just bottom out on patient satisfaction scores — they get [low] scores — and yet they’re some of the best surgeons in the country.”

Fletcher also notes that patient satisfaction is different from patient-reported outcomes, in which patients are asked how they fared after surgery. That is a valid measure of quality, though it can be influenced by subjective assessments to a lesser degree than satisfaction surveys, Fletcher says. Proliance uses patient-reported outcomes as a key measure of quality.

Proliance also relies on data on quality outcomes from sources such as MPIRICA and ProPublica, a non-profit news organization that publishes information on hospital quality, mostly derived from Medicare data.

“With those sources, we can get a much more accurate understanding of the quality of our physicians than we could ever get by asking patients if they were satisfied with their wait time and if the nurse explained the medication,” Fletcher says.


  • William Fletcher, Director of Clinical Outcomes, Proliance Surgeons, Seattle, WA. Telephone: (206) 264-8100. Email: