Health Care Delivery

Organizational factors beyond the control of primary care physicians may affect patient satisfaction ratings

A growing number of physician groups and medical care organizations use patient satisfaction data to assess the quality of care provided by primary care physicians. In fact, patient satisfaction ratings play a large role in medical group decisions about physician employment and compensation. But credit or blame for the quality of a patient's primary care experience needs to be shared by the doctor and the organizational manager. This is because patient satisfaction with an office visit often hinges on more than the quality of the physician's direct care. It includes organizational factors that may be outside the physician's control, such as waiting time to see the physician and courtesy of the nonphysician staff, according to a study supported by the Agency for Healthcare Research and Quality (HS09350).

It is unwise to reward or penalize physicians for the effects of systemic factors that are out of their control, concludes Donald Barr, M.D., Ph.D., of Stanford University. Dr. Barr and his colleagues surveyed 291 patients making an office visit in the primary care departments of a large, multispecialty medical group. They gave patients questionnaires on three aspects of patient satisfaction (access to care, direct interaction with the doctor, and the overall visit) and concurrently observed the care process from patient arrival at the group practice to the end of the visit.

Survey responses showed that factors external to the doctor-patient interaction explained 36 percent of the variance in patient satisfaction with the visit overall and 24 percent of patient assessment of the quality of the direct doctor-patient encounter. Two organizational variables—waiting time to see the doctor and courtesy of the nonphysician office staff—explained 20 percent of the variance in patient responses to the four questions used specifically to evaluate the quality of the physician's care (i.e., time spent with the doctor, information provided by the doctor, technical skills, and personal manner).

See "Problems in using patient satisfaction data to assess the quality of care of primary care physicians," by Dr. Barr, Pamela Vergun, Ph.D., and Stephen R. Barley, Ph.D., in the September 2000 Journal of Clinical Outcomes Management 7, pp. 19-24.

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