Does Hospital Size Affect Patient Satisfaction?

Area of Science:

• Healthcare Management
• Patient Experience Research
• Hospital Operations

Background:

• Hospital reimbursement from the Centers for Medicare & Medicaid Services (CMS) now depends on quality metrics, including patient satisfaction.
• Patient satisfaction is measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.
• Understanding system-level factors, like hospital size, is crucial for improving patient-centered care.

Purpose of the Study:

• To investigate the association between hospital size and patient satisfaction scores.
• To identify specific HCAHPS domains most affected by hospital size.

Main Methods:

• Data on HCAHPS scores, hospital bed count, and nursing magnet status were collected from public sources.
• An aggregate patient satisfaction score was calculated from all HCAHPS domains.
• Multilevel regression modeling was employed to analyze the relationship between hospital size and patient satisfaction.

Main Results:

• Larger hospital size was significantly associated with lower overall patient satisfaction (β = -.312, P < .001).
• Key areas with lower satisfaction in larger hospitals included receiving timely help, room cleanliness, and doctor communication.
• Nurse communication was positively associated with higher ratings in larger hospitals (β = .194, P < .001).
• Magnet nursing designation correlated with larger hospital size.

Conclusions:

• Patients in larger hospitals report lower satisfaction due to perceptions of cleanliness, response times, and doctor communication.
• Targeting improvements in cleanliness, timely assistance, and doctor communication may enhance patient satisfaction in large hospitals.