The limited influence of neurosurgeons' behavior on inpatient satisfaction: a retrospective multihospital analysis

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey that assesses patient satisfaction, which is an important measure of the quality of hospital care and ultimately the overall hospital rating (OHR). However, the survey covers several elements of patient satisfaction beyond the patient-surgeon interaction. In this study, authors investigated which admission and experience factors had the highest impact on the OHR.

This was a retrospective cohort analysis of HCAHPS surveys from patients who, in the period between August 1, 2016, and January 31, 2018, had been discharged from the neurosurgical or orthopedic service at three hospitals serving a single metropolitan area. The top-box score was defined as the highest rating obtainable for each survey question. Baseline admission attributes were obtained, and multivariate logistic regression was used to determine predictors of the top-box OHR.

After application of the inclusion and exclusion criteria, 1470 patients remained in the analysis. Categories on the HCAHPS included OHR, communication, education, environment, pain management, and responsiveness. After excluding identifying questions from the survey and adjusting for subspecialty and hospital, 7 of 17 HCAHPS survey items were significant predictors of OHR. Only 2 of these were related to the surgeon: 1) discharge, "Did you get information in writing about what symptoms or health problems to look out for after you left the hospital?" (OR 5.93, 95% CI 2.52-13.94); and 2) doctor, "Did doctors explain things in a way you could understand?" (OR 2.78, 95% CI 1.73-4.46). The top three strongest correlating items were 1) discharge; 2) nursing, "Did nurses treat you with courtesy and respect?" (OR 3.86, 95% CI 2.28-6.52); and 3) hospital environment, "Were your room and bathroom kept clean?" (OR 2.86, 95% CI 1.96-4.17).

The study findings demonstrated that there are several nonmodifiable factors (i.e., specialty, experience) and items that are not under the direct purview of the neurosurgeon (e.g., nursing communication, hospital environment) that are significant influences on overall inpatient satisfaction on the HCAHPS survey. Furthermore, components of the survey that ultimately influence the OHR vary across different hospitals. Hence, HCAHPS survey results should be broadly interpreted as a way to make health systems more aware of the overall hospital factors that can improve quality of care and patient experience.