Are measures of patient satisfaction hopelessly flawed?

Measures of patient satisfaction and the patient experience—as instituted in the UK Quality and Outcomes Framework for primary care—supply feedback that helps health professionals provide patient centred care; they also give insight about the interpersonal dimension of quality of care as a complement to the technical quality of care. In the linked study (doi:10.1136/bmj.c5004), Salisbury and colleagues explore whether responses to questions in patient surveys that claim to assess the performance of general practices or doctors reflect differences between the practices, the doctors, or the patients themselves.1 The analysis separates the variance in patient satisfaction and patient experience into that attributed to differences between practices and those between doctors. The study found that when patients were asked a single question about how satisfied overall they were with their practice, only 4.6% of the variance in their satisfaction ratings was a result of differences between practices; the remaining variance resulted from differences between patients plus random error. In contrast, when asked to report on their experience with usual time they had to wait for an appointment, more than 20% of the variance in responses was a result of differences between practices. The authors …