The New York Times
July 20, 1999
City Hospitals’ First Survey of Satisfaction Among Customers Finds It Unexpectedly High By RANDY KENNEDY
Following the lead of department stores, fast-food chains and now even private hospitals, the city’s sprawling public hospital system has conducted its first-ever customer satisfaction survey.
And some of what officials found surprised them: on the whole, patients expressed good feelings about city hospitals. Other things were not so surprising: a lot of patients thought doctors and nurses were too rushed and not very nice.
While private hospitals have been conducting such surveys for years — responding to increased competition for patients and making themselves more like other service businesses — the study represents a sea change for the city’s hospital system, long the health care provider of last resort for many of the poorest New Yorkers.
There was a time not long ago, in fact, when city hospital officials wished for fewer patients. But with the rise of managed care and cost-cutting, struggling private hospitals have begun to siphon off many of the public system’s Medicaid patients and the working poor with insurance. As a result, city hospital officials are becoming as concerned about patient loyalty as big corporations are about brand loyalty.
»There was a sort of ‘We don’t need you’ attitude in the public sector,» said Dr. Luis R. Marcos, president of the city’s Health and Hospitals Corporation. »We never thought that we needed to reflect on this — the patients just kept coming. But that has changed.»
The survey, which cost slightly more than $500,000, was conducted from March through November last year and is expected to be presented to the hospital corporation’s board of directors tomorrow. It was performed by Parkside Associates, a health care research company based in Park Ridge, Ill., that specializes in customer and staff surveys for dozens of hospitals around the country, city officials said. The officials said the survey was the first statistically valid look at the city’s hospitals, which often conducted their own anecdotal studies.
The New York survey was based on face-to-face interviews, in five languages, with more than 16,000 patients in every part of the 11-hospital system — clinics, emergency rooms, inpatient wards, outpatient surgery departments, nursing homes and other areas.
Hospital officials said they would not make public the results for individual hospitals but would use the information only internally, because patient responses for poorly performing hospitals might drive more patients away.
But they said a preliminary look at overall results showed a fairly consistent pattern. While many patients said they trusted doctors, nurses and other hospital workers and felt that they were competent and thorough, a troubling number in several areas said they thought those who treated them had bad bedside manners and did not take enough time with the patients.
For example, while 89 percent of about 7,000 clinic patients interviewed said they were likely to return for their care to the clinics, almost 40 percent were dissatisfied with doctors’ manners, and with getting advice from them on how to stay healthy and instructions about medication and follow-up care.
In city emergency rooms, where slightly more than 4,000 people were interviewed, about 17 percent said they thought doctors were discourteous and 20 percent said the same of nurses. At inpatient wards, interviewers found a 22 percent dissatisfaction rate with doctors’ courtesy and 29 percent dissatisfaction rate with that of nurses.
The system received the best ratings for the quality of its services, including the courtesy of the medical staff, in home care and in ambulatory surgery, or operations that do not require hospital stays. Nearly all of the 300 home care patients interviewed said, for example, that they would recommend the services to others and nearly all of the 1,100 ambulatory surgery patients said the same.
But the apparently widespread sentiment that doctors, nurses and other medical staff — blood and X-ray technicians, registration clerks, food workers and others — overlooked the more intangible needs of the patients for a little human warmth is being viewed by hospital officials as a big problem.
Using an average price for a hospital stay of about $5,000, officials estimate that they could lose as much as $80 million a year if, as the survey says, 8 percent of those receiving in-patient treatment do not return.
»I think in the past there was a culture of taking the patients for granted, and there is still some residue of that culture left,» said Jane D. Zimmerman, a senior vice president of the hospital corporation, who oversaw the survey. »Now we have an exact target of what to change, whereas before we would have to guess from anecdotal information.»
Dr. Edward R. Fishkin, the medical director for the North Brooklyn Health Network, which operates several city clinics, said that the news would probably not be received well by many doctors, but that many came from a medical school culture in which bedside manners were not stressed. »What I hope is that a lot of doctors will become more introspective,» Dr. Fishkin said.
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