Association of Patient Satisfaction with Complaints and Risk Management among Emergency Physicians

Abstract

Background

Patient-physician interactions in the emergency department (ED) are unique in that prior relationships may not exist; interactions are brief, and the environment is hectic.

Objectives

The research hypotheses were that patient satisfaction scores on a commonly used national satisfaction survey are associated with patient complaints and risk management file openings or lawsuits (risk management episodes).

Methods

Administrative databases from an emergency physician management group that staffs 34 EDs in 8 states were merged with patient satisfaction data. Dates of inclusion were January 2002-April 2006. Estimates of physician contribution to satisfaction utilized a multi-level mixed-effects linear regression with a random-effect for practice site and physician, and fixed-effect adjustments for patient factors, time pressures, acuity mix, and physician productivity. Adjusted satisfaction scores were used to explore the relationship with complaints and risk management episodes.

Main outcome measure

Association of patient satisfaction scores with risk of complaint and risk management episodes.

Results

There were 3947 physician-quarters of practice data analyzed, representing 2,462,617 patient visits. There were 375 complaints and 61 risk management episodes. Those in the lowest quartile of satisfaction were nearly twice as likely to have a complaint (adjusted odds ratio 1.84; 95% confidence interval [CI] 1.29–2.63) as those in the highest quartile. Satisfaction was not directly related to risk management episodes. Complaints were more strongly associated with risk management episodes than other variables: those receiving ≥ 2 complaints in a quarter were 4.13 (95% CI 1.12–15.2) times more likely to have a risk management episode.

Conclusions

Patient satisfaction scores are not associated with increased risk management episodes but are closely related to receiving complaints. Receiving complaints is a strong marker for increased risk management episodes and should prompt early corrective action.

Introduction

Getting complaints is a costly process in terms of personnel time and service recovery costs for physicians and the organizations for which they work.

When complaints lead to litigation, costs in terms of financial expenses, time, psychological toll, and health care provided soar 1, 2. Depression and adjustment disorders, thoughts of early retirement, and the practice of defensive medicine are common among physicians who receive multiple patient complaints or have been sued 3, 4, 5.

Risk of complaint and malpractice seems to be related to patient dissatisfaction with their physicians’ communication skills, sensitivity to patient needs, and ability to meet expectations, rather than to complexity of patient illness, particular patient characteristics, or physician technical skills 6, 7, 8, 9, 10, 11, 12. Studies in the primary care and surgical specialities have demonstrated that the differences between physicians who get complaints or are sued and those who are not is not readily explained by quality of care or by chart documentation, but that patient satisfaction and non-clinical factors are critical 6, 9, 10, 11, 13, 14, 15, 16, 17.

Health care organizations have long recognized that patient satisfaction is associated with customer loyalty and is thus linked to the organization’s financial performance (18). Patient dissatisfaction can lead to selection of a different practice or organization for medical services. Consumer groups have begun to publish results of patient satisfaction among various health care organizations (19).

Maintenance of Certification activities for physicians certified by the American Board of Emergency Medicine will soon require assessment of physician communication skills and patient satisfaction (20). Patient questionnaires will be the usual method used to meet this requirement.

The practice of emergency physicians (EPs) differs from that of other physicians in that the staff has no choice in its clientele or in the pace at which they arrive; they are not permitted to refuse new patients when all beds are full, and must simultaneously treat patients of varying levels of acuity. In addition, although emergency department (ED) volumes have increased over the past decade, available resources remain static or have declined. EPs must be able to quickly communicate caring and concern with patients and families with whom they often have no previous relationship.

The ability of hospital and ED group leaders to maintain a high level of patient satisfaction while being able to identify physicians at risk for complaints and malpractice risk before such episodes occur may aid in improving patient satisfaction and decreasing complaint rates and litigation risk. Although patient satisfaction is increasingly measured among EPs working in hospital EDs, the role of patient satisfaction in patient complaints and malpractice risk among EPs has not been studied 7, 11, 14, 17, 21, 22. Among inpatient physicians, lower patient satisfaction scores have been linked to increased rates of unsolicited complaints from patients and risk management episodes (22).

The primary research hypothesis was that patient satisfaction scores on a commonly used national satisfaction survey are associated with risk management episodes. A secondary hypothesis of this study was that unsolicited patient complaints are associated with risk management episodes.