Hospitals set to make patient survey results public

For years, hospitals have surveyed patients about their experiences: Did a nurse come quickly when they pressed the call button? Was the bathroom clean? Were the doctors attentive, or were they rushed? If you're deciding where to give birth, or have surgery, you probably want answers to these questions.

Most hospitals, however, keep their results secret, using them quietly to shape employee training. But under pressure from the federal government and employers, US hospitals are preparing to tell the public how their patients respond to these and other detailed questions about their care. The hope is that the data will help patients choose hospitals and that public scrutiny will drive hospitals to improve care.

The federal Medicare program, working with hospital and other industry groups, has developed a 27-question survey that will be the first standard, national ''patient experience" questionnaire allowing comparisons among hospitals. Many hospitals will begin giving patients the survey early next year, and Medicare will post patients' answers on its website starting late next year or in early 2007.

Hospital participation is voluntary, but the American Hospital Association said it expects most hospitals to participate, because of peer pressure and because Medicare's website will make it clear which hospitals refuse to report their results to the agency, raising consumers' suspicions about their treatment of patients. Some business groups do not believe a voluntary program will work, however, and are lobbying Congress to require hospitals to publicly report patient satisfaction scores.

The survey is part of a broad push by health insurers, government officials, and employers to push hospitals to be more open about their quality of medical care. Various government and private organizations now compile ''report cards" comparing hospitals on a broad range of self-reported measures, such as how frequently hospitals give heart attack patients aspirin to increase their chances of survival, the percentage of patients who get infections, and death rates after specific types of surgery and illnesses.

But studies indicate that most patients do not use this data when selecting a hospital -- although evidence is growing that public reporting encourages hospitals to improve nonetheless. Federal officials and hospital executives say the new patient satisfaction surveys will be more popular with consumers because they are easier to understand and cut across all types of hospital care. They're not the opinions of specialists, but those of fellow patients.

''What happens to a heart attack patient at a specific hospital will not help me make a decision about where to deliver a baby," said Katherine Browne, managing director of the Consumer-Purchaser Disclosure Project, a national coalition of employers pushing for public hospital performance data. ''What patients say about their experiences will be more applicable to more people."

California hospitals began using a survey similar to Medicare's three years ago, and patients rated some hospitals far better than others. Patients also generally rate community hospitals better than teaching hospitals.

Many of the Boston area's largest institutions -- including Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Tufts-New England Medical Center, Lahey Clinic, the Caritas Christi hospitals, and Boston Medical Center -- plan to participate in the new program, executives said.

Most of the local hospitals have used some type of patient satisfaction survey for several years, but have kept most results confidential. Only Brigham and Women's, which surveys 9,000 patients annually, using a questionnaire similar to Medicare's, posts some results on its website.

Results on the site show that patients hospitalized between April and June this year rated the hospital's nurses 88 out of 100 possible points on measures including friendliness and prompt response to the call button. Brigham patients gave their worst score to food -- 76 points.

Hospitals have used the surveys to identify aspects of care that need improvement.

Greg Townsend, director of performance improvement and medical staff office at Tufts-NEMC, said hospital executives were concerned after the hospital received a score of 83 from October 2003 to June 2004 on ''personal issues," a category that includes questions about whether staff members addressed a patient's emotional and spiritual needs and were sensitive to ''the inconvenience that health problems and hospitalization can cause."

Tufts-NEMC adopted a rigorous training program for its 3,000 employees, including requiring all managers up to the chief executive to spend an hour a month at a desk in the lobby helping patients with a wide range of problems, including where to go for lab tests and how to find a particular doctor. The hospital's score inched up to 85 this year.

To help design the new questionnaire, Medicare held 16 focus groups last year with recently discharged patients in Baltimore, Los Angeles, Phoenix, and Orlando.

The consensus was that having physicians and nurses communicate well with patients is the most important aspect of hospital care. Clear explanations are ''a total sign of respect because we don't . . . have the education they do, and [we need] to understand what is going on with your body . . . put in layman terms," one patient said, according to a report summarizing the conversations.

Participants in the Baltimore group said it was very important for doctors to spend enough time with them, but others said they weren't hopeful that they could motivate physicians to change, even with public reporting. ''Doctors, they're going to treat you how they want to anyway," said one patient. ''And most of the time they think they're like little mini-gods and they're going to grace you with their presence."

Despite hospitals' promises to participate, some business groups are lobbying Congress to require participation. They point to the experience in California, where almost half -- 189 of 389 -- of the state's hospitals don't participate in the program, which is in its third year.

''Often it's the better hospitals that step up," said Peter Lee, president of the Pacific Business Group on Health, a coalition of large employers. ''The danger of voluntary initiatives is that consumers are still driving blind relative to the hospitals that are likely to be doing worse."

But Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, the leading industry group, said the association is planning a major push with hospital executives and trustees to encourage participation in the patient experience survey. ''We have a lot of consumers we hear from," she said. ''No one asks about cardiac data and aspirin in the hospital. Everyone wants to know about this."

Liz Kowalczyk can be reached at kowalczyk@globe.com.