Patient satisfaction in otolaryngology: Can academic institutions compete?

Objectives: Public reporting and transparency of patient experience is an emerging national healthcare priority. The objectives of this report are to describe patient satisfaction scores in ambulatory otolaryngology and examine the association of teaching status across multiple service domains. Study Design: Cross-sectional patient-level analysis of Press Ganey outpatient medical practice surveys completed by otolaryngology patients in fiscal year 2010. Methods: The survey contains 29 Likert-scaled items that comprise an overall score and scores in six service domains: access, visit, nursing, care provider, personal issues, and assessment. The item "likelihood-to-recommend practice" was measured as an indicator of patient loyalty. Surveys were grouped according to teaching or nonteaching setting. Mean scores were compared by Kruskal-Wallis rank test for nonparametric data with Bonferroni's correction for multiple comparisons. A dichotomous variable (ALL-5s) was created to measure percentages of surveys with highest scores in each domain. Multivariate logistic regression adjusting for sex, age, geographical region, urban-rural status, and first visit was performed to evaluate the association of teaching status with ALL-5s in each domain. Pearson correlation (r) was used to evaluate correlation of individual survey items to the "likelihood-to-recommend practice" question. Results: A total of 36,089 surveys were included, of which 16,057 (44%) were from a teaching setting. The mean age of respondents was 54.1 years (range, 0-90 years), and 52.7% were female. Patients seen in the teaching setting had lower mean scores overall and in domains of access, visit, and personal issues (P =.004) but had higher mean scores for likelihood-to-recommend practice (P =.007). No differences were identified between groups in domains of nursing, care provider, and assessment. Multivariate analysis of association of teaching setting with ALL-5s demonstrated that patients in a teaching setting were more likely to have the highest scores (ALL-5s) in the domain of nursing (OR, 1.09; 95% confidence interval [CI], 1.03-1.16; P =.002) and for the loyalty question of "likelihood-to-recommend practice" (OR, 1.12; 95% CI, 1.05-1.19; P =.001), and less likely to have highest scores for the overall survey (OR, 0.88; 95% CI, 0.83-0.93; P <.001) and domains of access (OR, 0.89; 95% CI, 0.84-0.94;P <.001) and visit (OR, 0.89; 95% CI, 0.85-0.94; P <.001). No association was identified between teaching status and domains of care provider, personal issues, and assessment. Survey items correlated with likelihood-to-recommend practice were similar between groups. Items most closely correlated with loyalty were all within the care provider domain consisting of "likelihood-to-recommend care provider" (r = 0.839), "confidence in care provider" (r = 0.785), and "concern care provider showed" (r = 0.733; P <.001). Items least closely correlated were within the visit domain related to waiting room comfort (r = 0.467), registration speed (r = 0.447), and wait time (r = 0.432; P <.001). Conclusions: Otolaryngology patients evaluated in the teaching setting report lower patient satisfaction overall, primarily related to access to care and visit-specific processes; however, they are more likely to display loyalty and recommend their practice and care provider. The teaching setting does not influence care provider satisfaction scores. Because practice loyalty is most closely correlated to provider-specific behaviors, otolaryngologists may consider enhancement of provider-patient communication to improve patient satisfaction regardless of the practice setting. Academic otolaryngology practices should consider focusing on access systems and process improvement to enhance the overall patient experience.