PhotoThere's nothing doctors and dentists hate more than review sites that let patients rate their experience. Their argument, often expressed in profane emails and expensive lawsuits, basically boils down to questioning the competence of healthcare consumers to tell whether or not they were helped or harmed by the care they received.

Besides wounding their pride, doctors say the online reviews can lead to over-testing and over-treating, as they try to improve their scores by bowing to unreasonable patient demands.

But a new study in the December issue ofAcademic Medicine bolsters research linking good patient satisfaction scores with good patient outcomes.

It also sheds light on another, unspoken benefit by showing how openly sharing patient satisfaction metrics created a culture of empathy, communication, trust, and shared decision making between patients and providers at a health system in Utah, the University of Utah Health Care (UUHC).

"Our duty to respond"

"Everyone, from payers and policy makers to patients, yearns for reliable, understandable information about the cost and quality of care, and it's our duty as the region's sole academic medical center to respond to that demand," said UUHC's CEO and the study's lead author Vivian S. Lee, M.D., Ph.D., M.B.A. "What we underestimated was how being transparent with our scores would be such a force for cultural change within our organization -- a catalyst for engaging physicians in patient-centered care and the glue to further cement the physician-patient relationship."

Lee's predecessor, Lorris A. Betz, M.D., Ph.D., was the architect of the University's "exceptional patient experience" initiative. Launched in 2008 with the mantra, "medical care can only be truly great if the patient thinks it is," the effort culminated in 2012 when UUHC became the first academic medical center in the country to put its patient reviews online, complete with unedited comments and an accessible five-star ranking.

Over the past seven years, patient satisfaction has markedly increased. Half of UUHC providers now rank in the top 10 percent when compared to their peers nationally, and 26 percent rank in the top 1 percent, a significant improvement from 2008, when the program began.

"What began as a patient satisfaction initiative evolved into a model for physician engagement, values-based employment practices, enhanced professionalism and communication, reduced variability in performance, and improved alignment of the mission and vision across hospital and faculty group practice teams," Betz and colleagues say in the article.

Neither the quality nor the cost of care has suffered, the researchers found. In fact, for six years running UUHC has placed in the top 10 of the University HealthSystem Consortium's rankings, a comparison of the nation's teaching hospitals based on quality and safety. What's more, UUHC has managed to bend its cost curve even as costs nationally continue to rise, the study found.

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