Age influences patients' perceptions of -- and consequently
their satisfaction with -- hospital services. Gallup's 2003 patient
database shows that younger patients are consistently less
satisfied than older patients when it comes to emergency
department, outpatient surgery, and outpatient test and treatment
services (see "Do Patient Expectations Mellow With Age?" in Related
Items).
But are satisfaction ratings adequate measures of success in
healthcare patient tracking?
The answer is no. Consider the exchange I recently had with a
friend over lunch at a restaurant. She ordered a dish she had never
had before, and after the meal I asked her if she liked it. She
said yes -- but when I asked if she would order the dish again, she
said no. It's a question of intensity -- my friend liked the meal
enough to say she was satisfied with it, but not enough to
be loyal to it given all the other culinary options
available to her.
The same difference applies to hospital ratings. Patients may
say they're satisfied with the services they receive at a hospital,
but that doesn't necessarily mean that they would return to that
hospital again. So while Gallup's database shows that differences
in average patient loyalty (as measured by their stated likelihood
to return to the hospital) by age follow the same pattern as
average patient satisfaction by age in many cases, there are some
exceptions.
Emergency Department
In the emergency department, age seems to affect patient loyalty
and patient satisfaction in similar ways. Younger patients (those
between the ages of 18 and 45) tend to have loyalty levels that are
below the overall mean, while older patients tend to average above
the mean (46- to 55-year-old patients score right at the overall
mean). Patients under the age of 18 (or at least the guardians or
caretakers of these patients, who actually participate in the
surveys) score below the mean on satisfaction, but above the mean
on loyalty.
Outpatient Surgery
Patient loyalty to outpatient surgery services varies less by
age than does loyalty in emergency department services. The only
age group that differs substantially from the overall average
patient loyalty score is the 18- to 25-year-old group, which tends
to be less loyal. Patient satisfaction with outpatient surgery
services follows a nearly identical pattern.
Outpatient Test and Treatment
In this department there is a clear difference: while there is
an almost linear relationship between patient age and
satisfaction with outpatient test and treatment (the
younger the patient, the lower the satisfaction), age seems to have
very little impact on patients' loyalty to outpatient test
and treatment departments. Variation from the mean is relatively
small among all age groups, but there is no clear pattern.
Inpatient
Inpatient loyalty scores also do not follow a linear pattern by
age group. The youngest patients tend to be most loyal, while the
older patients (with the exception of 65+ year-olds) are least
loyal. Patient loyalty scores among patients in the middle
age groups (those between the ages of 36 and 55) are even lower
than the already low patient satisfaction scores for those
groups.
Bottom Line
Gallup analysis has shown that overall, the strongest
single predictor of patients' stated likelihood to return
to a facility is patient satisfaction. Thus, it is not surprising
that these two measures follow similar patterns by age in many
cases.
How, then, do we explain the instances in which patient loyalty
scores clearly show less variation by age than patient
satisfaction, as in the outpatient test and treatment area? In some
cases, the answer is simple: convenience of that facility's
location trumps a patient's satisfaction with the services there.
Younger patients may have been unhappy with an outpatient test and
treatment facility, but that unhappiness might not be intense
enough to overcome the fact that it's easily accessible, especially
if follow-up visits are necessary.
When patients are very unhappy, however, convenience
considerations may go out the window -- meaning low satisfaction
scores will translate to low loyalty scores. In such cases, which
seem to occur particularly frequently among 18- to 35-year-old
emergency department patients and 36- to 55-year-old inpatients,
dissatisfaction is clearly driving patients not to return to a
facility.
