Many U.S. Patients Believe Their Hospital Falls Short in Addressing Basic Quality Issues

While patients in U.S. hospitals are generally satisfied with their care, satisfaction levels are not as high as they could be, and rise significantly when hospitals have more nurses at bedside, a new Commonwealth Fund-supported study finds.


The study, published in The New England Journal of Medicine by researchers at the Harvard School of Public Health, is based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The authors found that patients have moderately high levels of satisfaction with their care. The quality of clinical care and certain hospital characteristics, such as a higher ratio of nurses to patient-days, were associated with greater patient satisfaction. The study also notes that there is a consistent positive relationship between patient-reported experiences and the quality of care across U.S. Hospitals, suggesting that the aims of providing patient-centered care and ensuring high clinical standards can be met simultaneously.

Summary of findings:

  • Almost 2/3 of patients gave their care a high overall rating, and that same proportion said they would definitely recommend the hospital in which they received care
  • The ratio of nurses to patient-days was associated with patients' satisfaction
  • Fewer patients in for-profit hospitals gave a 9 or 10 rating than patients in nonprofit hospitals
  • Areas noted for needing improvement included nursing care, communication about medications, pain control, and provision of clear discharge instructions.
  • Patients' satisfaction was associated with quality of clinical care for four conditions: acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications.
  • Patients' satisfaction ranged widely across regions

(SOURCE: The Commonwealth Fund e-Alert,, October 30, 2008)