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The Stockholm Effect of Patient Satisfaction Surveys
Justice scholars have compiled volumes of research on what has become known as the “misinformation effect” in witness testimony. The longer it takes to obtain testimony after an incident, the greater the chance of memory “contamination” as the witness recalls what happened.
At the risk of overdramatizing, I would argue that the same thing can occur with patient satisfaction surveys, especially for longer inpatient stays for complicated ailments.
I vividly remember my patient satisfaction survey call — just days after being released from a 100-day hospitalization for COVID. I was in two hospitals in the same health system for over three months. One of which I spent 45 days in a coma. I was then transferred to a rehab hospital to learn to walk and breathe again.
While my mental faculties were fortunately wholly intact, as a healthcare writer, professor, and researcher, I struggled with many of the questions in the survey. And I found myself challenging the surveyor about the ambiguity of the questions.
Some of the most critical patient experiences, good or bad, are momentary, especially during extended stays. To expect the patient to remember something that occurred in Hospital A in May after awakening from a coma after being released from Hospital B in July is a stretch. But these moments between admissions in March and departure in June are some of the most important insights the healthcare enterprise would want to gather.
Additionally, patients can grow more emotionally attached to their caretakers over longer stays — in much the same way the Stockholm Effect occurs with those held hostage. Again, I am adding hyperbole here, but I can assure you that this phenomenon does occur with many patients just before and immediately after their release. Some will refresh their memory over time to recall more granular incidents, but many will just want the whole thing behind them.
So how do providers capture the most important insights during a patient stay and ideally in the moment?
Many patient satisfaction survey firms realize that “momental” data is challenging in a clinical setting compared to their standard data gathering techniques. One only needs to look at the stress and challenges of capturing typical EMR data to realize that adding patient satisfaction data would wreak havoc on workflow admin. In reality, those experiential elements should be best documented in some way by definition, from the patient experiencing them, whether good or bad.
The notion of real-time patient satisfaction surveys is plausible, and I’ve found several studies (including this one) that have explored HCAHPS improvement as a result of more timely patient feedback. But some studies saw no difference in scores regarding positive real-time feedback vs delayed questionnaires. What seems to be missing is the need to track those negative experiences that would decrease satisfaction scores in real-time.
Healthcare technology vendors clearly feel real-time feedback technology is valuable. These products range from clicking on an emoji to reflect your mood at a specific moment during your care to sending more granular grading scales through an app to the patient’s cell phone.
However, despite these advances, capturing momental dissatisfaction remains challenging in a setting where the patient might not have access to such a device or the mobility to use one. Scribing companies have an opportunity here for patients to express feelings verbally the instant positive or negative experience occurs.
Circling back to my original premise, the longer we wait to gather patient satisfaction data, the greater chance the Stockholm Effect will bias our results.
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