Editor’s note: While the format of this piece is doesn’t conform to the ‘five points’ you normally see, the ties to clinical and digital remain. We will return to the usual format in the next offering.

Patient advocacy and patient satisfaction are both popular terms these days, but they are far from synonymous. Patient advocacy is defined by Wikipedia as “An area of lay specialization in healthcare concerned with patient education about the use of health plans and how to obtain needed care.” This is considerably narrower than what I consider a more appropriate description by Trisha Torrey, “patient advocacy regards any activity which ultimately benefits a patient…it can apply to caregiving for an individual patient, to groups that develop policies and advice that help patients, to government groups that develop legislation to improve systems or processes for patients.”

Patient Satisfaction While patient satisfaction might intuitively seem to have a simple definition, it is now defined by a conglomerate of defined metrics. These metrics are a flawed reflection of patient advocacy for a number of reasons. Firstly, the government surveys are available only in English, Spanish, Chinese, Russian and Vietnamese in the mail format and in English and Spanish in the telephone and Interactive Voice Response formats. Clearly one can imagine the resulting lack of survey response rate as well as the underestimation of patient satisfaction from this literacy barrier. There are tools such as real-time language translation of healthcare materials in any language.

With regards to the timing of the distribution of the HCAHPS survey, “…Sampled patients are surveyed between 48 hours and six weeks after discharge, regardless of the mode of survey administration. Interviewing or distributing surveys to patients while they are still in the hospital is not permitted.” I would submit that average (and perhaps most) patients are not be able to recollect in sufficient detail enough information after six weeks of a prolonged hospitalization to provide meaningful input to such a survey. A real-time HCAHPS survey tool on a mobile platform would be ideal. An objection the government might raise is the prospect of patients reluctant to criticize the care that they are presently getting. While this is quite reasonable as an assumption of human nature, it defies logic. Why do hospitals employ patient ‘advocates’? Are they merely for risk reduction or do they really care to take immediate corrective action? They should not in that case have it both ways with regards to real-time surveys. The survey results are not returned to hospitals for many months and therefore timely corrective measures are not possible. Not surprisingly, hospitals are strategizing to improve patient scores.

While there are many digital tools which can improve patient satisfaction including communication tools, patient portals, and the ideal patient education tool, the idea that patient satisfaction is a metric and separate from patient advocacy must be dispelled. Patient satisfaction as a driver for provider payment continues to be debated.

Patient Advocacy Patient advocacy is distinctly different from patient satisfaction. It is grass roots driven and not top-down regulatory driven. It is not a popularity contest, but a movement which has interests in digital technology ranging from patients’ rights to their own electronic record data to online patient support groups.

Analogous to the government wanting to believe that payment penalties for 30 day hospital readmissions has something to do with patient outcomes, patient satisfaction scores do little for significant patient advocacy issues. It is time for the public, patients and caregivers to see the difference between financial metrics and real patient and caregiver issues.