EMS Insider, Healthcare Reform

Patient Satisfaction, Part One

We all know quality medical service when we see it. You, me, the emergency department staff, even members of the general public who have had to call for help in an emergency—they all can identify certain providers within our system and say, “Those are the two people I would want to come get me if I were sick.”

However, when people call 9-1-1, they never say:

“My mom is having a heart attack at 1234 Main Street, Your Town, USA. I need an ambulance and send the two best EMS providers that you have.”

Do you know why? That is the public’s anticipation: that we always send our best. This is because the public does not have a very complicated expectation of what they imagine from us as healthcare providers. If we simply listen to our patients, it is easy to cross the threshold of what is considered excellent service.

Determining Value

What is the value of your service? Not what the individual components cost, but what does it mean to the patient?

There is a simple formula for determining value: Value=Quality/Cost1

We already know what our service costs; this is relatively easy to determine. Quality, on the other hand, without an understanding of patient satisfaction, is harder to pin down. The patient experience is the newest benchmark we need to quantify.

The implementation of the Patient Protection and Affordable Care Act and new regulations under the Centers for Medicare and Medicaid Services (CMS) have placed new challenges on us as providers.2, 3

When I was a paramedic in Newark, N.J., I had patients who would call 9-1-1 and ask for me by name. One such patient, Larry, was well-known to the system because he was a patient with chronic renal failure and hypertension, and he would be in hypertensive crisis or respiratory distress when he would call. One time he called and asked if I was working. When dispatch told him no, he asked when I was working again said that he would call back later! They sent the ambulance anyway and he ended up going to the hospital.

The dispatcher related the incident to me the next time I came in, so I made the effort to go see Larry at the hospital. I told him, “Larry, everyone here in Newark can take care of you. You don’t have to ask for me.”

He said, “Yes, but you do it right.”

I thought a long time about that, what I did to make Larry satisfied enough that he would want me to come and get him. Then I thought about the other patients who would call and ask for me and I started to figure it out.

Patients. They are the reason we exist, yet for some reason the patient experience has escaped us as a performance benchmark.


EMS agencies have many metrics we examine and collect: response time for life-threatening emergencies, STEMI care, stroke care, on-scene time for trauma and pre-arrival instructions, just to name a few.

Some metrics are specifically for quality improvement activities, some are derived to collect information on our patient population to improve service and paint a picture of the people we serve. Some metrics are gathered yearly, for example population and income, and some are gathered weekly or monthly. If we are looking for very specific trends, or we are working on resolving serious problems, we may look at data daily.

The one metric we rarely review is patient satisfaction, yet patient satisfaction is our most important benchmark. Patient satisfaction scores are vital to any EMS organization because they allow us to perform sequential and lateral benchmarks that will facilitate comparisons for performance both internally and externally.

The Myth of the ‘Captive Audience’

I was previously the chief of operations for a large healthcare system, and I had a discussion with a colleague from another service regarding patient satisfaction surveys. He chuckled when he said to me, “Dan, you have a captive audience. It isn’t like they can call someone else when they dial 9-1-1.”

The reality is that the community, elected officials, hospitals and healthcare systems all have the capability to choose a new provider, and if dissatisfaction is great enough, they will make the change at whatever the cost. It may not be easy for them, it definitely will not be pretty for you, and ultimately it may destroy your brand in an irrevocable way.

It is more difficult for a politician to replace you if your satisfaction scores are sky-high and your clinical performance is excellent. They may even want to take a picture with you come election time. If people are complaining about you, regardless of your clinical performance, you have a target on your back.

Think about it like this: If you do not currently measure patient satisfaction and you receive a complaint, the nature of that one complaint and your agency’s response could define your service. If the story makes it to an elected official who has a problem with your service, or into the media, or the Internet; all bets are off.

Now, imagine the same scenario, but you have been conducting patient satisfaction surveys. If a complaint makes it to the front page of the paper or onto the mayor’s desk, it is just one complaint against an overwhelming majority of otherwise satisfied patients. This is not to underscore a catastrophic issue, nor is it an excuse for sentinel events, but rather it is an opportunity to address a serious issue without eroding public confidence in your service. You can stand on your patient satisfaction scores and your other clinical benchmarks to support your service.

The bottom line is: Don’t let a single complaint define your agency, your employees or the service you provide for your community. Measuring patient satisfaction the same way you would any other benchmark not only helps you meet payer requirements under the Affordable Care Act, it also helps you protect your reputation and your position.

In part two of this series, I will discuss different strategies to measure and earn patient satisfaction in your community.  



1. U.S. Dept. of Health and Human Services. (n.d.) Evaluating the impact of value-based purchasing: A guide for purchaser. Agency for Healthcare Research and Quality. Retrieved on Jan. 19, 2016, from http://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/valuebased/evalvbp1.html.

2. Centers for Medicare and Medicaid Services. (n.d.) The HCAHPS survey: Frequently asked questions. Retrieved on Jan. 19, 2016, from https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/downloads/hospitalhcahpsfactsheet201007.pdf.

3. U.S. Dept. of Health and Human Services (n.d.) Read the law: The Affordable Care Act, section by section. Retrieved on Jan. 19, 2016, from http://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html