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‘Unprecedented decline’: Here’s how much the hospital patient experience fell in the pandemic


A RAND Corporation study found patient satisfaction scores plunged across the country, among all types of hospitals.

Hospital patient satisfaction scores plunged in the COVID-19 pandemic, a recent study shows. Hospitals of all types saw declines. (Image credit: @moodboard - stock.adobe.com)

Hospital patient satisfaction scores plunged in the COVID-19 pandemic, a recent study shows. Hospitals of all types saw declines. (Image credit: @moodboard - stock.adobe.com)

Patient satisfaction scores tumbled at hospitals across America during the first two years of the COVID-19 pandemic, a new study reveals.

Researchers compared more than 9 million patient records, examining scores before the pandemic and after the emergence of COVID-19. Hospitals lost ground across the board, according to findings published Aug. 25 in Jama Health Forum.

The researchers wrote that they found an “unprecedented decline” in patient satisfaction at hospitals in every region of the United States, with little variation.

Marc Elliott, the study's lead author and a senior principal researcher at RAND, said hospitals with better staffing fared better at first, but they also plunged in performance.

“Hospitals with higher staffing levels and better overall pre-pandemic quality were more resilient and slower to see their decline. But eventually even their patients also reported worse experiences,” Elliott said in a statement from RAND.

Researchers cited a number of reasons that hospitals, including those with more resources, eventually saw declines by the end of 2021.

“The emergence of the highly contagious Omicron variant, ongoing staffing shortages, and cumulative effects of staff burnout may have compromised patient experiences of care in all hospitals,” the authors wrote.

Researchers examined patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which is referred to by the only marginally less awkward acronym of HCAHPS. The federal Centers for Medicare & Medicaid Services uses the responses as a measure of hospital quality. The CMS provided funding for the study.

By the fourth quarter of 2021, the summary of patient scores fell 3.6 percentage points lower than would have been expected across all hospitals, researchers found. Researchers analyzed data from more than 3,381 hospitals, looking at results from 2018 to 2019 and comparing the responses to surveys from 2020 to 2021.

Patient responses indicated declines in communication with doctors, communication with nurses, staff responsiveness, cleanliness, information about medications, and care transition.

“Staff responsiveness and cleanliness scores decreased by large amounts, possibly reflecting high absenteeism in the hospital workforce and delays in care associated with staff having to wear PPE,” the authors wrote.

Late in 2021, even hospitals with 5-star rankings from the CMS found notable declines in patient satisfaction. By the fourth quarter of 2021, the decline at 5-star rating hospitals was only 13% smaller than the drop seen at 1-star hospitals and 2-star hospitals, the researchers wrote.

The analysis suggests the patient satisfaction scores could have been worse. The authors noted that the overall ratings and hospital recommendation responses lagged more specific patient survey data. Researchers speculated that patients had lowered their expectations or perhaps exhibited greater understanding due to the pandemic.

But researchers noted that patients grew more dissatisfied later in the pandemic.

The researchers said it’s possible that global ratings “do not fully capture changes in specific patient experiences, nor do they identify the areas in need of improvement, especially in the face of unusual events, such as a pandemic.”

Other studies have found the pandemic took a toll on hospital quality and performance.

Federal officials said the COVID-19 pandemic eroded gains in patient safety. In an analysis published in the New England Journal of Medicine in February 2022, they cited substantial increases in hospital-acquired infections. Federal officials acknowledged that hospitals encountered unprecedented difficulties in the pandemic, but they also said they were disturbed that declines in patient safety metrics occurred very quickly.

The Leapfrog Group, which examines hospital safety, found a five-year high in some infections in a report released this spring. The report examined hospital performance in late 2021 and 2022 and compared it to how hospitals fared before the COVID-19 pandemic.

Hospital leaders have said the federal government provided vital funding during the worst of the COVID-19 pandemic, but they added that federal aid hasn’t matched health systems’ higher expenses.

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