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Managing Patients’ Expectations to Improve Satisfaction

In today’s competitive joint replacement market, healthcare providers are actively identifying and collecting measures of surgical quality. In addition to the traditional quality indicators, such as length of hospital stay and rate of complications and readmissions, more providers are beginning to focus on patient satisfaction. Being one of the most heavily weighted measures used by the CMS to evaluate hospitals and adjust their reimbursement models, patient satisfaction has become a growing priority for hospitals in the US.

A number of studies have recently demonstrated that patients’ expectations may be a key factor in determining postoperative satisfaction. While studies vary in their methods and their definitions of patient expectation and satisfaction, there is general indication that expectation may have an even more significant impact on patient satisfaction than objective levels of function.

Koenen et al. and Noble et al. have highlighted the wide prevalence of unrealistically high expectations among joint replacement patients and the association between the fulfillment of preoperative expectations and postoperative satisfaction. Similarly, Mancuso et al. have shown that patients with higher expectations of recovery, especially in regard to resuming sports activities such as running and hiking, reported greater dissatisfaction compared to those with lower expectations. These results are consistent with our human tendency to be disappointed when our expectations are not met.

Given the high volume of unrealistic expectations in total joint replacement patients, it is important to educate them on what is realistic. Although there isn’t an established gold standard in helping patients set achievable recovery goals, there are few practices that were shown to be effective. According to Elwyn et al., employing two-way communication is key. Traditionally, physicians have simply provided information to the patient - This one-way communication may cause patients to set unrealistically high expectations as most lack the necessary background clinical knowledge. Therefore, it is crucial to establish bi-directional communications and confirm how much the patients know about their procedure and their recovery plan. Also, it is crucial to review all aspects of the recovery plan with patients’ care partner during the pre-operative visit.

Further investigating on the pattern of patients’ recovery expectations will allow physicians and hospitals to improve their patient education preoperatively, better manage expectations and anxieties and ultimately improve patient satisfaction.

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