Patient Satisfaction Survey: Can Nonresponders be Ignored?

Dear Editor,

We read the article titled “High satisfaction rating by users of private-for-profit healthcare providers-evidence from a cross-sectional survey among inpatients of a private tertiary level hospital of North India” by Kumar et al.[1] with interest. This article is a testimony to the fact that patient satisfaction with the healthcare services can no longer be ignored even in developing countries. However, the participant selection bias is an important limiting factor while evaluating the patient satisfaction surveys. Kumar et al.[1] did not mention how many patients were approached to participate in the survey and how many of them declined to do so. Gayet-Ageron et al.[2] identified a number of barriers for nonparticipation including language barrier, substance abuse, cognitive limitations, a psychiatric diagnosis and a sight deficiency. We believe that a patient not willing to participate in the survey may have many other reasons also to do so. The nonresponder patient is likely to be the most dissatisfied patient with the present healthcare facility and may be in a haste to search for a better one. His anger and discontent may also be a barrier to his participation in a survey. Although a physically frail patient at discharge is unlikely to participate in the survey, yet he may be the best person to judge the healthcare facilities provided to him.

We believe had authors[1] provided the list of diseases that the patients in their survey were treated for; it would have provided a greater insight into the reasons for the level of satisfaction that is projected. In addition, with the longer length of stay, the associated invasiveness of the investigations, the rising cost, the understanding of the disease process by the patient and their relatives, the level of satisfaction may vary. The handling of these patients may provide a better assessment in the overall satisfaction in the care that is offered to them.

To conclude, inclusion of patients who declined to participate in the survey coupled with the nature of the diseases that were treated for would result in a more comprehensive assessment of the care that is provided and the degree of content a patient has.