Too big to fail or too big for success? The relationship between facility size and inpatient satisfaction
Average satisfaction [1] and Net Promoter Score [2], a measure of patients’ likelihood to recommend the facility, are crucial patient satisfaction performance metrics for psychiatric hospitals. Research in the broader medical field suggests hospital size, defined as the number of physical beds available in the facility (i.e., licensed bed count), can impact inpatient satisfaction 1, 2, 3, where larger hospitals tend to receive lower patient satisfaction scores due to factors such as perceptions of hospital cleanliness, timely assistance, and physician communication. Our curiosity was piqued, however, after finding this relationship has not been specifically explored in psychiatric hospitals.
To satisfy our data curiosity, we obtained licensed bed counts from the American Hospital Directory (AHD) database for 99 inpatient psychiatric hospitals with 2020-2023 satisfaction data in MHO’s database. Bed count data are reported by facilities to CMS however there is a 6-month lag. Furthermore, we do not have data on the staffed bed count which may be a more accurate metric. Each facility’s average daily census by year was also calculated using MHO data. Included hospitals had a median bed count of 110 and an average of 119 (SD: 52.4) and a median average daily census 71.7 and an average of 83.3 (SD: 43.8). The relationship between the two indicators of facility size and satisfaction metrics were investigated.
Drumroll…
Average satisfaction was found to be the same regardless of bed count or average daily census. In other words, these two indicators of facility size did not have an effect on average inpatient satisfaction and thus are not related to average inpatient satisfaction. Unlike average satisfaction, there was no pattern at all in inpatient Net Promoter Scores by average daily census or bed count. This too indicates no relationship between facility size metrics and this measure of patient satisfaction.
Figure 1. Hospital size and its relationship with patient satisfaction
Figure 2. Hospital size and its relationship with Net Promoter Score
While our findings contrast previous findings of larger acute hospitals having lower patient satisfaction, this trend does not seem to hold true for psychiatric facilities. It may be the different nature of treatment in psychiatric facilities as compared to medical facilities plays a role in this contrast. In psychiatric hospitals, patients participate in structured treatment activities throughout the day and have ongoing interactions with medical staff. Other drivers of satisfaction and patient likelihood to recommend seem to play a more important role than facility size.
Footnotes
[1] Patient Satisfaction Survey is a self-report measure of a patient’s satisfaction with their treatment, rated on a scale of 0 ‘strongly disagree’ to 5 ‘strongly agree’.
[2] Net promoter score is measured on a scale of -100 (less likely to recommend) to 100 (more likely to recommend) on the following item: “How likely would you be to recommend our facility to a friend or family member?”.
References
1 Haupeltshofer, S., Andermahr, B., Chmielewski, W., & Kreitschmann-Andermahr, I. (2023). Measuring patient experience and patient satisfaction—how are we doing it and why does it matter? A comparison of European and U.S. American approaches. Healthcare, 11(6), 797. https://doi.org/10.3390/healthcare11060797
2 Kraska, R. A., Weigand, M., & Geraedts, M. (2016). Associations between hospital characteristics and patient satisfaction in Germany. Health Expectations, 20(4), 593–600. https://doi.org/10.1111/hex.12485
3 McFarland, D. C., Shen, M. J., Parker, P., Meyerson, S., & Holcombe, R. F. (2017). Does hospital size affect patient satisfaction? Quality Management in Health Care, 26(4), 205–209. https://doi.org/10.1097/qmh.0000000000000149