The impact of public reporting of patient experience scores on quality of care in South African private hospitals, 2010-2019: An observational study

Abstract

Background: This study investigates public reporting in South Africa, specifically focusing on the impact of a large medical aid administrator's decision to publicly disclose patient experience scores, from private hospitals. The administrator initiated patient-experience surveys in 2010, to assess healthcare quality within private hospitals and shared the results confidentially with hospital groups. In 2015, the administrator began publicly reporting these scores. However, the impact of this public reporting initiative has not been formally evaluated, prompting the need for this research. Methods: This research is a longitudinal observational study, analysing patient experience surveys from South African private hospitals between 2010-2019. The surveys, based on the HCAHPS tool, comprised 26 questions covering eight key hospital experience categories, using a 5-Point Likert scale for responses. The analysis involved calculating composite scores from data that used Principal Component Analysis (PCA) to weight survey categories. Multiple linear regression was applied to assess the impact of Public Reporting (PR), adjusting for hospital group, size, and province. Interrupted Time-Series (ITS) analysis was also employed to discern trends and shifts in patient experience scores before and after the PR intervention in 2015. This method, using segmented regression, was instrumental in evaluating changes in trends and levels of scores at the point of intervention. This analytical approach aimed to unravel the nuances of PR's impact on patient care quality in private South African hospitals. Results: The results showed that the highest survey response (59,368) occurred in 2015, the year of PR implementation. The analysis demonstrated a statistically significant 5 percentage points increase in patient experience scores post-PR, with larger hospitals generally scoring lower than smaller ones. ITS analysis indicated a consistent annual increase in scores following PR. Sub-category analysis revealed major improvements in nursing care and medication information. Shorrock's decomposition analysis identified these areas as major contributors to the variance in patient experience scores, accounting for 18% each. Conclusions: This study reveals that public reporting in South African private hospitals resulted in an immediate, if modest, improvement in the level and trend of patient experience scores. The observed change underscores the potential of PR as a valuable tool in elevating perceived healthcare quality. These findings illuminate the effectiveness of PR as a catalyst for positive change and pave the way for further research and strategies to achieve sustained improvements in patient-centred healthcare.