The NY Times has a fascinating article about how Medicare reimbursement for hospitals is going to be in part calculated on patient satisfaction.  As explained in this government factsheet, this is part of a broader initiative to incentivize a range of measures of care, including objective ones.

The impact on hospital planning and operations is apparently significant.  As the article explains:

The ratings are based on Medicare-approved surveys, which hospitals hire companies to give to a random selection of patients after they are discharged. Some surveys are given by phone, others by mail. All ask the same questions: Did the doctors and nurses communicate well? Was pain well controlled? Was the room clean and the hospital quiet at night? The surveys go to younger patients as well as Medicare beneficiaries.

The article includes examples of both positive changes, such as improved staff training, but also attempts to improve perceptions, rather than the underlying performance:

In Connecticut, Bridgeport Hospital improved some of its lowest scores in its maternity unit after delivery nurses began telling patients how great the postpartum nurses are, said Eileen Callahan, the nurse manager for the maternity unit.

When the mothers and their babies are brought out of the delivery room, “the postpartum nurse greets them at the desk and starts the ‘oohs’ and ‘ahhs,’ and how lucky they were to have the nurse in the delivery,” Ms. Callahan said. She said initially there was “some hard swallowing going on” during exchanges for nurses who did not like each other. Ms. Callahan said she bases a portion of her nurses’ annual reviews on how well they followed these patient transfer practices.

Forgetting for a moment the questions that last practice might raise, just suppose that LSC and/or IOLTA programs found ways to use customer satisfaction surveys to allocate grants (there are ways that could be done even within a census formula driven system — funders could, for example, require for low scoring programs that portions of the budget be allocated to satisfaction-improving programs.

It could be a major cultural change.  The problem now is that with the need overload, there is just no incentive to worry about client satisfaction — in fact, today courts are far more likely to measure client satisfaction than legal aid programs.