Impact of Provider Attire on Patient Satisfaction in an Outpatient Dermatology Clinic
Provider attire has been studied as a potential vector for infectious microorganisms in the medical setting as well as a potential factor in patient satisfaction. Our objective was to determine if a change from formal attire to fitted scrubs had a measurable impact on patient satisfaction scores in an outpatient dermatology setting. We designed a 2-year retrospective cohort study of 22 providers in an outpatient dermatology setting who transitioned from formal attire to fitted scrubs and had at least 12 months of patient satisfaction scores (measured by a third-party patient satisfaction survey) before and after the change in attire. The primary outcome was statistically significant change in patient satisfaction scores before and after the institution of fitted scrubs. A total of 3511 completed surveys were evaluated from the 12 months prior to the change in attire (study period 1), and 4191 completed surveys were evaluated in 12 months after the change (study period 2). No significant change was seen in the overall survey responses. A small but statistically significant improvement was noted for several questions in study period 2, which suggested that a change from formal attire to fitted scrubs did not have a strong impact on patient satisfaction scores. Factors beyond provider attire likely have the greatest impact on patient satisfaction.
Practice Points
- Provider attire is known to harbor disease-causing microorganisms, potentially serving as a vector and contributing to hospital-acquired infections.
- A change from formal provider attire, including white coats, to fitted scrubs had no measurable impact on patient satisfaction in an outpatient dermatology clinic.
- Patient satisfaction is most strongly linked to other provider characteristics, such as communication skills, concern for patient well-being, ability to empathize, and timeliness.
Results
Data for 22 providers in the dermatology service line—13 staff dermatologists, 6 physician assistants, 1 nurse practitioner, and 2 podiatrists—were included in the study, with a total of 7702 patient satisfaction surveys completed between February 1, 2014, and January 31, 2016: 3511 were completed between February 1, 2014, and January 31, 2015 (study period 1), and 4191 were completed between February 1, 2015, and January 31, 2016 (study period 2).
Analysis of the overall distribution of possible responses for each survey item showed significant differences between study periods 1 and 2 for friendliness/courtesy of the care provider (P=.0307), explanations the care provider gave about the problem or condition (P=.0038), concern the care provider showed for questions or worries (P=.0087), care provider’s efforts to include the patient in decisions about treatment (P=.0377), and patient confidence in the care provider (P=.0156). These survey items trended toward more positive responses in study period 2. The full results are provided in eTable 1.
The analysis that looked at responses as binary (very good vs less than very good) showed a greater proportion of very good responses for friendliness/courtesy of the care provider (P=.0438), explanations the care provider gave about the problem or condition (P=.0115), concern the care provider showed for questions or worries (P=.0188), and patient confidence in the care provider (P=.0417). The full results are provided in eTable 2.
There were no significant differences in the overall satisfaction scores between the first and second study periods. The differences were statistically significant when the overall score was calculated if any questions were answered (P=.5177) and when the overall score was calculated if all 10 questions were answered (P=.9959). For patients who responded to all survey items, 75.3% selected all very good responses for both the first and second study periods.
Review of the surveys for comments from both study periods revealed only a single patient comment pertaining to attire. The comment, which was submitted during study period 2, was considered positive, referring to the fitted scrubs as neat and professional. No negative comments were found during either period.
Comment
In this study, we did not find that a change from formal attire to fitted scrubs had a measurable negative impact on patient satisfaction scores. Conversely, we found a small but statistically significant improvement on several survey items after the change to fitted scrubs. The data suggest that changing from formal attire to fitted scrubs in an outpatient dermatology clinic had little impact on overall patient satisfaction. Only 1 positive comment and no negative comments were received regarding providers wearing fitted scrubs.
A prior study in an outpatient gynecology/obstetrics clinic showed similar results.6 In that study, providers were randomly assigned to business attire, casual attire, or scrubs. A 10-question patient satisfaction survey was designed that specifically avoided asking about provider attire to reduce any bias. The study found that over a 3-month period, attire had no influence on patient satisfaction.6
Our data suggest that factors beyond provider attire have the greatest influence on patient satisfaction scores. Patient satisfaction is likely driven by other factors such as provider communication skills, concern for patient well-being, ability to empathize, and timeliness. Given the biologic plausibility of increased infection rate from contaminated provider attire, we feel that comfortable, washable, fitted scrubs provide a sanitary and acceptable alternative to more traditional formal provider attire in the office setting. Bearman et al1 suggest consideration of a bare-below-the-elbows policy (with or without scrubs) for inpatient services and lab coats (if worn per facility policy), and other articles of clothing should be laundered frequently or if visibly soiled. We feel these policies also can be applied to outpatient dermatology clinics, as long as the rationale is well communicated to all parties.
Several items on the patient satisfaction survey were statistically improved during the second study period; however, it is impossible to determine if provider attire was an important factor in this change. Improvement in satisfaction scores could be attributed to ongoing departmental and institutional emphasis on patient care and servic
Anecdotally, most providers in our department were enthusiastic and supportive of the change to fitted scrubs. It is possible that provider happiness is reflected in improved patient satisfaction scores. Provider satisfaction has been shown to correlate with patient satisfaction.7
Limitations include possible other unmeasured variables that had a more substantial impact on patient satisfaction survey results. We also recognize that the survey used in this study contained no questions that directly asked patients about their satisfaction with provider attire; however, bias or any preconception patients may have had regarding attire may have been avoided in the process. We also were not able to separate patient surveys based on age or other demographics. Finally, our results may not be generalizable to other settings where patient perceptions may be different from those of central Pennsylvania.
Conclusion
Transitioning from formal provider attire to fitted scrubs did not have a strong impact on overall patient satisfaction scores in an outpatient dermatology clinic. Providers and institutions should consider this information when developing dress code policies.
