The Protective Effect of Pathway to Excellence Designation on Patient Satisfaction During the COVID-19 Pandemic

Background The Pathway to Excellence® (Pathway) program, operated by the American Nurses Credentialing Center (ANCC), recognizes healthcare organizations globally for fostering optimal work environments for nurses. While its role in supporting nurses is well established, its impact on patient satisfaction during crises like the COVID-19 pandemic remains largely unstudied. This investigation examined the longitudinal association between Pathway status and patient satisfaction during and after the pandemic. We hypothesized that Pathway hospitals would have a protective effect, exhibiting a slower decline in patient satisfaction scores compared to non-Pathway hospitals, despite the nationwide downturn during the pandemic. Methods This longitudinal, observational study integrated hospital data from three sources: Care Compare data from the Centers for Medicare & Medicaid Services from 2019 to 2023, the American Hospital Association Annual Survey, and the list of Pathway hospitals from the ANCC. The dependent variables were two global patient satisfaction scores: overall hospital ratings and likelihood to recommend the hospitals. The independent variable was hospitals’ Pathway status. Linear mixed-effects models evaluated the longitudinal associations between Pathway designation and patient satisfaction outcomes, accounting for hospital-level covariates, including hospital size, teaching status, percentage of Medicaid patients, nursing hours per patient day, specialized service capacity, ownership type, metropolitan classification, and system affiliation. Results Of the 3,242 unique hospitals, 133 (4.1%) held Pathway status for at least one year between 2019 and 2023, while 3,109 (95.9%) did not. Pre-pandemic patient satisfaction scores did not differ significantly between the groups. During the pandemic, patient satisfaction scores declined across all hospitals, but the decline in overall hospital ratings (b = 0.17; 95%CI: 0.03, 0.31) and likelihood to recommend the hospital (b = 0.20; 95%CI: 0.03, 0.37) was significantly slower in Pathway hospitals than in non-Pathway hospitals. Conclusion Pathway hospitals exhibited a protective effect on patient satisfaction during the COVID-19 pandemic. These findings emphasize the critical role of nurse work environments in maintaining patient-centered care during crisis situations.