Patient satisfaction. The survey says...

Health care organizations and providers compete in a marketplace where loyal consumers are essential to a successful business. Contemporary consumers have health care knowledge and power. As employers negotiate benefits with providers, most will consider input from employees receiving care. Negative feedback from dissatisfied recipients of care can affect employers' selection of facilities and providers. This is significant leverage that health care organizations should consider when providing services to customers. Information obtained through patient satisfaction programs has proven to be a valuable source for quality improvement marketing, risk management, strategic planning, and finance initiatives. In this article, the authors describe variables associated with a patient satisfaction survey, identify key elements of a patient satisfaction survey program, and offer workable solutions to maximize patient satisfaction programs.     

Quality assurance by interviews with patients

Subjective criteria like patient satisfaction are of increasing interest in evaluation of psychiatric care. Although many improvements have been made in patient satisfaction research, methodological problems limit the interpretation of the findings. Further research is needed to develop reliable and valid instruments for measuring patient satisfaction within quality assurance. Own studies and findings are presented.     

Rating satisfaction research: is it poor, fair, good, very good, or excellent?

Satisfaction is one of the core outcome measures for health care. It is intuitively more appealing than measures of health care effectiveness or efficiency that are more difficult to understand. Satisfaction with health care is a measure with a long history in the social sciences. Most current research is less interested in correlations between patient characteristics and satisfaction and more focused on improving the quality of care and service delivered to patients and health plan members. While this article provides a brief overview of historical satisfaction literature, the primary focus is on current trends in measuring satisfaction, including efforts by the National Committee for Quality Assurance and the Foundation for Accountability. Limitations of current satisfaction measures are discussed; alternatives to using satisfaction to understand the experience of the health care system are suggested.     

The benefits of patient education

In this article, the role of the nurse in patient education is described, as well as the benefits of patient education, such as improved quality of care, improved patient satisfaction, increased compliance, improved staff satisfaction, and effective use of resources. Strategies for effective patient teaching also are presented.     

Consumer information, patient satisfaction surveys, and public reports

This article describes information useful for consumers and purchasers in making choices about health care services. Two types of information are described, patient satisfaction surveys and public reports about the price and outcomes of health care services such as those published by the Pennsylvania Health Care Cost Containment Council. Patient satisfaction surveys can be used to provide valuable information about health care. The goal of patient satisfaction reporting is to incorporate the patient's perspective to improve care. Public reports about the price and outcome of hospital and physician services not only facilitate consumer and purchaser choice, they also encourage continuous quality improvement by providers.     

Measuring quality of care in neurology

Neurologists are being asked to incorporate methods into daily practice that measure quality of care. Standards of care are increasingly being defined using evidence-based assessments of neurological literature. To evaluate quality of care, a widely accepted and useful model considers the structure, process, and outcomes of care. Outcomes, the impact of care on patients' health, should include measures of mortality, morbidity, disability, patient functioning and well-being (health-related quality of life), and patient satisfaction with care. A variety of private organizations and government programs exist to encourage documentation and promotion of high quality of care. This explosion in quality information is not yet standardized, so that much confusion exists about appropriate data elements to be measured. The challenge is to collect, summarize, and disseminate practical data useful to neurologists and the purchasers and consumers of our services.     

Patient satisfaction: a review of issues and concepts

This review presents issues arising from an analysis of over 100 papers published in the field of patient satisfaction. The published output appearing in the medical and nursing literature which incorporated the term "patient satisfaction" rose to a peak of over 1000 papers annually in 1994, reflecting changes in service management especially in the U.K. and U.S.A. over the past decade. An introductory section discusses the setting and measurement of patient satisfaction within this wider context of changes in service delivery. Various models are examined that have attempted to define and interpret the idea of determining individual perceptions of the quality of health care delivered. Determinants of satisfaction are examined in relation to the literature on expectations, and demographic and psychosocial variables. These are distinguished from the multidimensional components of satisfaction as aspects of the delivery of care, identified by many authors. The review highlights the complexity and breadth of the literature in this field, the existence of which is often not acknowledged by researchers presenting the findings of studies.     

Primary care within the VA: the firm model

Many of the VA medical centers are reorganizing total care across a continuum that includes outpatient, inpatient, long-term, and home based care, into interdisciplinary firms. The goals of reorganization are to improve patient access to care and continuity of care, to improve housestaff education by assigning a specific panel of patients for the residents to follow longitudinally in a variety of situations supervised by the same mentors, and to enhance research in primary care issues. Preliminary results show increased patient satisfaction and improvements in both quality of care and increased efficiency in its delivery. Many large health care organizations might be expected to reorganize care delivery around a similar interdisciplinary team concept.     

Optimizing cardiothoracic surgery information for a managed care environment

The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.     

Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.     

The case management model of patient care delivery

Case management is a model of care delivery that integrates patient and provider satisfaction and consideration of cost factors and provides a method of managing individuals' holistic health concerns. Using the case management approach, nurses can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance clients' quality of life, decrease length of hospitalization, increase client and staff satisfaction, and promote cost-effective use of scarce resources. Case management offers nurses an opportunity to demonstrate their roles in multidisciplinary health care teams. Case management is relevant in ambulatory surgery settings and in the perioperative care of complex surgical patients.     

Measuring and evaluating hospital restructuring efforts. Eighteen-month follow-up and extension to critical care, Part 1

Increasingly, hospital restructuring is viewed with skepticism because of a lack of systematic and rigorous evaluation of its impact on quality of care. This first article in a two-part series describes comprehensive evaluation of the effects of hospital restructuring on patient satisfaction, nurse satisfaction, costs of care, and clinical quality on four medical-surgical units at a large tertiary hospital. In addition, early application of the model to critical care is described. A quasiexperimental pre- and post-design combined with concurrent control units for selected measures was the overall strategy. The authors conclude that comprehensive restructuring of hospital-based care can take place in a manner that preserves multiple dimensions of quality while decreasing costs. This only can be ascertained, however, through rigorous and systematic measurement and evaluation. Part 2 will detail application and evaluation of the restructuring model in the critical care environment.     

Assessment of medical care by elderly people: general satisfaction and physician quality

OBJECTIVE: To identify personal characteristics and factors related to health and patterns of healthcare utilization associated with the elderly people's satisfaction with medical care. DATA SOURCES/STUDY SETTING: Data from the 1991 Medicare Current Beneficiary Survey (MCBS) on 8,859 persons age 65 and over living in the community. STUDY DESIGN: Items reflecting general satisfaction with care and views of physician quality are examined and, based on factor analysis, grouped in dimensions of two (global quality, access) and three (technical skills, interpersonal manner, information-giving), respectively. The relationship of high levels of satisfaction in each dimension to personal characteristics of elderly people, and to measures of access and utilization, is assessed using logistic regression. PRINCIPAL FINDINGS: While satisfaction is high, with over 90 percent surveyed expressing some satisfaction, there is substantial variation with less likelihood of high satisfaction among those 80 or older, with less education and income and in poorer health. Longer waiting time at visits and less frequent visits are factors in lower satisfaction as well. A favorable perception of physician quality, especially regarding technical skills, appears to play a significant role in satisfaction with global quality of care. CONCLUSIONS: Studies of patient satisfaction in elderly people are rare. Some factors expected to be related to positive assessment based on earlier studies, were, e.g., better health and shorter waiting time, while others were not, e.g., increasing age. Elderly people appear to place greater importance on physician technical skills, as opposed to interpersonal dimensions, in assessing global quality. These findings suggest the need for a better understanding of how elderly people evaluate care and what they value in interactions with the healthcare system.     

Impact of a CareMap and case management on patient satisfaction and staff satisfaction, collaboration, and autonomy

The purpose of this research was to evaluate the effect of a CareMap and nursing case management on patient satisfaction and staff job satisfaction, collaboration, and autonomy. The patients who had a CareMap and a nurse case manager were more satisfied with their care. The multidisciplinary staff who worked on the experimental unit had increased job satisfaction and nurses who applied and were selected for case management positions had higher levels of collaboration and increased autonomy. Multidisciplinary team members who developed the CareMap also had higher levels of collaboration than other multidisciplinary staff on the experimental unit and their job satisfaction with quality of care increased under this new care delivery system.     

The correspondence of patient satisfaction and nurse burnout

This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses' perception of their work is discussed.     

Initiating a patient service partner program

Rising costs and the need to increase patient satisfaction are driving hospitals to restructure care delivery. At one hospital, housekeeping, food service and nurse technician duties are combined to form one nurse-extender role: the Patient Service Partner (PSP). Findings about patient and nurse satisfaction before and after implementation show that nurses agreed that the PSP program improved patient care delivery and helped control costs. Patients reported the same or higher rating of satisfaction with various aspects of their hospitalization. Call lights were answered more quickly and attitudes of personnel answering the lights were more positive. Nurses are finding more time for patient education and documentation.     

CQI and anemia management: maximizing positive outcomes. Case study of the anemic patient

Quality improvement techniques provide a scientific approach that allows nurses and other health care professionals to improve patient satisfaction and outcomes. Continuous quality improvement (CQI) encourages the health care team to move beyond minimum standards of care and create an environment in which all team members are continuously working to improve services. This article reviews the principles of CQI and discusses the nurses' role in implementing and maintaining a successful CQI program. Anemia management is used as an example to illustrate how CQI principles and tools can lead to improvements in patient outcomes.     

The importance of caring as a determinant of patient satisfaction among active duty beneficiaries

The satisfaction scores of active duty Department of Defense beneficiaries with the medical care they receive in military facilities are compared to test the hypothesis that caring is a primary determinant of patient evaluations. Patient satisfaction scores and sociodemographic and social psychological correlates of patient satisfaction were regressed to illuminate the attributes patients use to judge their health care experiences. Results show that very specific interpersonal aspects, such as reassurance, support, and interest in outcomes of the care experience, are important to patients.     

Feasibility of national benchmarking of patient satisfaction with Australian hospitals

PURPOSE: This paper discusses the feasibility of developing national benchmark questions on patient satisfaction with hospital care in Australian hospitals. The research was undertaken for the Australian government under the National Health Outcomes Programme. DATA SOURCES AND SELECTION: The paper draws on a review of research with consumers to identify issues of importance to them about hospital care. The Australian sources were reports by consumer and community organizations, research reports by hospitals, governments and academics, and data from complaints authorities. The emphasis was on consumers' own views. The main debates on patient satisfaction methodology were reviewed. Published material from the USA and Britain highlighting organizational policy issues was reviewed, as well as literature on benchmarking. Material was obtained through journal searches and identification of organizations which undertake consumer-oriented or service development research. CONCLUSIONS: The paper argues that national benchmarking of patient satisfaction is not reliable because patient satisfaction is a poorly understood concept and not a unitary concept. Also, the paper argues that benchmarking is about processes, and that the link between survey results and hospital processes is not well researched or understood. While patient satisfaction surveys appear to promote consumer perspectives, they remain caught within a passive approach to consumer participation in shaping service development and improving the quality of hospital care. The task of government is to mandate consumer feedback, resource the development of expertise and technologies, trial and evaluate approaches to obtaining feedback, disseminate research and effective models, and resource consumer organizations to be participants at all stages. This is described as providing the resources for benchmarking at local levels.