Beyond the ceiling effect: Using a mixed methods approach to measure patient satisfaction

Abstract This study reports patient satisfaction with the nursing care on a neurosurgical critical care unit. A modified version of the Ludwig-Beymer Patient Satisfaction Questionnaire (PSQ-7) was used, and included structured items and semi-structured interview questions. Data were collected from 149 patients. Participants rated their satisfaction as high (Mean = 25.14; SD = 2.96). The distribution of scores was skewed and every item demonstrated a ceiling effect. Principal component analysis yielded a one-component solution which explained 48% of the variance. NVivo® was used to match PSQ-7 scores with qualitative data. Participants’ comments were categorised as positive, negative or ‘yes, but’. Just over half the patients made positive comments and 29% of patients in the low group made negative comments. Three categories: ‘communication’, ‘nursing care delivery’ and ‘the hospital environment’ emerged from the qualitative data. A mixed method approach enables researchers to move beyond the ceiling effect of quantitative measures of patient satisfaction and to gain a more meaningful explanation of patient satisfaction.

[1]  K. Hegarty,et al.  How do Australian patients rate their general practitioner? A descriptive study using the General Practice Assessment Questionnaire , 2008, The Medical journal of Australia.

[2]  Yenna Salamonson,et al.  Integrating mixed methods data analysis using NVivo: An example examining attrition and persistence of nursing students , 2008 .

[3]  R. Rowell,et al.  A pilot mixed methods study of patient satisfaction with chiropractic care for back pain. , 2008, Journal of manipulative and physiological therapeutics.

[4]  P. Bower,et al.  What are the key attributes of primary care for patients? Building a conceptual ‘map’ of patient preferences , 2006, Health expectations : an international journal of public participation in health care and health policy.

[5]  Cheryl B. Jones,et al.  Call Bell Requests, Call Bell Response Time, and Patient Satisfaction , 2009, Journal of nursing care quality.

[6]  J. Jamison.  PATIENT SATISFACTION , 1996, Australasian Chiropractic & Osteopathy.

[7]  C. McCabe,et al.  Nurse-patient communication: an exploration of patients' experiences. , 2004, Journal of clinical nursing.

[8]  H. Rubin.  Patient evaluations of hospital care. A review of the literature. , 1990, Medical care.

[9]  C. Mee,et al.  Nursing2006 Patient-safety survey report. , 2006, Nursing.

[10]  F. Oflaz,et al.  The evaluation of nurses and nursing activities through the perceptions of inpatients. , 2010, International nursing review.

[11]  R. Kane.  Understanding Health Care Outcomes Research , 1997 .

[12]  S. Grobe,et al.  Casting light on the concept of patient satisfaction by studying the construct validity and the sensitivity of a questionnaire. , 2006, International journal of health care quality assurance incorporating Leadership in health services.

[13]  Jette Ammentorp,et al.  User satisfaction is influenced by the interval between a health care service and the assessment of the service. , 2010, Social science & medicine.

[14]  M. Conner,et al.  Validation of a questionnaire measuring patient satisfaction with general practitioner services , 2000, Quality in health care : QHC.

[15]  Martin Stevens,et al.  Patient satisfaction at and after discharge. Effect of a time lag. , 2006, Patient education and counseling.

[16]  J E Ware,et al.  Methods For Measuring Patient Satisfaction With Specific Medical Encounters , 1988, Medical care.

[17]  P. Bower,et al.  What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients’ Priorities , 2008, The Annals of Family Medicine.

[18]  N. J. Johnson,et al.  Using patient perceptions to improve quality care , 1993, Journal of nursing care quality.

[19]  Valerie J. Caracelli,et al.  Toward a Conceptual Framework for Mixed-Method Evaluation Designs , 1989 .

[20]  D. Wagner,et al.  Patient satisfaction with nursing care: a concept analysis within a nursing framework. , 2009, Journal of advanced nursing.

[21]  Introduction to Mixed Methods Research for Nursing and the Health Sciences , 2009 .

[22]  J. Hedges,et al.  Patient satisfaction investigations and the emergency department: what does the literature say? , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[23]  P. Bower,et al.  The General Practice Assessment Questionnaire (GPAQ) – Development and psychometric characteristics , 2008, BMC family practice.

[24]  D. Streiner,et al.  Health measurement scales , 2008 .

[25]  Michael A. West,et al.  Components and predictors of patient satisfaction , 1996 .

[26]  Young-Hee Yom,et al.  A comparative study of patients' and nurses' perceptions of the quality of nursing services, satisfaction and intent to revisit the hospital: a questionnaire survey. , 2007, International journal of nursing studies.

[27]  E. Halcomb,et al.  Mixed Methods Research for Nursing and the Health Sciences , 2009 .

[28]  C. Lemonidou,et al.  Evaluation of patient satisfaction with nursing care: quantitative or qualitative approach? , 2004, International journal of nursing studies.

[29]  P. Atkinson,et al.  Making Sense of Qualitative Data: Complementary Research Strategies , 1996 .

[30]  J. Sitzia,et al.  Patient satisfaction: a review of issues and concepts. , 1997, Social science & medicine.

[31]  A. Gallini,et al.  Using discovery interviews to understand the patient experience. , 2010, Nursing management.

[32]  J E Ware,et al.  My Medical Care Is Better Than Yours: Social Desirability and Patient Satisfaction Ratings , 1986, Medical care.

[33]  F. Pouwer,et al.  Ceiling effect reduces the validity of the Diabetes Treatment Satisfaction Questionnaire. , 1998, Diabetes care.

[34]  John W. Creswell,et al.  Designing and Conducting Mixed Methods Research , 2006 .

[35]  J. Donovan,et al.  Patient Decision Making: The Missing Ingredient in Compliance Research , 1995, International Journal of Technology Assessment in Health Care.

[36]  R. Gerber,et al.  Development and factor analysis of a questionnaire to measure patient satisfaction with injected and inhaled insulin for type 1 diabetes. , 2000, Diabetes care.

[37]  C. Jackson,et al.  Patients' accounts of the differences in nurses' and general practitioners' roles in primary care. , 2007, Journal of advanced nursing.

[38]  B. Tabachnick,et al.  Using multivariate statistics, 5th ed. , 2007 .

[39]  J. Hunt.  The cardiac surgical patient's expectations and experiences of nursing care in the intensive care unit. , 1999, Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.

[40]  Pat Bazeley,et al.  The evolution of a project involving an integrated analysis of structured qualitative and quantitative data: From N3 to NVivo , 2002 .

[41]  E. Halcomb,et al.  Mixed methods research is an effective method of enquiry for community health research , 2007, Contemporary nurse.

[42]  C. Lin,et al.  Patient satisfaction with nursing care as an outcome variable: dilemmas for nursing evaluation researchers. , 1996, Journal of professional nursing : official journal of the American Association of Colleges of Nursing.

[43]  R. Kane,et al.  The relationship of patient satisfaction with care and clinical outcomes. , 1997, Medical care.