Patient satisfaction: a strategic tool for health services management

Background In the last years a growing number of health care o rganizations adopted multidimensional systems in order to evalua te the performance of health services, considering also the patient perspective. In most of the cases, patient satisfaction indicators are created by using data c ollected through surveys. However, it was observed that a critical aspect in the patie nt satisfaction measurement is related to the methodology issue about the propert ies of questionnaires. Objectives This study aims at describing the development of a questionnaire on patient satisfaction with primary care services in the Italian contest and evaluating its validity and reliability properties. Methodology A structured questionnaire with 33 demands was crea ted in order to investigate the patient experience with GP, Family Pediatricians, Specialist and Diagnostic outpatient services. In January 2009 a t elephone survey (by means of Computer Aided Telephone Interviews technique) was conducted among a random sample of 2136 citizens of Liguria Region (Italy). Factor analysis, inter-items correlations and Cronbach’s alpha were performed in order to evaluate the validity and reliability of the patient satisfaction dimensi ons. Results The psychometric analysis of the questionnaire prop erties provided positive evidences. Factor analysis confirmed the p attern of developed dimensions and identified four factors (substantial loading > 0.40) corresponding to: GPs care (factor1), Family Pediatricians care (factor2), spe cialist outpatient services (factor3) and diagnostic outpatient services (factor4). The i nt rnal consistency of the four dimensions ranged from 0.74 to 0.93 and the correla tion between each item and the overall evaluation scale was generally <0.60. Conclusion The results of this study highlighted the validity and reliability of the Primary Care Patient Experience Questionnaire. As a consequence, the collected data can be considered a valid source in order to c eate indicators for evaluating the performance of primary care services.

[1]  P. Cleary,et al.  Patient assessments of hospital care. , 1989, QRB. Quality review bulletin.

[2]  J. Sitzia.  How valid and reliable are patient satisfaction data? An analysis of 195 studies. , 1999, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[3]  S. Levy,et al.  Broadening the concept of marketing. , 1969, Journal of marketing.

[4]  Paul R. Rosenbaum,et al.  Comparing the Contributions of Groups of Predictors: Which Outcomes Vary with Hospital Rather than Patient Characteristics? , 1995 .

[5]  Health systems: improving performance , 2000 .

[6]  S. Abramowitz,et al.  Analyzing patient satisfaction: a multianalytic approach. , 1987, QRB. Quality review bulletin.

[7]  J. Ware,et al.  Involving consumers in quality of care assessment. , 1988, Health affairs.

[8]  G. Moon,et al.  Context, composition and heterogeneity: using multilevel models in health research. , 1998, Social science & medicine.

[9]  P. Shackley,et al.  What is the Role of the Consumer in Health Care? , 1994, Journal of Social Policy.

[10]  P D Cleary,et al.  The relationship between reported problems and patient summary evaluations of hospital care. , 1992, QRB. Quality review bulletin.

[11]  C McDaniel,et al.  Compendium of instruments measuring patient satisfaction with nursing care. , 1990, QRB. Quality review bulletin.

[12]  L. Hamilton.  Statistics with Stata , 1990 .

[13]  W. C. Benton,et al.  Performance measurement criteria in health care organizations: Review and future research directions , 1996 .

[14]  J. Kremer,et al.  Organizational determinants of patient-centered fertility care: a multilevel analysis. , 2011, Fertility and sterility.

[15]  Thomas A. Louis,et al.  League tables and their limitations: Statistical issues in comparisons of institutional performance - Discussion , 1996 .

[16]  Angela Coulter,et al.  The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. , 2002, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[17]  Patients' experiences with continuum of care across hospitals. A multilevel analysis of Consumer Quality Index Continuum of Care. , 2011, Patient education and counseling.

[18]  J. Seager,et al.  Interpersonal and organizational dimensions of patient satisfaction: the moderating effects of health status. , 2003, International journal for quality in health care : journal of the International Society for Quality in Health Care.

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

[20]  K. Ambrose.  Patient experience. , 2009, Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association.

[21]  A. Atkinson,et al.  A Stakeholder Approach to Strategic Performance Measurement , 1997 .

[22]  J. Arndt.  How Broad Should the Marketing Concept Be , 1978 .

[23]  J. M. Quintana,et al.  Development and validation of an in-patient satisfaction questionnaire. , 2005, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[24]  C. Hood.  A PUBLIC MANAGEMENT FOR ALL SEASONS , 1991 .

[25]  Anne Frølich,et al.  An international review of projects on hospital performance assessment. , 2008, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[26]  A. Coulter,et al.  The Point of Care Measures of patients ’ experience in hospital : purpose , methods and uses , 2009 .

[27]  D. Hofoss,et al.  Patient Experiences With Information in a Hospital Setting: A Multilevel Approach , 2003, Medical care.

[28]  A. Coulter,et al.  European patients' views on the responsiveness of health systems and healthcare providers. , 2005, European journal of public health.

[29]  R. Saltman,et al.  Conceptualizing decentralization in European health systems: a functional perspective , 2006, Health Economics, Policy and Law.

[30]  S. Nuti,et al.  L’esperienza dei cittadini del servizio di medicina generale: come la comunicazione influenza la relazione medico – paziente. Quattro regioni a confronto , 2010 .

[31]  S. Cihangir,et al.  Patient satisfaction revisited: a multilevel approach. , 2009, Social science & medicine.

[32]  Patient Survey , 2010, Practice Management Consultant.

[33]  S. Nuti.  La valutazione della performance in Sanità , 2008 .

[34]  Where to focus efforts to improve overall ratings of care and willingness to return: the case of Tuscan emergency departments. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[35]  S. Schubert,et al.  Seeing the Person in the Patient , 2007 .

[36]  P D Cleary,et al.  The increasing importance of patient surveys. , 1999, Quality in health care : QHC.

[37]  S. Hampson,et al.  The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature. , 2002, Health technology assessment.

[38]  G. Sandoval,et al.  Comparing patient reports about hospital care across a Canadian-US border. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[39]  D M Mirvis,et al.  Patient satisfaction: can patients evaluate the quality of health care? , 1998, Tennessee medicine : journal of the Tennessee Medical Association.

[40]  James G. Wright,et al.  The metaphor of patients as customers: implications for measuring satisfaction. , 2003, Journal of clinical epidemiology.

[41]  C. Salisbury,et al.  Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling , 2010, BMJ : British Medical Journal.

[42]  D. Delnoij,et al.  Patients' experiences with quality of hospital care: the Consumer Quality Index Cataract Questionnaire , 2007, BMC ophthalmology.

[43]  D. Woodbury,et al.  Does considering severity of illness improve interpretation of patient satisfaction data? , 1998, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[44]  A. Roux,et al.  A glossary for multilevel analysis , 2002, Journal of epidemiology and community health.

[45]  Shou-Hsia Cheng,et al.  Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care. , 2003, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[46]  O A Arah,et al.  Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement. , 2003, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[47]  A. Thompson,et al.  The meaning of patient involvement and participation in health care consultations: a taxonomy. , 2007, Social science & medicine.

[48]  H R Rubin,et al.  Can Patients Evaluate the Quality of Hospital Care? , 1990, Medical care review.

[49]  Peter E. Hilsenrath,et al.  The World Health Report 2000 , 2002 .

[50]  Anna Bonini,et al.  Performance assessment in the maternity pathway in Tuscany region , 2009, Health services management research.

[51]  PhD Dr. Dina Pilpel MPH.  Hospitalized patients’ satisfaction with caregivers’ conduct and physical surroundings , 2007, Journal of General Internal Medicine.

[52]  A. Blenkinsop,et al.  World Health , 1957, Nature.

[53]  P. Hjortdahl,et al.  Doctor and nurse perception of inter-professional co-operation in hospitals. , 2004, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[54]  G. Zipp,et al.  The Relationship Between Patient Satisfaction and Inpatient Admissions Across Teaching and Nonteaching Hospitals , 2009, Journal of healthcare management / American College of Healthcare Executives.

[55]  J. Jamison.  PATIENT SATISFACTION , 1996, Australasian chiropractic & osteopathy : journal of the Chiropractic & Osteopathic College of Australasia.

[56]  N. Ratanawongsa,et al.  Hospital self-discharge among adults with sickle-cell disease (SCD): associations with trust and interpersonal experiences with care. , 2010, Journal of hospital medicine.

[57]  R. Carey,et al.  A Patient Survey System to Measure Quality Improvement: Questionnaire Reliability and Validity , 1993, Medical care.

[58]  A Donabedian,et al.  Quality assessment and assurance: unity of purpose, diversity of means. , 1988, Inquiry : a journal of medical care organization, provision and financing.

[59]  Onyebuchi A Arah,et al.  A conceptual framework for the OECD Health Care Quality Indicators Project. , 2006, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[60]  B. Guldvog,et al.  The Patient Experiences Questionnaire: development, validity and reliability. , 2004, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[61]  G. Gasperoni,et al.  Statistica per la ricerca sociale , 2001 .

[62]  G. Young,et al.  Patient satisfaction with hospital care: effects of demographic and institutional characteristics. , 2000, Medical care.

[63]  B. Guldvog.  Can patient satisfaction improve health among patients with angina pectoris? , 1999, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[64]  Miolo Vitali Paola,et al.  Sperimentazione dell’Activity Based Management nella sanità pubblica: l’esperienza dell’Azienda USL 3 di Pistoia , 2004 .

[65]  T. Delbanco,et al.  National survey of hospital patients , 1994, BMJ.

[66]  L. Chambers,et al.  How was your hospital stay? Patients' reports about their care in Canadian hospitals. , 1994, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[67]  F Champagne,et al.  A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. , 2005, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[68]  M. Calnan.  Towards a conceptual framework of lay evaluation of health care. , 1988, Social science & medicine.

[69]  Roel Bosker,et al.  Multilevel analysis : an introduction to basic and advanced multilevel modeling , 1999 .