Understanding patient willingness to recommend and return: a strategy for prioritizing improvement opportunities

A Look at Collaborative Service Provision: Case for Cosmetic Surgery Medical Tourism at Korea for Chinese Patients

Consumers admiring the beauty standards of other countries are approaching cosmetic surgery medical tourism. This study examines the roles of hospitals and facilitating agents as the main entities of cosmetic surgery medical tourism. 334 Chinese patients who underwent cosmetic surgery in Korea were collected and structural equation modeling is used to analyze the data. The results show that a hospital’s service quality in terms of tangibles, assurance, and empathy affect customers’ attitudes toward medical tourism for cosmetic surgery, which in turn, influences satisfaction with medical tourism. More importantly, facilitating agents’ service quality moderates the effects of hospitals’ service quality dimensions on service satisfaction. Findings extend the existing literature on medical tourism by identifying the roles of hospitals and facilitating agents to enhance customers’ attitudes and satisfaction with respect to collaborative service provision. Moreover, this research provides the first empirical evidence for the facilitating agents’ role in determining satisfaction with medical tourism.

Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives

Phenomenon: Transgender patients experience discrimination, limited access to care, and inadequate provider knowledge in healthcare settings. Medical education to address transgender-specific disparities is lacking. Research that engages transgender community members may help address health disparities by empowering patients, increasing trust, and informing medical curricula to increase competence.

APPROACH

A 2015 Community Forum on Transgender Health Care was hosted at the University of Louisville School of Medicine, which included healthcare professionals and transgender community members to facilitate dialogue among mixed-participant groups using a World Café model. Fifty-nine participants discussed the status of transgender healthcare and made recommendations for local improvements. A follow-up survey was administered to 100 individuals, including forum participants and their referrals. The forum discussion and survey responses were analyzed to determine common perceptions of transgender healthcare, priorities for improvement interventions, and themes to inform curriculum.

FINDINGS

The community forum discussion showed that local transgender care is overwhelmingly underdeveloped and unresponsive to the needs of the transgender community. The follow-up survey revealed that priorities to improve transgender care included a multidisciplinary clinic for lesbian, gay, bisexual, and transgender (LGBT) patients, an LGBT-friendly network of physicians, and more training for providers and support staff. This mutually constructive engagement experience influenced reform in undergraduate curricula and continuing education opportunities. Insights: Community engagement in healthcare disparities research can cultivate improbable discussions, yield innovative insight from marginalized populations, and build relationships with community members for future collaborations and interventions. Societal acceptance of transgender identities, which could be promoted through healthcare providers, could stimulate significant progress in transgender healthcare. Supplemental educational interventions for practicing physicians will improve the current conditions of transgender healthcare, but a comprehensive medical school curriculum specifically for transgender health that includes interactions between the transgender community and medical students could be particularly impactful.

Environmental Variables That Influence Patient Satisfaction: A Review of the Literature

Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient's own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research.

Effect of team training on improving MRI study completion rates and no-show rates

PURPOSE

Magnetic resonance imaging (MRI) is a high-cost imaging modality, and an optimized encounter ideally provides high-quality care, patient satisfaction, and capacity utilization. Our purpose was to assess the effectiveness of team training and its impact on patient show-up and completion rates for their MRI examinations.

MATERIALS AND METHODS

A total of 97,712 patient visits from three tertiary academic medical centers over 1-year intervals were evaluated, totaling 49,733 visits at baseline and 47,979 after training. Each center's MRI team received team training skill training including advanced communication and team training techniques training. This training included onsite instruction including case simulation with scenarios requiring appropriate behavioral and communicative interventions. Orientation and training also utilized customized online tools and proctoring. The study completion rate and patient show-up rate during consecutive year-long intervals before and after team training were compared to assess its effectiveness. Two-sided chi-square tests for proportions using were applied at a 0.05 significance level.

RESULTS

Despite differing no-show rates (5-22.2%) and study incompletion rates (0.7-3.7%) at the three academic centers, the combined patients' data showed significant (P < 0.0001) improvement in the patients' no-show rates (combined decreases from 11.2% to 8.7%) and incompletion rates (combined decreases from 2.3% to 1.4%).

CONCLUSION

Our preliminary results suggest training of the imaging team can improve the no-show and incompletion rates of the MRI service, positively affecting throughput and utilization. Team training can be readily implemented and may help address the needs of the current cost-conscious and consumer-sensitive healthcare environment. J. MAGN. RESON. IMAGING 2016;44:1040-1047.

The employee's productivity in the health care sector in Poland and their impact on the treatment process of patients undergoing elective laparoscopic cholecystectomy

BACKGROUND

Increasing the engagement of employees in the treatment process of patients may benefit a hospital and employee productivity and may result in better patient care and satisfaction with medical services. Given this, the first step in improving the quality of patient care is better availability of doctors for patients in a hospital ward.

METHODS

The research for this paper was conducted in six health care units in the Kuyavian-Pomeranian province in Poland. The research assessed how the elements relating to employees' behavior and things characteristic to medical service influence patients' willingness to recommend a hospital.

RESULTS

Patients' perception of services is linked with the behavior of medical employees and their engagement in the treatment process.

CONCLUSION

Our research indicates that individual employee recognition and collective recognition of hospital employees as a whole were identified as the most important factors in employee engagement in the treatment process (employee productivity) and patients' satisfaction with medical service.

Incorporating research technology into the clinical assessment of balance and mobility: perspectives of physiotherapists and people with stroke

PURPOSE

To describe the perspectives of people with stroke and their physiotherapists on the use of biomechanics technology to assess balance and mobility.

METHODS

This qualitative study used semi-structured interviews with patients with stroke and a focus group with their physiotherapists. Coding of interview and focus-group data used a line-by-line inductive approach, with qualitative software to develop codes into themes.

RESULTS

The quantitative data from the assessment were seen as beneficial to providing patients with insight into balance and mobility problems. Physiotherapists found that the assessment confirmed clinical reasoning and aided in precise evaluation of progress but expressed mixed opinions as to whether treatment choice was influenced. Patients would have liked more communication regarding the purpose of the assessment. Patients also stated that trust in their physiotherapists helped them overcome anxieties and that confidence was gained through exposure to more challenging balance assessments. Physiotherapists advocated for the use of a harness system to safely incorporate reactive balance control assessment and training into practice.

CONCLUSION

Both patients and therapists saw value in the quantitative data provided by the assessment. Regardless of the technology used, patients value a strong physiotherapist-patient relationship. Ongoing collaboration between clinicians and researchers should guide the evolution of technology into clinically useful tools.

Teaching and assessing professionalism in medical learners and practicing physicians

Professionalism is a core competency of physicians. Clinical knowledge and skills (and their maintenance and improvement), good communication skills, and sound understanding of ethics constitute the foundation of professionalism. Rising from this foundation are behaviors and attributes of professionalism: accountability, altruism, excellence, and humanism, the capstone of which is professionalism. Patients, medical societies, and accrediting organizations expect physicians to be professional. Furthermore, professionalism is associated with better clinical outcomes. Hence, medical learners and practicing physicians should be taught and assessed for professionalism. A number of methods can be used to teach professionalism (e.g. didactic lectures, web-based modules, role modeling, reflection, interactive methods, etc.). Because of the nature of professionalism, no single tool for assessing it among medical learners and practicing physicians exists. Instead, multiple assessment tools must be used (e.g. multi-source feedback using 360-degree reviews, patient feedback, critical incident reports, etc.). Data should be gathered continuously throughout an individual's career. For the individual learner or practicing physician, data generated by these tools can be used to create a "professionalism portfolio," the totality of which represents a picture of the individual's professionalism. This portfolio in turn can be used for formative and summative feedback. Data from professionalism assessments can also be used for developing professionalism curricula and generating research hypotheses. Health care leaders should support teaching and assessing professionalism at all levels of learning and practice and promote learning environments and institutional cultures that are consistent with professionalism precepts.

Increasing patient satisfaction: a new model development

Most patient satisfaction studies put an emphasis on finding key drivers (attribute) to increase overall patient satisfaction. However, it is not clear how much health care managers need to improve certain attributes to attain the target overall patient satisfaction level. The study aims at finding not only what attributes, but also how much these attributes need to be improved to attain the target levels of patient satisfaction. The study uses an ordinal logistic regression model to analyze attribute reactions to salient drivers. This approach would significantly enhance health care managers' capabilities to develop a strategic plan to improve their patient satisfaction levels.

Understanding patient satisfaction ratings for radiology services

OBJECTIVE

Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services, patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives patient satisfaction data and how the data are obtained, converted into scores, and formulated into rankings is increasingly critical for imaging departments. The objectives of this article are to describe the potential impact of patient satisfaction ratings on institutions and individuals, explain how patient satisfaction is rated and ranked, identify drivers that affect the ratings and rankings, and probe the resulting challenges unique to radiology departments.

CONCLUSION

Research results indicate that training providers to make simple modifications in their language and behavior during patient care can significantly impact patient satisfaction, which, in turn, can impact both quality-of-care ratings and the bottom line of hospitals. Training providers is a simple and cost-effective way to potentiate the clinical expression of compassion into improvement of patient satisfaction and financial reward, a national trend that no one in the game can afford to ignore.

Patient satisfaction and organizational impact: a hierarchical linear modeling approach

This article presents the rationale for using multilevel analysis to address the broad environmental contexts in patient satisfaction research. This study utilized patient satisfaction data and the American Hospital Association Hospital Guide Book (2004). This study found significant contributions of individual patient attribute reactions (nursing care, physician care, etc.), and also clearly demonstrated hospital-level effects and cross-level interactions on patient satisfaction. Thus, it is clear that patient satisfaction is not solely explained by patients' attribute reactions and their demographic variables, but is also explained by patients' hospital levels. This approach would offer additional understanding in patient satisfaction research.

Patient satisfaction scores and their relationship to hospital website quality measures

Hospitals and health systems are using web-based and social media tools to market themselves to consumers with increasingly sophisticated strategies. These efforts are designed to shape the consumers' expectations, influence their purchase decisions, and build a positive reputation in the marketplace. Little is known about how these web-based marketing efforts are taking form and if they have any relationship to consumers' satisfaction with the services they receive. The purpose of this study is to assess if a relationship exists between the quality of hospitals' public websites and their aggregated patient satisfaction ratings. Based on analyses of 1,952 U.S. hospitals, our results show that website quality is significantly and positively related to patients' overall rating of the hospital and their intention to recommend the facility to others. The potential for web-based information sources to influence consumer behavior has important implications for policymakers, third-party payers, health care providers, and consumers.

The 2012 Chitranjan Ranawat award: intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study

BACKGROUND

Postoperative pain after total knee arthroplasty remains one of the most important challenges facing patients undergoing this surgery. Providing a balance of adequate analgesia while limiting the functional impact of regional anesthesia and minimizing opioid side effects is critical to minimize adverse events and improve patient satisfaction.

QUESTIONS/PURPOSES

We asked whether bupivacaine delivered through an elastomeric device decreases the (1) patients' perception of pain after TKA; (2) narcotic consumption; and (3) narcotic-related side effects as compared with a placebo.

METHODS

In this prospective, double-blind, placebo-controlled study, all patients received standardized regional anesthesia, a preemptive and multimodal analgesic protocol, and a continuous intraarticular infusion at 5 mL/hour through an elastomeric infusion pump. The patients were randomized to receive either an infusion pump filled with (1) 300 mL of 0.5% bupivacaine, the experimental group (n = 75); or (2) 300 mL of 0.9% normal saline solution, the control group (n = 75). Data concerning postoperative pain levels through a visual analog scale, postoperative opioid consumption, opioid-related side effects, and complications were collected and analyzed.

RESULTS

Patients in the experimental group receiving the bupivacaine reported a reduction in pain levels in highest, lowest, and current visual analog scale scores compared with the placebo group on the first postoperative day and highest visual analog scale score on postoperative Day 2 along with a 33% reduction in opioid consumption on postoperative Day 2 and a 54% reduction on postoperative Day 3.

CONCLUSION

In patients undergoing TKA, continuous intraarticular analgesia provided an effective adjunct for pain relief in the immediate postoperative period without the disadvantages encountered with other analgesic methods.

Inpatients' willingness to recommend: a multilevel analysis

BACKGROUND

Satisfaction with health care is one of the most widely assessed measures of hospital care quality, yet studies that account for clustering effects are uncommon. We constructed a multilevel model to identify predictors of willingness to recommend while controlling for clustering effects due to hospital and care unit. We also examined differences in predictors by care unit.

PURPOSE

The aim of this study was to identify factors that both influence patient perceptions of care and are potentially modifiable by the hospital delivering care.

METHODOLOGY

Our sample includes Hospital Consumer Assessment of Healthcare Providers and Systems survey data collected between July 1, 2007, and June 30, 2008, for 131 hospitals and 33,445 patients. The primary outcome was willingness to recommend the hospital to family and friends. Variables were collected at three levels: patient (Hospital Consumer Assessment of Healthcare Providers and Systems survey item responses and demographics), care unit, and hospital. Data were analyzed using multilevel modeling. We also ran a series of two-level models to explore differences in predictors by care type.

FINDINGS

The strongest predictors of willingness to recommend, controlling for clustering effects, were items that generally reflected interpersonal aspects of care such as nursing and physician behaviors. In the two-level models, predictors of willingness to recommend overlapped across care units, but important differences were noted.

PRACTICE IMPLICATIONS

Our results suggest that hospitals that wish to improve their performance would benefit most from focusing on interpersonal aspects of care. Hospitals that focus resources on improving in these areas, that assess care units separately, and that investigate the meaning and context of survey responses will be most likely to see improvements in satisfaction scores.

Understanding nonresponse to the 2007 Medicare CAHPS survey

PURPOSE

The Medicare Consumer Assessments of Healthcare Providers and Systems (MCAHPS) survey, a primarily English-language mail survey with English and Spanish telephone follow-up, is the primary means of assessing the health care experiences of American seniors. We examine unit (whole survey) and item nonresponse for this survey to explore issues regarding surveying seniors about their health care.

DESIGN AND METHODS

We describe overall rates and analyze predictors of unit and item nonresponse for the 695,197 Medicare beneficiaries selected for the 2007 MCAHPS survey (335,249 unit respondents, 49% overall response rate).

RESULTS

Asians, African Americans, and Hispanics responded at adjusted response rates 7-17 percentage points lower than non-Hispanic Whites (p < .001 for each). Among seniors, response rates dropped beyond age 75. Asians and older beneficiaries were especially likely to respond by mail, and African Americans and Hispanics by phone. Breakoff from telephone surveys was most common among African Americans and older respondents. Among respondents, older age was the strongest predictor of item missingness (e.g., those 85 years and older failed to answer items at twice the rate of those aged 65-74 years, p < .001). Non-Hispanic Whites had lower rates of item missingness than other racial/ethnic groups (p < .001 for each; one-third lower than African Americans).

IMPLICATIONS

Survey research on older adults, especially regarding racial/ethnic disparities in health care, could benefit from improved response rates. These results suggest that targeted prenotification materials and campaigns, tailored follow-up, targeted Spanish mailings, Chinese translations/calls, and adjustments to telephone protocols may improve representation and response.

Nursing work environment and nurse caring: relationship among motivational factors

AIM

This paper is a report of a study of the relationships among compassion satisfaction, nurse job satisfaction, stress, burnout and compassion fatigue to nurse caring.

BACKGROUND

Nurse caring is the most influential dimension of patient advocation and is predictive of patient satisfaction. Qualitative studies have indicated that nurse caring is a key motivational factor impacting recruitment and retention.

METHODS

A correlational study of nurses (N = 126) was conducted in 2008 at a single, academic medical center. The six variables of interest were operationalized using four valid and reliable research instruments: (1) the Mueller McCloskey Satisfaction Scale, (2) the Professional Quality of Life Scale, (3) the Stress in General Scale and (4) the Caring Behaviors Inventory.

RESULTS

Pearson Product-moment correlations showed statistically significant relationships between nurse caring and compassion satisfaction (r = 0.51, P < 0.001), nurse job satisfaction subscales (r = 0.16-0.28, P < 0.05), stress (r = -0.21, P < 0.05), and burnout (r = -0.22, P < 0.01). A statistically significant relationship was found between the nurse caring subscale of knowledge and skill and compassion fatigue (r = -0.22, P < 0.01). Hierarchical multiple regression analysis demonstrated that compassion satisfaction (R(2) = 0.287, beta = 0.536, P = 0.000) and nurse satisfaction with social interaction opportunities related to work (beta = 0.223, P = 0.032) explained variability in nurse caring.

CONCLUSION

Fostering compassion satisfaction and social interaction opportunities among nurses may improve nurse caring, potentially sustaining long-term improvements in patient.

Incorporating professionalism into medical education: the Mayo Clinic experience

Professionalism is a core competency of physicians. In this article, the statements of professional societies (e.g., the Charter on Medical Professionalism), the expectations of patients and society regarding professionalism, and a framework for defining medical professionalism are described. The framework's foundation consists of clinical competence, communication skills, and a sound understanding of the ethical and legal aspects of medicine. Rising from this foundation are attributes of professionalism: accountability, altruism, excellence, and humanism. The capstone of the framework is professionalism, or the complete physician. Reasons for teaching professionalism to and assessing professionalism among medical students, physicians in training, and physicians in practice are also described. These reasons include patient expectations; the association between professionalism and improved clinical outcomes (and the association between unprofessional behavior and adverse outcomes); accreditation organization requirements; and observations that professionalism can be taught, learned, and assessed. In addition, methods for teaching professionalism are described (e.g., didactic lectures, discussion groups, simulation, and role-modeling). To ensure that medical students, physicians in training, and physicians in practice are competent in professionalism, they should be assessed for professionalism. Thus, approaches to assessing professionalism are also described (e.g., multiple tools and observers). Professionalism assessments can be used for formative and summative feedback, evaluation of professionalism education programs, and generating hypotheses for professionalism research. Finally, the rich history and culture of clinical excellence and professionalism and specific programs for teaching and assessing professionalism at Mayo Clinic are described throughout this article. Indeed, the Mayo Clinic experience validates professionalism a s a core physician competency.

Interpersonal processes of care and patient satisfaction: do associations differ by race, ethnicity, and language?

OBJECTIVE

Describe association of patient satisfaction with interpersonal processes of care (IPC) by race/ethnicity.

DATA SOURCES/STUDY SETTING

Interview with 1,664 patients (African Americans, English- and Spanish-speaking Latinos, and non-Latino Whites).

STUDY DESIGN/METHODS

Cross-sectional study of seven IPC measures (communication, patient-centered decision making, and interpersonal style) and three satisfaction measures (satisfaction with physicians, satisfaction with health care, and willingness to recommend physicians). Regression models explored associations, controlling for patient characteristics.

PRINCIPAL FINDINGS

In all groups: patient-centered decision making was positively associated with satisfaction with physicians (B=0.10, p<.0001) and health care (B=0.07, p<.001), and "recommend physicians" (OR=1.23, 95 percent CI 1.06, 1.43); discrimination was negatively associated with satisfaction with physicians (B=0.09, p<.05) and health care (B=0.17, p<.001). Unclear communication was associated with less satisfaction with physicians among Spanish-speaking Latinos. Explaining results was positively associated with all satisfaction outcomes for all groups with one exception (no association with satisfaction with physicians for Latino Spanish-speakers). Compassion/respect was positively associated with all outcomes for all groups with two exceptions (no association with satisfaction with health care among English-speaking Latinos and Whites).

CONCLUSIONS

All IPC measures were associated with at least one satisfaction outcome for all groups except for unclear communication.

Brief report: Hospitalized patients' attitudes about and participation in error prevention

BACKGROUND AND OBJECTIVE

Although many patient safety organizations and hospital leaders wish to involve patients in error prevention, it is unknown whether patients will take the recommended actions or whether error prevention involvement affects hospitalization satisfaction.

DESIGN AND PARTICIPANTS

Telephone interviews with 2,078 patients discharged from 11 Midwest hospitals.

RESULTS

Ninety-one percent agreed that patients could help prevent errors. Patients were very comfortable asking a medication's purpose (91%), general medical questions (89%), and confirming their identity (84%), but were uncomfortable asking medical providers whether they had washed their hands (46% very comfortable). While hospitalized, many asked questions about their care (85%) and a medication's purpose (75%), but fewer confirmed they were the correct patient (38%), helped mark their incision site (17%), or asked about handwashing (5%). Multivariate logistic regression revealed that patients who felt very comfortable with error prevention were significantly more likely to take 6 of the 7 error-prevention actions compared with uncomfortable patients.

CONCLUSIONS

While patients were generally comfortable with error prevention, their participation varied by specific action. Since patients who were very comfortable were most likely to take action, educational interventions to increase comfort with error prevention may be necessary to help patients become more engaged.

Review of the literature on survey instruments used to collect data on hospital patients' perceptions of care

OBJECTIVE

To review the existing literature (1980-2003) on survey instruments used to collect data on patients' perceptions of hospital care.

STUDY DESIGN

Eight literature databases were searched (PubMED, MEDLINE Pro, MEDSCAPE, MEDLINEplus, MDX Health, CINAHL, ERIC, and JSTOR). We undertook 51 searches with each of the eight databases, for a total of 408 searches. The abstracts for each of the identified publications were examined to determine their applicability for review.

METHODS OF ANALYSIS

For each instrument used to collect information on patient perceptions of hospital care we provide descriptive information, instrument content, implementation characteristics, and psychometric performance characteristics.

PRINCIPAL FINDINGS

The number of institutional settings and patients used in evaluating patient perceptions of hospital care varied greatly. The majority of survey instruments were administered by mail. Response rates varied widely from very low to relatively high. Most studies provided limited information on the psychometric properties of the instruments.

CONCLUSIONS

Our review reveals a diversity of survey instruments used in assessing patient perceptions of hospital care. We conclude that it would be beneficial to use a standardized survey instrument, along with standardization of the sampling, administration protocol, and mode of administration.

Patterns of unit and item nonresponse in the CAHPS Hospital Survey

OBJECTIVE

To examine the predictors of unit and item nonresponse, the magnitude of nonresponse bias, and the need for nonresponse weights in the Consumer Assessment of Health Care Providers and Systems (CAHPS) Hospital Survey.

METHODS

A common set of 11 administrative variables (41 degrees of freedom) was used to predict unit nonresponse and the rate of item nonresponse in multivariate models. Descriptive statistics were used to examine the impact of nonresponse on CAHPS Hospital Survey ratings and reports.

RESULTS

Unit nonresponse was highest for younger patients and patients other than non-Hispanic whites (p<.001); item nonresponse increased steadily with age (p<.001). Fourteen of 20 reports of ratings of care had significant (p<.05) but small negative correlations with nonresponse weights (median -0.06; maximum -0.09). Nonresponse weights do not improve overall precision below sample sizes of 300-1,000, and are unlikely to improve the precision of hospital comparisons. In some contexts, case-mix adjustment eliminates most observed nonresponse bias.

CONCLUSIONS

Nonresponse weights should not be used for between-hospital comparisons of the CAHPS Hospital Survey, but may make small contributions to overall estimates or demographic comparisons, especially in the absence of case-mix adjustment.

Satisfaction with Medical Care Among Elderly Patients

Research on patient satisfaction has focused predominantly on the mainstream adult population (ages 18-64). Satisfaction in older patients has not been adequately studied. Moreover, a systematic review of the research literature that does exist on this topic has not yet been conducted. The literature search yielded only 17 studies that met the selection criteria established for this review. Key research elements and findings from each of the studies are arrayed in matrix form. The results of the literature review are organized and analyzed in terms of four major categories of variables: background characteristics, predispositional variables, service quality attributes, and contextual factors. Special attention is awarded to identifying the determinants of satisfaction among elderly patients and the ways in which their service quality appraisals may differ in comparison with the general adult population of medical care consumers. Implications for management practice and directions for future research are discussed.

Using Patient Satisfaction Data to Improve Home Healthcare

Patient satisfaction surveys are used extensively by home health agencies for a wide variety of purposes, but their utilization is often limited by a variety of practical and methodological problems. This article explores current and potential uses of satisfaction data and outlines steps that home health agencies may take to focus their use of these data to improve quality of care.

Predictors of patient satisfaction with inpatient hospital nursing care

The purpose of this predictive nonexperimental study was to investigate the influence of registered nurse (RN) job satisfaction, context of care, structure of care, patient-perceived nurse caring, and patient characteristics on patient satisfaction with inpatient hospital nursing care in an academic medical center in north-central West Virginia. Convenience samples of patients (N = 362) and RNs (N = 90) were recruited from two medical units, two surgical units, and three intensive care step-down units. Causal modeling identified patient-perceived nurse caring as the major predictor of patient satisfaction, with nurse/physician (RN/MD) collaboration as the only other direct predictor. Age had an indirect influence on patient satisfaction. Strategies to achieve and maintain patient satisfaction should address the enhancement of patient-perceived nurse caring and RN/MD collaboration.

Patient Satisfaction in Gastroenterology Clinics

Satisfaction surveys of patients who had a gastrointestinal procedure at an ambulatory surgery center in 2002 were drawn from a national database and analyzed. The resulting data were used to report the status of patient satisfaction with their care and to illustrate several ways in which patient satisfaction data can be used to guide quality improvement efforts. It was found that patient satisfaction is generally quite high, with ratings of nurses and physicians topping the list. On the other hand, convenience factors such as parking and waiting times were rated lower. Uses of data to guide quality improvement efforts were illustrated in terms of response category percentages (i.e., percentage of time an item was rated "good," "poor," etc.) and a measure of item priority.

Quality improvement in primary care and the importance of patient perceptions

Increasing consumerism poses many challenges for health care providers, particularly for those in primary care. Quality improvement to meet patients' heightened demand for service excellence will require effective, continuous measurement of patient perceptions. The study described in this article evaluated the psychometric properties of a new instrument designed to survey patients' experiences with the delivery of primary care and assessed the factors that contribute to patient retention and likelihood to return. By systematically measuring patient satisfaction and perceptions of quality, medical practices can increase the effectiveness of primary care, improve patient outcomes, and control costs.