Perceptions of care quality and the effect on patient satisfaction

Strategies that facilitate the delivery of exceptionally good patient care in general practice: a qualitative study with patients and primary care professionals

BACKGROUND

In recent years, proactive strengths-based approaches to improving quality of care have been advocated. The positive deviance approach seeks to identify and learn from those who perform exceptionally well. Central to this approach is the identification of the specific strategies, behaviours, tools and contextual strategies used by those positive deviants to perform exceptionally well. This study aimed to: identify and collate the specific strategies, behaviours, processes and tools used to support the delivery of exceptionally good care in general practice; and to abstract the identified strategies into an existing framework pertaining to excellence in general practice; the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework.

METHODS

This study comprised a secondary analysis of data collected during semi-structured interviews with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers. Discussions explored the key factors and strategies that support the delivery of exceptional care across five levels of the primary care system; the patient, provider, team, practice, and external environment. For analysis, a summative content analysis approach was undertaken whereby data were inductively analysed and summated to identify the key strategies used to achieve the delivery of exceptionally good general practice care, which were subsequently abstracted as a new level of the IDEAL framework.

RESULTS

In total, 222 individual factors contributing to exceptional care delivery were collated and abstracted into the framework. These included specific behaviours (e.g., patients providing useful feedback and personal history to the provider), structures (e.g., using technology effectively to support care delivery (e.g., electronic referrals & prescriptions)), processes (e.g., being proactive in managing patient flow and investigating consistently delayed wait times), and contextual factors (e.g., valuing and respecting contributions of every team member).

CONCLUSION

The addition of concrete and contextual strategies to the IDEAL framework has enhanced its practicality and usefulness for supporting improvement in general practices. Now, a multi-level systems approach is needed to embed these strategies and create an environment where excellence is supported. The refined framework should be developed into a learning tool to support teams in general practice to measure, reflect and improve care within their practice.

Identifying Factors that Support the Delivery of Exceptional Care in General Practice and Development of the IDEAL Framework: A Qualitative Study

The positive deviance approach seeks to identify and learn from those that perform exceptionally well. Positive deviance as an approach to quality improvement is gaining traction in general practice. This study aimed to explore and compare stakeholders' perceptions of the factors that support the delivery of exceptional care in general practice and to refine a previously developed theoretical framework of factors associated with positively deviant care in general practice: the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework. Semi-structured interviews were conducted with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers in Irish general practice. Subsequently, a directed content analysis approach was employed to deductively analyse interview data using the IDEAL framework, and newly emerging factors were inductively analysed and abstracted into the framework. Several distinct strategies (e.g. patient activation and team collaboration), structures (e.g. facilities and staffing), and contextual factors (e.g. communication and rapport, and culture) were found to support the delivery of exceptional care, and differences in perceptions, values, and expectations emerged between patients and practice staff. Interview data largely supported the pre-determined factors posited by the IDEAL framework, and new factors were abstracted into the framework (e.g. facilities and infrastructure). Stakeholder engagement regarding the factors supporting exceptional care in general practice supported and extended the IDEAL framework, contributing to a more comprehensive understanding of how exceptional care is delivered in general practice. The refined framework will support researchers, policymakers, and teams looking to support, measure, and achieve exceptionally good patient care in general practice.

A Systematic Review of Patient-Report Safety Climate Measures in Health Care

OBJECTIVES

Patients are a valuable, yet underutilized source of information for safety measurement and improvement in health care. The aim of this review was to identify patient-report safety climate (SC) measures described in the literature, analyze the included items to consider their alignment with previously established SC domains, evaluate their validity and reliability, and make recommendations for best practice in using patient-report measures of SC in health care.

METHODS

Searches were conducted, with no limit on publication year, using MEDLINE, EMBASE, CINAHL, PsycINFO, and Academic Search Complete in November 2019. Reference lists of included studies and existing reviews were also screened. English-language, peer-reviewed studies that described the development or use of a patient-report measure to assess SC in health care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool.

RESULTS

A total of 5060 studies were screened, with 44 included. Included studies described 31 different SC measures. There was much variability in the coverage of SC domains across included measures. Poor measure quality was marked by inadequacies in the testing and reporting of validity and reliability. There was also a lack of usability testing among measures.

CONCLUSIONS

This review identified the extant patient-reported SC measures in health care and demonstrated significant variance in their coverage of SC domains, validity and reliability, and usability. Findings suggest a pressing need for a stand-alone measure that has a high validity and reliability, and assess core SC domains from the patient perspective, particularly in primary care.

Antecedents and outcomes of patient satisfaction in healthcare: A conceptual model

This study develops a conceptual model and establishes the relationships between the variables, both influencing and affected by patient satisfaction. The authors conducted a thorough search for peer-reviewed articles obtaining a final sample of 64 studies. Service quality was found to be the only antecedent influencing patient satisfaction, while patient satisfaction was found to impact trust, loyalty and word of mouth, also mediating the influence of service quality on these variables. While the study integrates the scattered literature, from a practical standpoint it exhibits how increased patient satisfaction plays a key role in influencing patient trust, loyalty and word-of-mouth.

The effects of service quality and perceived price on revisit intention of patients: the Malaysian context

Purpose

This paper aims to investigate the effects of service quality and perceived price (monetary and behavioural price) on the revisit intention of patients to hospitals, as well as the mediating role of perceived price on the relationship between service quality and revisit intention.

Design/methodology/approach

This paper distributes questionnaires to outpatients in three major cities in Malaysia, namely, Penang, Melaka and Johor. Patients who were in the foyer, dispensary area and waiting area were intercepted where their responses were sought. The responses obtained from 400 patients were analysed using the structural equation modelling technique. Besides analysing the path coefficients, this study has examined the common method variance, bias and indirect effects of the relationships.

Findings

The results suggest that patients pay more attention to certain values in their search for the best health-care service and subsequently move on to new values. Pricing is an effective strategy to promote favourable behavioural intentions amongst patients. Better service quality is reflected in the reasonableness of monetary costs incurred by patients in acquiring health-care services. Patients who received poor services will be more likely to compare such services to the medical costs incurred to ascertain the worthiness of the amount paid. In addition, service quality also influences how patients perceive spending their time and efforts (waiting for nurses and physicians, as well as queueing in hospitals) as worthy and vice-versa. Their revisit intention will also be affected by the extent of which they invest their time, energy and efforts to search for relevant information.

Practical implications

The hospitals which desire to charge additional fees should enhance their service quality to reflect price equity. This is imperative in view of the pricing structure which can be relatively complex in subsequent follow-up treatments that may affect the decision of patients on the sources of health-care services.

Originality/value

Given the inevitable increase in medical fees, the perceived price can be a key determinant to the overall judgement patients had in terms of the health-care services received and the time and efforts sacrificed. However, the importance of monetary price and the behavioural price is still relatively unstudied, particularly their influence on revisit intention in the health-care setting.

The influence of servicescape and service credibility on older adults' intention to recover

PURPOSE

Based on the stimuli-organism-response (SOR) model and relationship marketing theory, the paper aims to examine whether servicescape influences trust, service credibility and affective commitment amongst older adults, and their effects on the intention to recover in a rehabilitation setting.

DESIGN/METHODOLOGY/APPROACH

The study takes a quantitative approach, applying confirmatory factor analysis and structural equation model to examine the responses. A total of 400 data were collected using questionnaires distributed to older adults in Malaysia. Respondents were selected based on two criteria: they should be over 65 years, and they should have been visiting the rehabilitation centres in the last 12 months.

FINDINGS

The results suggest that trust and affective commitment play significant roles in increasing the intention of older adults to recover. Contradicting previous research findings, service credibility does not have any significant impact on the intention to recover as hypothesised. The direct effect of service credibility on trust and affective commitment enhances the premise further that the relationship between service credibility and intention to recover is primarily indirect. Even though we expect servicescape to be a significant driver in forming the behaviour of older adults, its impact on intention to recover, trust and affective commitment remain non-significant, with the exception of service credibility.

ORIGINALITY/VALUE

Past studies have focused on the roles of servicescape and service credibility separately. We have extended the literature by examining the combined effects of both servicescape and service credibility. The findings, therefore, contribute to a deeper understanding of the literature on the intention-behaviour relationship in the context of healthcare, as well as in service marketing.

Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems

Objective

The installation of EHR systems can disrupt operations at clinical practice sites, but also lead to improvements in information availability. We examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience.

Methods

We collected data on provider satisfaction through 4 survey rounds during the phased implementation of the EHR. Data on patient satisfaction were drawn from Press Ganey surveys issued by the healthcare network through a standard process. Using multivariable models, we determined how provider satisfaction with information transmission and patient satisfaction with their care experience changed as the EHR system allowed greater information flow between OB/GYN practices and the hospital.

Results

Outpatient OB/GYN providers became more satisfied with their access to information from the inpatient perinatal triage unit once system capabilities included automatic data flow from triage back to the OB/GYN offices. Yet physicians were generally less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. Patient satisfaction dropped after initial EHR installation, and we find no evidence of increased satisfaction linked to system integration.

Conclusions

Dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements.

Portuguese university hospital patient satisfaction and service quality

Purpose The purpose of this paper is to investigate Portuguese hospital inpatient satisfaction. Design/methodology/approach The study was conducted at a major university hospital in Portugal. Using the IAQH-IA mailed questionnaire, data were collected over three months (March to June 2015) from patients and families. From 1,500 former inpatients, 434 participated (29 percent response rate). Using the structural equation modeling, the authors derived satisfaction models and analyzed the relationship between quality, satisfaction and patient attitudes. Inferential statistics (bivariate analysis) were used to deal with global satisfaction determinants. Findings The satisfaction model was confirmed using factor analysis. Results show that developing a system for delivering timely information to both patient and relatives is relevant. Communication is a fundamental aspect for patients, which to date, seems to have been neglected by hospital managers. Education and current perceived health are important global satisfaction determinants. Practical implications Hospital managers can use the authors' findings to measure and improve operational performance. Originality/value Knowledge about patient perception and satisfaction leads to continuing improvement in healthcare quality.

A multi-year SEM model predicting the impact of behavior attributes on overall patient satisfaction

Purpose

Pressure from competition; inflexible third-party reimbursements; greater demand from government, regulatory and certifying agencies; discerning patients; and the quest of healthcare entities for greater profitably place demands and high expectations for service quality impacting overall patient experience. Extending a prior multivariate, single-period model of varied medical practices predicting patient experience to a three-year time period to understand whether there was a change in overall assessment using data analytics. The paper aims to discuss these issues.

Design/methodology/approach

SEM was employed on a per year and aggregated, three-year basis to gain insights into qualitative psychometric constructs predicting overall patient experience and strength of the relationships.

Findings

Statistically significant differences were uncovered between years indicating the strength of the relationships of latent variables on overall performance.

Research limitations/implications

Study focused on data gathered from a questionnaire mailed to patients who visited various outpatient medical clinics in a rural community with over 4,000 responses during the three-year study period. A higher percentage of female respondents over the age of 45 may limit the generalizability of the findings.

Practical implications

Practitioners can gain a broader understanding of different factors influencing overall patient experience. Administrative processes associated with the primary care provider are inconsequential. Patients are not as concerned with patient flow as they are with patient safety and health.

Originality/value

This research informs healthcare quality management of psychometrics and analytics to improve the overall patient experience in outpatient medical clinics.