Assessment of the quality of healthcare services is an integral part of the development of medical organizations. The quality of services provided by medical organizations is a multidimensional indicator that includes various factors. One of these factors is patient satisfaction.
Medical organizations are increasingly including the results of patient satisfaction assessments in the development of quality control and efficiency improvement strategies.
For example, patient satisfaction assessment became mandatory for all hospitals in France starting in 1996. Then a wave of studies followed, which were aimed at determining the value of satisfaction and developing standardized methods for its assessment.
In the USA, in 2002 CMS (Centers for Medicare & Medicaid Services) jointly with AHRQ (Agency for Healthcare Research and Quality) developed a standardized method for assessing patient satisfaction (HCAHPS - hospital consumer assessment of healthcare providers and systems) for evaluating the medical care provided.
The aim of the project was to provide the public with information about the effectiveness and quality of all hospitals for the convenience of patients. In addition, it was to create the ground for the development of medical services.
The Department of Health of England is required to conduct surveys every year among patients. In parallel, in Switzerland, the local quality improvement authority recommended using surveys to collect data on the medical services provided. Patient satisfaction can provide significant information in assessing the quality of medical care delivered, which cannot be measured by monitoring clinical indicators.
As you can see, patient satisfaction has been the focus of attention for more than 25 years. And today we’ll try to give you a short but sufficient answer to the question:
Why are patient satisfaction surveys so crucial for your practice?
The Basic Principles of Ensuring High-quality Patient Experience
From various sources and survey results, we can identify the most common indicators of excellent patient feedback. Check out our table:
There are several reasons why it is important to assess the satisfaction of the population with the quality of medical services.
- Satisfaction is an indicator of the quality of healthcare services
- It can also be used to predict the level of patient retention
- It’s vital for organizational aspects of hospitals (patient/nurse and patient/doctor relationships, cleanliness and absence of noise, hospital staff behaviour).
Getting access to the results of the satisfaction assessment is helpful for identifying problems and developing an action plan.
Commonly, patient satisfaction in the UK is assessed by means of a questionnaire, which consists of 12 questions and is calculated by the average value of the proportion of positive responses to the survey questions. It is recommended to cover at least 10% of respondents from the number of patients discharged from the hospital. In addition, it is recommended to cover at least 5% of respondents from the actual number of visits per shift for organizations.
Most patient experience surveys agree that age, gender, health status and level of education correlate with patient satisfaction
What does it mean?
A high quality of care score is associated with elderly patients, a high assessment of people’s own health and a low level of education.
According to the results of a study in Scotland, it was revealed that patients over 50 years of age with a favorable assessment of their own health and its improvement showed a high level of satisfaction.
Also, it was found that married men tend to rate the level of satisfaction highly, but the longer patients stay in the hospital, the lower their satisfaction.
In a study conducted among 430 American hospitals, it was found that the "nurse work environment" and the "patient–nurse" relationship are statistically significant with patient satisfaction and their future hospital recommendations to their acquaintances. It is critical to know that in this study patient satisfaction was measured by factors of the HCAHPS questionnaire developed by CMS in collaboration with AHRQ.
NHS Adult Inpatient Survey
The British government proposed to include annual surveys of patients and users of medical services in the journal "The new NHS: modern, dependable, 1997".
The questionnaire for the survey of hospital patients in England was first conducted in 2002 by all NHS hospitals (National Health Service), and it has been conducted annually since 2004.
In 2017, the average hospital coverage rate was 41%. The information is collected by the CAR (Care Quality Commission), after which the results are used by the NHS and the Department of Health and Social Security to assess, improve and regulate quality. The data also compile national statistics on patient experience in the NHS.
How to Make the Most Effective Patient Satisfaction Questionnaire for Your Practice
The development of the application form should begin with the selection of questions that respond to patient perceptions. Usually, interviews with patients are conducted to solve this problem, the main questions being:
- What did you enjoy the most?
- What did you like the least?
- What would you like to change?
Depending on the category, patients' responses must be coded and grouped. Additionally, survey data allows us to select questions for the pilot version of the questionnaire. Additional questions should be divided into categories that are reliable and accurate.
Learn more about actual preferences of your patients and make right decisions via Management Reporting Module at Medesk.Learn more >>
To fully understand the main ideas of reliability and accuracy, we recommend you to have a look at the example of CAHPS online surveys. Many existing survey instruments are based on its questions and principles.
Recommendations for evaluating the results
There are 10 categories (19 questions) and a final rating in the HCAHPS questionnaire, which are used to determine the overall rating of the hospital.
Questions are evaluated based on their type.
- The hospital score is evaluated on a ten-point scale
- Yes/No questions are evaluated on a 1-point scale.
It is imperative to adjust the effects of personal experience, the survey method (by phone, email or apps) and quarterly weighing.
Correction methods and their compilation methods, such as: patient-mix adjustment, phone/mail mode adjustments can be found on the official website, in the category "Mode & Patient-Mix Adj".
The application of adjustments is accompanied by a weighted average of the scores for each indicator, by weighing proportionally for each patient who answered the care survey.
The table below shows, as an example, the awarding of points by “stars”.
Regardless of the statistical results, the choice of the distribution of questions by category, the number of categories and the inclusion/exclusion of individual questions from the template should be developed during discussion with experts.
When developing and translating into other languages, questions include:
Be clear and ask about one element
Be evaluated on the Likert Scale - 4-5 point scale; hospital assessment, the work of nurses and doctors on a ten-point scale.
The results of this evaluation method give healthcare organizations the opportunity to check the relationship between variables, and build a model that will predict the behavior of some factors. In addition, it will allow for a more objective assessment.
Special attention should be paid to the content of the questions regarding patient satisfaction with the quality of medical care. Let’s consider some most common ones.
"Are you satisfied with the organization of primary care in this institution (for example, the work of the registry, the availability of an appointment, offices schedule, waiting rooms, etc.)?"
Patients are asked about several elements of organization. Both respondents and researchers will not be able to understand the content of the question objectively.
The next question has a similar drawback:
"How do you evaluate sanitary and hygienic conditions and comfort in a medical organization?"
Sanitary and hygienic conditions and comfort carry different concepts. These are separate variables that need their own questions.
Please keep in mind that, during the pilot analysis of the satisfaction scores, it is recommended that questions be simplified and the content changed. This is because respondents had difficulty understanding the questions. Questions should ask about one variable.
We have often come across questions like:
"Did you have to pay for medical services or the cost of a drug included in the list of guaranteed free medical care in this institution?"
In this case, we recommend you check beforehand whether your patients know what free services they can receive. Then, if needed, you can ask this question.
Otherwise, the answers may be incorrect and don’t show the real picture (frankly speaking, they are going to show nothing).
The developed survey should not remain unchanged after the pilot study (online or offline). It is recommended to conduct a regular analysis of the questionnaire to improve it.
During each analysis, questions must be asked about the need for new questions and factors, as well as their exclusion.
Defining the meanings of some terms before developing a questionnaire can reduce misunderstandings and difficulties among patients, researchers and medical organizations.
Don’t forget to use the 21st century advantages! Modern practice management software has a Reports and Analytics module that can help you create real-time reports showing your patient's demographic and statistics. It is likely that you will need this information while making your own question forms for surveys.
Medesk allows you to set arbitrary parameters in your reports and get filtered data. For example, you can create a report on a specific group of patients, on a selected employee, his position, department, as well as by any tags.Learn more >>
Criteria for the Successful Conduct of Patient Studies
To conduct an independent assessment of the quality of medical organizations, a system of indicators of the quality of work is proposed.
For medical organizations in outpatient settings, it is recommended to use indicators of the quality of work (17 pieces) that characterize it according to 5 criteria, one of which is:
#1. Satisfaction with the quality of service in a medical organization
assessed by the following indicators:
- Satisfaction with the conditions of waiting for a doctor's appointment in the queue (in the hospital environment)
- Availability of quality healthcare at home
- Satisfaction with visiting a medical organization
- The percentage of patients who are ready to recommend a medical organization or a clinician.
Other evaluation criteria and indicators:
#2. Openness and accessibility of information about the medical organization:
- The rating level on the website
- Completeness, relevance and clarity of information about the medical organization posted on the official website
- Availability and accessibility of feedback methods with consumers of health services
- The proportion of patients who consider informing themselves about the work of a medical organization and the procedure for providing medical services sufficient, from the number of respondents
- The proportion of patients satisfied with the quality and completeness of the information available on the official website of the medical organization.
#3. Comfort of conditions and accessibility of medical services, including for citizens with disabilities
- The percentage of patients who made an appointment with a doctor at the first visit to a medical organization
- The average waiting time for a doctor's visit since the appointment
- Availability of an appointment with a doctor, including by phone, on the Internet, at the reception, through personal communication with the attending physician.
#4. Waiting time in the queue when receiving medical services
- For a doctor's visit (in minutes)
- For planned hospitalization from the moment of receiving a direction for planned hospitalization
- For diagnostic test results.
#5. Benevolence, politeness and competence during the patient care
- The share of service consumers who highly appreciate the benevolence, politeness and attentiveness of medical organization employees
- The share of service consumers who highly appreciate the competence of medical workers.
Less Is More
Also, it is worth mentioning that for a successful study of patient satisfaction you must pay specific attention to the implementation of a system of customer surveys, starting with an annual strategic cross-section of changes in the customer experience, ending with a system for dealing with complaints and appeals to the clinic.
We highly recommend you to focus your attention on one or two priority areas, which reveal the model of customer behavior. Spraying funds on everything will lead to mediocre results that no one can notice.
Clients are asked to evaluate the company, so make sure the words you use are not ornate or vague, that the questions in your survey aren't too deep, and that you don't take up the client's personal time asking dozens of questions - limit yourself to no more than 10-12 questions that include information about the client and patient’s perspectives.