Patient Satisfaction with Their Practitioners of TCM or Acupuncture and Overall Consumer Experience - Essay Example

Patient Satisfaction with their Practitioners of TCM or Acupuncture and overall Consumer Experience Introduction In healthcare, measures of consumersatisfaction are being increasingly used in order to guide administrative measures to assess quality of health. In the current scenario of healthcare delivery, there are rapidly notable changes in approaches to achieve quality health care. Therefore, there is a perceived need to measure quality of care. There is general consensus as to the assessment of quality of healthcare based on three criteria. These are structure indicating the characteristics of the provider, process indicating various parameters of care encounters between the provider and the patient, and outcomes of care. In many healthcare scenarios, there is a lack of precise definition about the outcomes since quantifiable outcome parameters are difficult to discern. Despite this, evaluation of quality of healthcare still remains an issue of paramount importance for all service providers since consumers or patients inclination to any service is dictated by the quality of the available services (Fitzpatrick 1993). Since patients are important components of this system, one of the important variables that determine outcomes of any care remains to be patient satisfaction. Many studies now incorporate patient satisfaction to be a major identifier and an essential component of care quality. Doll (1973) proposed that even for an organisation like NHS (National Health Service) the evaluation of service parameters should have at least three distinct criteria, namely, clinical outcomes, cost-effectiveness, and social acceptability with the later indicating satisfaction of the patients (Doll 1973). As far as quality is concerned, quality is a class of functionally related attributes of heterogeneous assortment, this context research in this area tends to derive and examine data from a variety of resources. Although the data from other sources such as administrative records or treatment charts are easy to use, these do not reflect the true parameters of client satisfaction as a measure of quality of care. Recent studies focus on direct observations of patient-provider interactions, questionnaires related to outcomes, and above all, patient surveys. Information directly available from consumers, usually in the form of patient satisfaction surveys may provide information that can be more relevant than administrative data in assessing quality. One of the definitions of quality healthcare is patient satisfaction. Research involving patient satisfaction usually requires collection of information directly from the patients. Primary data collection is more costly and time consuming. However, there is evidence that the consumers also consider satisfaction questionnaire surveys to be a better means and an essential component complementary to administrative measures for healthcare quality. Studies have shown that satisfaction measures can characterize the process and the outcomes in care. Measures of patient satisfaction can provide information about treatments and its efficacy, but actually, it can provide the consumer perspectives on the success of those treatments. The levels of satisfaction that the patients experience in different phases and aspects of any care hold important grounds in assessing quality and effectiveness of care. Any acceptable treatment or modality of treatment for a disease must in itself generate satisfaction in the recipient. Therefore, any proposed treatment modality must produce patient satisfaction as a desirable goal. If the patient is satisfied with treatment, the compliance with treatment no longer is an issue (Ley 1998). Additionally, patients' satisfaction can be an important indicator for effective treatment so it may work as a feedback system helping practitioners to identify ways of improving their practice in any relevant area. White (1999) suggests that improving practice based on patient satisfaction surveys may translate into better care and happier patients (White 1999). Although it has been argued that most of the available patient-satisfaction studies is based on patients' experiences during clinical scenarios involving one-time encounters, rather than their experiences over time during a continued course of therapy, even then these can provide important information on the overall quality of therapy if interpreted on the context of the disease condition, chronicity, and other available therapeutic modalities available for such conditions. On the other hand, most of the questionnaire satisfaction surveys intentionally avoid direct questions about the customer appraisals or feelings. Thus there may be a lack measurement of quality of care in these studies. This might be due to the traditional and orthodox concept that the nave patients may fail to assess the technical skills of the physicians or professionals delivering the treatment. As Thiedke (2007) has interpreted, these studies may typically end up measuring a combination of the patient's expectations before the visit, the patient's experience during the visit and the extent to which the patient experienced a resolution of the symptoms that led him or her to make the visit (Thiedke 2007). There has been further argument that patient satisfaction studies may be subject to bias, specifically nonresponse bias. This means that the knowledge of participation in surveys may make these patients opinionated. Ideally all these surveys must take place immediately after the care. If the patients are allowed to recall about their satisfaction about a care event that took place must earlier than the study time. This would open the scope for recall bias when the patients do not recall the experience involving their care. These potential problems may reduce the reliability and validity of the data. This indicates that health care performance monitoring research must be designed in such a way that patient based measures may be able to measure quality of care by incorporating scales of measure that can help plan quality. Another important issue while assessing quality of care is that despite being collected at the level of the individual patient, comparison of quality of the service is conducted generally at the provider level. There is a considerable volume of literature relating satisfaction to experiences and behaviour of the individual patient that can be correlated with the outcome measures of care. Therefore, there is enough indication that a better outcome from delivered care is often associated with patient satisfaction, although it is not known whether patient satisfaction results in better clinical outcomes in all cases. This is not known just due to the fact that there is a paucity of studies that measure satisfaction as well as compare qualities across different providers in the same modality of therapy. Satisfaction with care and quality of care are important to patients, policy makers, physicians as well as the tax payers (vom Eigen et al 1998, Drain 2001, Institute of Medicine 2001, Clark 2003, Epstein et al 2005, Epstein 2006, Stewart et al 2000) and can serve as a motivation behind the development of physician ratings (Centers for Medicare and Medical Services and Agency for Healthcare Research and Quality 2006). Dugdale et al (1999) indicated that physicians will be required to respond as patient satisfaction ratings would become commonplace. It has also been indicated that the physicians will be challenged by constraints, which tend to force a balance between time that can be spent with patients and financial pressures from management to deliver more care in the same time, leading to more revenue generation. Thus there may be conflicts of in the interests between organisational financial goals and quality mission of the same organisation. Ultimately, it is a reality that any health care professional working within an organisational framework would have to succumb to organisational policies and pressures. These pressures will often reduce the time available for a given patient (Dugdale et al 1999). Time allowed for each patient is a considerably important parameter for patient satisfaction since a part of this time is spent in communications with the patient. As Wood et al. (2009) have indicated although these times vary based on practitioners, practice style, patient management, and communication skills are likely to be important to maintaining patient satisfaction and the viability of ambulatory practices (Wood et al 2009). Additionally, a sustained relationship between a patient and a primary care physician (PCP) is a key characteristic of primary care (Platonova 2008). Recent research has indicated that a sustained relationship with a PCP as well as the resulting comprehensiveness of care, organizational accessibility, and coordination of specialty care are associated with greater patient satisfaction (Donahue et al 2005, Saultz et al 2004). Other have demonstrated that a stronger patient - doctor relationship leading to better treatment outcome (O'Malley et al 2002, Parchman et al 2003), compliance with medications and appointments, patient disclosure of behavioural problems, and reduced cost of care (Gabel et al 1993) also play roles in dictating patient behaviour and satisfaction. However, these works are based on research conducted with patients who were using western medicine. As of yet, there is no study available which involves research in the field of Traditional Chinese Medicine (TCM) and acupuncture. Therefore, it would be prudent to carry out such a study in the area of TCM and acupuncture. This is a neglected but important area, since there is evidence that TCM and acupuncture are being increasingly used as a complementary management strategy for many hitherto difficult to cure diseases in unison with Western Medicine. This researcher is convinced that more research in such areas will help practitioners to improve their services and obtain a better understanding of their patients' and marketplace's needs. This, in turn, will improve their business and make them more successful. Aim The purpose of this proposed research is to add to the current knowledge and understanding about the relationship between the TCM practitioner or acupuncturist and the patient in order to improve the patient's satisfaction. This in turn, drawing on other areas of healthcare research would improve compliance with the medical advice. Improved satisfaction and compliance are likely to result in better patient satisfaction which would directly enhance practice of the practitioner. This can motivate other care providers, such as their staff, to improve quality of care and meet the needs of the consumers. Personal back ground This author runs three businesses, and one of them is an eldercare business. The company delivers care professionals to patients' homes in order to assist them and their families. Clients often ask us if we have any recommendations for good practitioners, not only for conventional but also complementary medicine. Therefore, the company needs to be able to supply such information. Literature review Wood's (2009) work is based on research conducted on patients using " Press Ganey satisfaction questionnaire" to measure their satisfaction. This questionnaire includes ten questions where the patients' responses are recorded in a 5-element Likert scale with 0 indicating very poor and 4 indicating "very good." This scale allows the patients to rate different parameters of patient experiences with their clinicians. Based on the responses of these questions, a scoring system is available to rate the overall response of the patients regarding a specific care delivery. This study was an observational study in one health system using patients' personal reports about their experiences of satisfaction and estimated waiting times in the clinic. Therefore, the productivity and satisfaction measures do not cover all domains of interest or all ranges of values. The response rate of 30% to 35 % led the researcher to seriously consider sample selection bias. This could lead to limitation of reliability and validity and hence the generalizability of the results. Another point to note in this study was that the sample sizes of patient satisfaction surveys per physician varied from the one to the other survey scenarios. Although these drawbacks in design exist, it is evident that such a design may be made more perfect by adequate consideration of the settings. Regarding the instrument used, adding more questions to evaluate more parameters of satisfaction of patients more accurately would be prudent (Wood's 2009). Platonova et al (2008) used eight variables in their model, which were drawn from either research in health care or from academic business literature. Some minor modifications were made in some instances to adapt the measures to suit the purpose of the study and the design as may be applicable in a healthcare scenario. For example, in a primary care physician context, the patient may think "I trust this doctor so much I always try to follow his or her advice." Both of the above-mentioned studies clearly described their methodologies, which include survey, analysis and outcomes. These authors provided sufficient information about what could be expected from their studies. They showed patient's satisfaction could be directly correlated to the amount of time that a physician spent with his patients, especially elderly patients. In addition, it was also demonstrated that patient age and gender were markers of higher patient satisfaction (Platonova et al 2008). There were few limitations in the above study. This study was limited only to one health care institution. This would restrict the scope of the study since various patients and practitioners would be automatically excluded. Moreover in any single institution, the organisational framework would decide the pattern of consultation and care delivery. This loss of variety in the sample may prove to be limiting in that the results may not be generalizable to other geographical areas. Clearly and ideally, a sample drawn from multiple healthcare institutions would enhance the external validity of the study findings. Secondly, the authors could not use validity in instrument, although there are no validated and reliable instruments measuring patient loyalty to physicians. Therefore, the authors had to modify existing customer loyalty or commitment scales found in general business, organizational behaviour, and marketing journals which could also affect the results. Therefore, additional research in this area is indicated. The article written by Thiedke (2007) is actually a literature review itself acting as a critique about thirty-one articles. The most important lesson for physicians to learn is to take the time and effort to find out and meet patients' expectations. This view has been drawn on Rao et al. (2000) who contend that when physicians recognize and address patient expectations, satisfaction is higher not only for the patient but also for the physicians (Rao et al, 2000). Doctor - patient communication can also affect rates of satisfaction. When the physician took the patient's work-related low-back pain seriously, explained the condition clearly, tried to understand the patient's working circumstances, and gave advice to prevent re-injury, their rates of satisfaction were higher than could be explained by symptom relief (Shaw et al, 2005). Physicians can also improve patient satisfaction by relinquishing some control during the encounter. When physicians exhibited less dominance by encouraging patients to express their ideas, concerns and expectations, patients were more satisfied with their visits and more likely to adhere to physicians' advice (Cecil et al 1997). Sherbourne et al (1999) showed that patient satisfaction can also be influenced by physicians' medical decision making. Patients expressed a preference for physicians who recognized the importance of their social and mental functioning. Moreover, time spent during a visit played a role in patient satisfaction, with satisfaction rates improving as visit length increases (Gross et al, 1998). Time spent chatting during the visit was also related to higher rates of satisfaction. Physicians with high-volume practices were more efficient with their time but had lower rates of patient satisfaction, offered fewer preventive services and were viewed as less sensitive in the physician-patient relationship (Zyzanski et al, 1998). Patients also appear to respond to a physician's appearance. Lii et al. reported that patients indicated that they preferred in order of preference "semi-formal" dress without a smile, white coat, a formal suite, jeans and casual dress. They were less comfortable with facial piercings, short tops, or earrings on men. In addition, most patients wanted to be called by their first name, be introduced to the physician by his full name and title, and see a name badges. Patient satisfaction is not simply a product of patients' demographics and the physician's skills. It is also affected by the system in which care is provided. Although it is clear that patients' first concern is their physician, they also value the team with which the physician works. Lii et al found that while physician care was most influential to patients' satisfaction, the compassion, willingness to help and promptness of the physician's staff were next in importance. Overall, all the above are studies in the field of conventional medicine. However, according to some articles (Cassidy 1998a, 1998b, Gould et al 2001, Peterson et al 2004) existing attitudinal data indicates that the popularity of acupuncture among users is strikingly high these days. Thus, I believe that this study will prove valuable and add greater understanding to the field of TCM or acupuncture. Research methodology A quantitative study design using a survey will be used as methodology. The Press Ganey patient satisfaction survey will be selected as the model. Furthermore, for this study, a questionnaire will be developed based on previous work and studies, but with additional relevant questions added from the perspective of TCM or acupuncture. For example, Q1 Have you had Traditional Chinese Medicine treatment before Yes, No Q2 If your answer is 'yes' to question1, please state how satisfied you were with the service of that clinic. Very Poor, Poor, Fair, Good, Very Good Research setting I am going to carry out a research in several private TCM or acupuncture clinics in London. Research methods Investigations into patients' satisfaction will be done by using a questionnaire which would include a range of areas which might affect patient satisfaction. A survey will be conducted to collect data. The questionnaire will be distributed to various practitioners from different London Clinics with the intention of collecting data on 35-50 patients, 35 being regarded as the absolute minimum for a statistically significant sample. Data will be collected involving both the males and females. Data analysis will be conducted using SPSS for Windows. In terms of limitation identification, the issues will be duration of the research and the number of samples. If a survey would be carried out, the bigger the number of samples, the better is the reliability, validity, and generalisability. However, time constraints would act as a barrier to collect a lot of participants. Regarding my supervisor, she recommended minimum thirty-five participants. So ideally, I will try to access as many as I can. < Timetable > The research supervision had started in December 2009 and would have lasted until October 2010. The refining proposal and drafting methodology section had also started in December 2009 and would have lasted until January 2010. The review of literature to date and drafting dissertation sections will start in March 2010 and last for five months. The development of data collection tool would start in December 2009 and would have lasted until January 2010. The data collection will start in February 2010 and last for three months. The data analysis will need three months spanning between May 2010 to July 2010. The first draft of dissertation will be prepares in August 2010. Finally, the submission of dissertation report will be done in September 2010. Conclusion Patient satisfaction surveys lead to the benefit to patients, practitioners, staff of clinic and communities. < References > 1. Centers for Medicare and Medicaid Services and Agency for Healthcare Research and Quality. CAHPS Hospital Survey (HCAHPS9 QualityInits/30_HospitalHCAHPS.asp. Accessed August 16, 2006 1. Clark, PA. (2003). Medical practices' sensitivity to patients' needs. Opportunities and practices for improvement. Journal Ambulatory Care Manage, Vol.26, pp110-123 2. Dugdale, DC et al. (1994) Time and the patient-physician relationship. Journal Geriatrics Internal Medicine, Vol.14, No. 1, S34-S40 3. Drain, M. (2001). Quality improvement in primary care and the importance of patient perceptions. Journal Ambulatory Care Manage, Vol.24, pp30-46 4. Epstein, RM et al. (2005). Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues, Social Science Medicine, Vol. 61, pp1516-1528 5. Epstein, RM et al. (2006). Making communication research matter: what do patients need Patient Education Couns, Vol.60, pp272-278 6. Fitzpatrick, R et al. (1993). Measurement of patients' satisfaction with their care, ROYAL COLLEGE OF PHYSICIANS OF LONDON 7. Institute of Medicine. Crossing the Quality Chasm: A New Health System for 21st Century. Washington, DC: National Academies Press 8. Ley, F. (1998). COMMUNICATING WITH PATIENTS. CHAOMAN & HALL 9. MacPherson, H et al. (2008). Acupuncture Research. CHURCHILL LIVINGSTONE, ELSEVIER 10. Pratonova, E. et al. (2008). Understanding Patient Satisfaction, Trust, and loyalty to Primary Care Physicians, Medical Research an Review, Vol.65, No. 6, pp696-712 11. Stewart, M et al. (2000). The impact of patient-centered care on outcomes. Journal Family Practice, Vol. 49, pp796-804 12. Thedike, C.C. (2007). What Do We Really Know About Patient Satisfaction Family Practice Management, Vol.14, No. 1, pp33-36 13. vom Eigen, K.A. et al. (1998). Perceptions of quality of care and decision to leave a practice. American Journal Medicine of Quality, Vol.13, pp181-187 14. White, B. (1999). Measuring Patient Satisfaction: How to Do it and Why to bother. Family Practice Management, Vol. 6, No.1, pp40-44 15. Wood, G.C et al. (2009). Patient Satisfaction and Physician Productivity: Complementary or Mutually Exclusive American Journal of Medical Quality, Vol. 24, No. 6, pp498-504 Read More