Patient Satisfaction as a Principal Element of Quality Healthcare - Essay Example

QUALITY IMPROVEMENT Lecturer: Introduction Focus has increased on the enhancement of quality healthcare delivery, with the major players in the health sector such as hospitals, insurance companies and government determined to establish a better characterisation of quality healthcare. Patient satisfaction is a principal element of quality healthcare and is an important indicator of the success of treatment. Section 1886 of the Social Security Act established the Hospital VBP program in which hospitals must meet the performance criteria for them to receive incentives every financial year (Martin & Weaver, 2005). Patient satisfaction assessments are used to determine if the hospitals have accomplished the performance standards to qualify for Medicare reimbursements. Efforts are therefore focused on accomplishing the standards set in the VBP program and hence improved patient satisfaction. This essay critically examines the use of patient satisfaction as a measure of healthcare quality. It is aimed at developing a critical understanding of the political, professional and public dimensions of quality as well as an assessment of the relevance and validity of quality measures within the context of public services. Patient Satisfaction as a Measure of Healthcare Quality Patient satisfaction is a multidimensional result that cannot easily be defined. The expectations of different patients for any healthcare setting are varied and significantly influence their satisfaction. The nature of ailment generates psychosocial aspects that may influence how a patient rates the level of satisfaction, such as pain, unhappiness and fear among others. For the healthcare professionals, patient satisfaction is characterized by the success of surgical procedures and the objective results. On the other hand, patients are likely to base their satisfaction on the inter-personal contact with the healthcare provider. This inconsistency between the parties involved is likely to weaken patient satisfaction as a measure of quality. Moreover, some of the survey questions are based on the communication between doctor and patient, focusing on doctor’s courtesy, esteem and attentiveness to the patient as well as simplicity with which a doctor explains issues to the patient (Neuner et al. 2014). There is a possibility of bias associated with individual perceptions of behavior and expectations. Doctors may not be focused on the interpersonal relationship as much as they do for the ailment, which makes efficient doctor-patient communication difficult. In most cases, inpatients are not aware of the doctor in charge of their treatment. This is associated with the circumstances under which the patient receives treatment (Cowan, 2002). For example, orthopaedic patients are faced with distressing challenges requiring critical care settings. Such patients may not be effectively evaluated as any other patient who volunteers for surgical procedures or admission. Emergency situations require professional intervention to stabilize the patient first so as he/she can proceed to the orthopaedic inpatient. Such patients may not recognize their interaction with the physician at the onset of treatment. Moreover, some situations in orthopaedic patients do not allow strong doctor-patient relationship before surgical procedures are completed due to their acuteness. Nevertheless, minimum pre-surgical discussions must be undertaken to determine and address the patient’s concerns due to the varied expectations of the doctor and patient regarding the interventions (Kaltoft et al. 2013). According to Yasmeen (2010), meeting patient expectations leads to greater satisfaction and better results of the treatment. Patient satisfaction as a measure of quality is based on individual perception and the expectation with regards to the services offered and the healthcare staff with whom he/she interacts. To this end, it means that only when the patient’s expectations are accomplished can quality healthcare exist. Satisfied patients have a tendency to adhere to the doctor’s recommendations and hence are inclined to a better outcome than their unsatisfied counterparts (Joss & Kogan, 1995). The quality assurance department needs patient feedback to understand the capacity of the hospital to address client needs and their overall expectations and perceptions of the services offered. Information acquired is applied in identifying the gaps that require improvements. Data acquired through patient appraisal is based on perception and level of understanding of the service and therefore may be skewed if the patient is not well versed with hospital operations. Nevertheless, evaluation of patient satisfaction as a quality measure may reveal essential areas that need more emphasis to enhance patient perception such as education to enhance patient understanding (Tylor et al. 2014). According to Gournay (2014), public dimensions of healthcare quality are based on dependability, guarantee, understanding, responsiveness and the facilities available for effective treatment. Dependability is considered to be the capacity of the healthcare provider to offer treatment to the patient in a reliable and accurate manner. This is an important indicator of quality as clients expect all their health needs to be achieved within the shortest time possible to minimize their time of stay in hospital and the cost of treatment. The public also needs to be guaranteed that their health will be restored by competent healthcare personnel. They need to gain confidence in the hospital facilities and staff that should be in a capacity to inspire expectation in the patients and the public. The patients expect to be treated with understanding and a caring attitude. Personalized attention generates a better relationship between healthcare staff and the patient that facilitates the recovery process. Patients are requested to give feedback with regards to the responsiveness of the hospital staff, which indicates the level of attention given to patients and the probability of errors occurring (Flanagan & Spurgeon, 1996). Prompt response is an indicator of good quality care due to the nature of service offered in hospitals. Poor response and negligence may cause unprecedented fatalities. The general hospital infrastructure needs to provide an enabling environment for healthcare staff to discharge duties effectively (Niamh & Maureen, 2013). Patient satisfaction may be influenced by the appearance such as unkempt floors and bedding, staff work gear, medical records and prescription forms. All these point to successful interplay between all the aspects of an ideal healthcare setting. Dissatisfaction among patients with regards to one aspect or the other may adversely affect the overall quality of healthcare because of the interdependence. For example, a good relationship between a physician and a patient may be frustrated by a cook who allows contamination of food. No matter how trivial the case may be, quality healthcare cannot be achieved in the hospital (Joss & Kogan, 1995). The professional’s perspective of quality care significantly diverges from that of patients. Medical practitioners understand quality of care on the basis of their technical competences. The capacity of a hospital to offer critical care in this perspective is evaluated according to the number and level of skills of medical staff. The more the number of staff in the highest skill level the greater the perceived quality. However, this characterization may not be meaningful to the patient who focuses on the inter-personal skills of the healthcare professionals (Kennedy, 2001). In the patient’s perspective, the good doctor is the one who demonstrates respect and understanding, with a caring attitude that generates hope. Nevertheless, medical interventions require skillful intervention and concentration. Acute cases require attentiveness and focus on the activity and progress of recovery rather than building relationships. A good practitioner in the professional viewpoint may be considered by the patient to be businesslike, instructive and uses all means in his/her knowledge to restore good health, disregarding the perception of patients and third parties. Building relationships and chatting with the patient may not fit in the treatment schedule, which makes it look rigid and unfriendly (Keogh, 2013). Tylor et al. (2014) argues that stakeholders in healthcare need to understand the significance of acute procedures that practitioners are faced with. This is important in promoting a shift from assessment based on social disposition to evaluation based on the outcome of medical interventions. Patient satisfaction can therefore be considered to be lopsided as it mainly focuses on the secondary aspects of healthcare rather than the treatment outcome. However, the significance professional competence to quality healthcare cannot be overemphasized in total disregard of interpersonal skills. Effective professional care may not be accomplished devoid of interactive practice. Poor communication is a major cause of patient dissatisfaction as a result of confusion regarding the treatment procedures applied and ignorance of the consequences. Patient education can help the healthcare professionals to avoid dissatisfaction associated with obliviousness. This can be accomplished through good communication skills that ensure a patient undergoes treatment through informed consent (Gaster, 1995). If patient satisfaction is used as the sole measure for quality, social skills would be emphasized over professional skills thereby compromising the quality of care. As Amanda (2002) observes, patients who are dissatisfied with the healthcare services of a hospital seek treatment elsewhere. On the other hand, patients in acute cases rarely care about interpersonal relations. The most important issue for them is to get their health rehabilitated. Such patients invest their energies on endurance and view the physician as a life saver, viewing quality care as positive outcome and hence behave in a way that promotes the process of achieving the treatment goal such as adhering to medication. This insinuates a disparity between patients based on the objective of seeking services from a particular hospital. The need for comfort, being in control and being listened to may be associated with patient’s social background. Patient from affluent backgrounds may not rate quality of services in a similar way as people from poor neighborhoods. Under such circumstances the assessment of quality may be skewed as the quality benchmarks vary greatly. There lacks significant empirical data concerning the specific interpersonal competences that have a positive impact on clinical outcomes. Professional competence as a measure of quality service may help to alleviate bias associated with patient perception and expectations (Ellis & Whittington, 1994). Political dimensions of healthcare quality point to certain guidelines that are believed to ensure that patient care is upheld. The government plays a significant role in developing the guidelines for the treatment of various diseases. Patient satisfaction is expected to reflect the accomplishment of these guidelines, though healthcare institutions have the capacity to develop their own treatment protocols based on a professional understanding of healthcare needs. The government funds quality assurance bodies such as the Quality Assurance Review Center aimed at enhancing the standards of healthcare through augmenting the excellence of experimental trials in medical practice (Kaltoft et al. 2013). Various challenges in the process of measuring patient satisfaction exist especially in the customer satisfaction surveys. Patient responses in the surveys are largely spontaneous and lacking the backing of critical thought. Patients’ judgment is unreliable as they lack the technical understanding with regards to some critical aspects of the medical intervention, while their assessment may be based on their social interactions with the physician (Yasmeen, 2010). Rade (2006) observes that the healthcare professionals perspective of patient satisfaction contradict the results of patient satisfaction surveys. While patients indicated a higher level of satisfaction in the data obtained, physicians pointed out dissatisfaction among patients thereby creating uncertainty concerning the precision of data obtained in patient satisfaction surveys. Patients tend to rate their satisfaction levels high in any of the survey questions. This indicates a response bias that Kogut et al. (2014) associate with the fact that it is highly unlikely that dissatisfied patients to criticize the services they continue to depend on. The fear of reprisals and maltreatment as well as the general perception that nothing will be done makes patients shun negative comments and therefore biased data is not uncommon. The option of remaining silent is preferred as healthcare service is unique in that it is possible to identify the patients that underwent certain treatments and this understanding among the patients demotivates them from laying bare their healthcare experience. Research instruments therefore need to conceal the identity of respondents to minimize chances of bias. Some of the questions applied in question satisfaction surveys are faulty in the sense that they seek information regarding two or more concepts which end up being assessed on one measurement scale while they ought to be appraised independently (Institute of Medicine, 2001). For example a double barreled healthcare quality survey question can be, “were you attended to promptly and with courtesy? The question would rather be separated in to two, one inquiring about promptness and the other courtesy. Under such circumstances, accuracy is lost as patients’ response is influenced by the concept that is regarded as superior while some patients rate the service quality by the average score. If none of the concepts is regarded as inconsequential by the patient, there is a likelihood of indistinct response thereby diminishing the reliability of data (Keogh, 2013). The success of patient satisfaction as a measure of healthcare quality has been recognized by many hospitals among other indicators. However, Niamh & Maureen (2013) argue that it does not automatically mirror the medical care that patients experience. The actual occurrences in the operation room have diminutive correlation with an individual’s perception of the value of the medical care administered. The independence quality of care disqualifies the generalization of patience satisfaction as the ultimate measure of health quality. Medicare and Medicaid Centers emphasize on patient satisfaction for hospitals to qualify for reimbursement. This has made it one of the strategic objectives of healthcare service providers including private insurers. Most of the healthcare websites contain patient satisfaction scores that are being used as a marketing tool to attract patients to the organizations. According to NHS Modernisation Agency, (2002), the growing trend of overemphasizing patient satisfaction as the sole metric for healthcare quality calls for re-assessment. There is high possibility for organizations to prefer the metric due to the simplicity of its application while disregarding the weaknesses as an all-inclusive measure of total quality especially for critical care such as surgery. Due to the rewards associated with patient satisfaction in most healthcare systems, hospitals and other healthcare providers have concerted efforts as it is the only quality metric with a financial motivation. The value of other aspects of quality, some of which may be core to the accomplishment of good health is often discounted as no financial incentives are attached (Institute of Medicine, 2001). For example, patient safety in surgical procedures where patient awareness is minimal may be more important than simple friendly interaction with a physician. However, patient satisfaction rewards the social relationship and the surgical procedure plays second fiddle. Other important aspects comprise effectiveness of the treatment and equitable medical intervention. Nevertheless, healthcare institutions may not have a choice but to uphold patient satisfaction even if it does not necessarily translate in to increased well-being of patients. Patient centered interventions have taken center stage as healthcare providers focus on maximizing their limited resources in the maintenance of the general well-being of the population (Niamh & Maureen, 2013). Patient satisfaction and customer satisfaction are two different perspectives in the sense that a patient wants are limited by circumstances while customers have unlimited control of their wants. In other words, patient centred care may not facilitate accomplishment of the healthcare goals if patients were to be treated the way they want, where they want and when they want. A greater portion of these wants is accomplished at the discretion of the healthcare professional. However, such wants can be delivered effectively in customer centred business. If customers are not served the way they want the business loses them while on the other hand if patients are allowed to dictate the wants in treatment procedures, their health and safety may be exposed to risks (Yasmeen, 2010). Michael Jackson’s personal doctor may have ensured patient satisfaction by treating him according to his wishes of a strong sedation at the comfort of his home. Even if patient satisfaction was accomplished, the result was fatal (Graham, 2013). The physician had a customer who could be lost if satisfaction was not guaranteed. However, he may also have considered the thin boundary between the perception of a common customer and a patient. In many instances, healthcare professionals are faced with such dilemmas as they strive to accomplish patient satisfaction as a measure of quality (Rade, 2006). In some cases when doctors diagnose minor problems that may not require prescriptions, patients end up dissatisfied unless they receive antibiotics as a form of reassurance. Patient centred healthcare may not meet the threshold of evidence based care. Nevertheless, patient wants may leave the healthcare professionals with no choice but to adopt the non-evidence based care to satisfy the patient (Amanda, 2002). The government and the public’s view of healthcare quality is influenced by desire to demonstrate value for money as most healthcare expenditures are financed through taxes and premiums and people want to see tangible outcomes. The easiest way to evaluate the utilisation of healthcare funds is by measuring patient satisfaction (Cowan, 2002). Conclusion Patient satisfaction has been entrenched in healthcare as a major metric for quality. Satisfaction is influenced by the patient’s perception and expectation regarding the service. Social interactions with healthcare staff are significant determinants of the level of satisfaction. It is important for hospitals to provide a comfortable and caring environment for patients and ensure that their expectations are fulfilled. Healthcare professionals have a duty to ensure that patient satisfaction is maintained as it influences the likelihood of effective use of prescription. Professionals are faced with the dilemma of applying evidence based practice or patient satisfaction approach. The limited understanding of patients with regards to surgical procedures may affect the outcome if their wants are adhered to. Patient satisfaction surveys are simple to apply. However, some of the survey instruments such as questionnaires lead to biased results as patients grapple with double barrelled questions. Reimbursements to hospitals are attached to patient satisfaction and therefore efforts must be made to keep them coming through patient centred care. The government and the public use customer satisfaction scores as indicators of quality and effective utilization of public funds. Patient satisfaction as a measure of healthcare quality needs to be reinforced with other aspects such as patient safety and staff competence among other aspects of quality healthcare. References Amanda, W. (2002). 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Quality audit experience for excellence in healthcare, Clinical Governance: An International Journal, 15, 113 – 127. http://www.emeraldinsight.com/products/journals/journals.htm?id=cgij Read More