Patient Satisfaction with Health Care Services - Term Paper Example

The Author’s Name] [The Professor’s Name] [The Course Title] [Date] Patient Satisfaction with Health Care Services Introduction A patient view of health care has become an important issue in recent decades and has been recognized as comprehensive assessment of quality of care. Satisfaction is a valid measure of quality of health care and has been used as a research outcome of the quality of healthcare delivery. Furthermore, it is known that patient satisfaction or dissatisfaction is a complicated phenomenon. Various instruments that measure different aspects of patient satisfaction have been developed for inpatient as well as outpatient care. Accessibility of medical care, organisation of healthcare services, treatment length, perceived competence of physicians, clinic size, general practitioner’s (GP’s) health services and the possibility of choosing one’s own family physician are important factors related to patient satisfaction. (Lochman 91-109) In addition to that, own doctor, doctor’s behaviour and doctor–patient relationship were found to be very important and related to patient satisfaction. However, physicians’ services were the strongest predictor of satisfaction with health care. Key Points Patient satisfaction is a meter of quality of care and comprises the elements of subjectivity, expectations, insights, previous experiences, personal rules for making judgments, and informs about care got from others. Researchers argue whether patients can charge the technical quality of their concern. Some researchers state that patients are capable to assess only the appearance of capability and not true clinical capability Cultural beliefs pressure a patient’s explanation of health and disease as well as the awareness of effective and ineffective care. Concurrently calculating patients’ perceptions of care quality, contentment with care, and quality of life (QOL) provides rich knowledge about their treatment incidents as well as the effect of treatment on QOL. NHS Inpatient Survey In a Picker Institute Europe survey, patients in the UAE reported wanting less paternalism, more involvement in decision-making and better self-care support. The recent NHS inpatient survey illustrates that patients’ experiences of their admittance to the Trust’s hospitals and in levels of hygiene have improved noticeably. The final is an area in which substantial investment has been completed over the previous months. The results established by the Trust approached from an NHS-wide survey, which was last approved out in 2004. (Hsieh 281-90) In that occasion the Trust saw their presentation advances in 17 of the 61 questions asked of patients and uphold its position in an additional eight. Performance fell in the residual 36, even though in many cases by a very trivial amount. (Hsieh 281-90) Picker Institute questionnaire was expanded with the use of qualitative techniques aimed to discover patients' needs and apprehensions, the Perceptions of Care questionnaire was created by selecting items linked to specific areas, from previous work and text review. The Picker instrument contains a set of questions connected to pain and surgery. Fascinatingly, these objects did not get a high amount of lost data, although ache may not have the identical meaning for heightened care and psychiatric patients, and operation is seldom used during psychiatric hospitalization. This may reproduce the suitability of skip samples. Not amazingly, the observations of Care questionnaire, which has the smallest mean number of answers categories per question, demonstrated the highest maximum effects. This questionnaire may consequently be less responsive to changes and less capable to distinguish at the high end of the contentment spectrum. (Attkisson 230-7) Dimensions of Quality Access Access refers to the timely availability of services when they are required, although it should be understood that adequate access is often seen differently by patients and health care providers. Health services are not used only to prolong life; a great many are rendered for the relief of pain and anxiety as well as to provide comfort and assurance for patients. With the recent realization of the importance of access in the United States, all industrialized nations now have access as a major health care goal. Operationalization and measurement of access varies. One method is to consider patient-physician contacts. William Hsiao (1992) found that of the five industrialized countries studied (the United States, the United Kingdom, Canada, Japan, and Germany); Americans have the fewest contacts with their physicians, while Germans and Japanese have the highest. (Lochman 91-109) However, the number of visits does not necessarily reflect the amount of time or quality of care rendered during a visit. For example, while the average time for a routine visit in the United States is 15-20 minutes, in Japan it is 5-8 minutes. (Lochman 91-109) Nonetheless, the data imply that the population of the other four countries has greater and more frequent access to their physicians Flaan does U.S. citizens. Other and related methods of access measurement need to be explored. (Attkisson 230-7)Access to physicians is just one of a myriad of access elements to be considered; access to clinics, preventive programs, and specialized treatment are but a few of these elements. Health Care Personnel Health care personnel are all the individuals and groups of individuals involved in the delivery of care. With the new consumer approach to health care, the personal and humanistic aspects of health care are becoming as inherent to quality of care as professional qualifications. Obvious carryover measurements with patient satisfaction are implied here. There is also increased impetus from the health care industry for the cross-training of health care professionals and the removal of certain professional-specific scope of practice boundaries. In many instances this appears to be pitting health care employees against hospital administrators along with profession against profession. Such questions as, "Should nurse anesthetists be able to deliver anesthesia independent of physician supervision in rural clinical settings?" Which health care professional should be responsible for mechanical ventilation in intensive care?" or "Should advanced nurse practitioners be allowed independent practice?" have different answers depending upon which location (state) one is in. The American Medical Association holds steady to its beliefs that peer review is the core of any assessment activities of quality health care (Kalda 55-62). Such reviews reflect many of the disadvantages of accreditation-focused evaluation. Peer reviews also incur public suspicion through the belief that review by one's peers is inherently conservative, potentially incestuous, and subject to possible conflict of interest. (Attkisson 230-7) Such suspicion is well-founded and should not be taken lightly. (Attkisson 230-7) Mere review of professional credentials, state-specific licensure requirements and disciplinary actions, and peer reviews are cursory measures at best. In addition, all have their share of political and turf-battle components which confound any objective measurement of quality and intensify in times of change. As the health care system continues to change in these tumultuous times, the subsequent changing role and responsibilities of health care personnel require continued attention and increased rigor in measurement approaches for any assessment of quality. Patient Satisfaction The importance of patient satisfaction cannot be overstated in the measurement of health care quality. As noted earlier, research on the subject has proliferated in recent years. However, some current issues concerning patient satisfaction should be noted. First, social scientists are questioning what is actually being measured by patient satisfaction surveys and whether patients actually fit the model of consumerism assumed by many surveys. Kalda suggests that patients might have a complex set of important and relevant beliefs that cannot be embodied in terms of expressions of satisfaction. Many of these beliefs and expectations originate from factors external to the health care system and remain to be identified. From reviewing four models of satisfaction and their related studies (the best known of which found expectations explained only 8% of the variance in satisfaction); Kalda concludes that "... We do not currently know the nature of the relationship between expectations and expressions of satisfaction; however, there is little evidence to suggest that satisfaction is largely the result of fulfilled expectations and values. Given the desire to improve levels of satisfaction one would naturally look to see how service provision could be altered in order to fulfill more patients' expectations; however, this would be a futile effort if expressions of satisfaction with care have little to do with the fulfillment of expectations." (Kalda 55-62) It is easy to say that patients should now act as consumers, but is this true in practice? There are several models of consumerism, each entailing a different role for the service user. (Roy 206-10) In essence, social scientists are calling for programmatic research to identify the ways and terms in which patients perceive and evaluate health care services before their opinions can be accurately collated, interpreted, and pragmatically implemented. Second, it appears that patients have been minimally involved in the identification of the aspects of health care to be evaluated (Roy 206-10). Usually professionals (consultants, researchers, and health care professionals) select the area, format, and methodology to be judged by patients. Interestingly, recent studies have demonstrated that physicians' perceptions of satisfaction correlate very weakly with patients' satisfaction (Roy 206-10). In fact several "gaps"--differences between perceptions and/or expectations between patients and service providers--have been identified. Included are differences between: (1) client expectations and client experiences, (2) client expectations and professional perceptions of client expectations, and (3) client experiences and professional perceptions of client experiences. (Howie 455-61) More qualitative research involving patients as informants for survey designs and interpretations is warranted. Moreover, as discussed by Howie, the issue of how patient attitudes affect behaviors must be adequately addressed before researchers can assess the importance of patient satisfaction to health services planning. Contexts of Quality General Is the quality of care and its measure the same for an outpatient diagnostic clinic as for a nursing home? Or for a Medicaid patient vs. a fee-for-service patient? It is logical to assume that the context in which a health service is administered will affect quality of care measures, if not quality itself. At this time, "assume," is the operative word because valid studies in this area are lacking. The majority of studies on patient satisfaction, for example, have focused on the hospital setting and, specifically, inpatient care. The great exodus of health services from this context has been recognized for years. Outpatient clinics, sub acute centers and extended care facilities are the growing and, in some cases, established alternatives. Research agendas in these areas are just beginning to emerge and address quality issues. A recent study in Florida found that physician joint ventures (i.e., health care services such as outpatient and inpatient physical therapy centers, clinical laboratories, and diagnostics imaging centers, hospitals and ambulatory surgical facilities with physician investors) are associated with decreased access. These facilities provided care to a lower proportion of rural patients and poor and under-served patients and rural patients than did their non-joint ventured counterparts (Ahern and Scott 1994). (Howie 455-61) The subsequent question--is of care quality context-bound?--car no longer be considered rhetorical in nature. Future studies comparing the conceptualization and measurement of quality between varying contextual entities will need continual attention. Several primary contexts are integral to such a research agenda. Value/Belief Systems. This micro-level context is primarily a compendium of psychosocial elements affecting the measurement of quality. The social structure and cultural values of a society, or even a community, help define the health care system. Sociocultural attributes, combined with the fact that health care behavior and beliefs are much more emotion-laden than are the same attributes of consumer behavior in other industries, accentuate this context's integral part in quality and its measurement. Models of chronicillness care that have been disseminated worldwide (e.g. the UAE National Health Service) serve as a backdrop for productive patient–provider interactions. Such models rely on a process called “collaborative care”, which involves: • Shared problem defining, goal-setting, and planning. • A continuum of self-management training and support services. • Active, sustained follow-up. Insight into this contextual area has primarily come through the research conducted in the disciplines of medical anthropology and medical sociology. Any serious attempt to measure quality needs to identify and incorporate the psychosocial influential aspects relevant to the health care system of interest. Review of the specific research or collaboration with individuals in these disciplines is warranted in any measurement of quality. Integrating Perspectives There is definitely no shortage of financing occasions for private equity companies, with requirement for high-quality healthcare services mainly strong in the area, given the high attention of wealth. Medical tourism in the region is also predictable to receive a chief boost through the growth of landmark plans which presents an academic complex, hospitals and pharmaceutical firms. But though the GCC governments are making major strides to improve the quality of healthcare in the region from a series of changes, there are still big challenges that need to be tackled. Except the governments take tough initiatives to conquer the under-supply of health professionals, the continuing efforts to improvement healthcare will be leaving far less effective. Although recent studies in health care marketing have significantly advanced our understanding of medical outcomes and patient satisfaction, theoretical and methodological improvements for integrating these two dimensions and understanding other dimensions of health service quality have been lacking. On the theoretical side, this absence may be explained in part by the fact that many health care marketers view patient satisfaction as a function of other dimensions such as access, clinical outcomes, and patient/physician relationships and, therefore, see these quality dimensions as being indirectly measured. Contexts receive some consideration, but not consistent treatment. The patient satisfaction dimension involves the use of surveys to measure satisfaction, although patients can be viewed more broadly to include other decision-makers (i.e., parents of patients and other significant persons involved in care assessment). Once again, qualitative data can and should be used to provide additional insight in UAE to understand why certain responses are given and how the interaction of several care dimensions drive the formulation of specific opinions and attitudes. References Attkisson CC and Zwick R. The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning 2007; 5:233–7. Howie JG, Heaney DJ, Maxwell M et al. Developing a ‘consultation quality index’ (CQI) for use in general practice. Family Practice 2000; 17:455–61. Hsieh MO and Kagle JD. Understanding patient satisfaction and dissatisfaction with health care. Health Social Work 2005; 16:281–90. Kalda R, Pollute K and Lember M. Patient satisfaction with care is associated with personal choice of physician. Health Policy 2003; 64:55–62. Lochman JE. Factors related to patients’ satisfaction with their medical care. Journal of Community Health 2003; 9:91–109. Roy MJ, Kroenke K and Herbers JE Jr. When the physician leaves the patient: predictors of satisfaction with the transfer of care in a primary care clinic. Journal of General Internal Medicine 2006; 10:206–10. Read More