[Patient satisfaction with inpatient care. Evaluation, methods and special features]

Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37,000 patients treated by 73 hospitals

OBJECTIVE

In many countries hospitals are undergoing accreditation as mandatory or voluntary measures. It is believed that accreditation positively influence quality of care and patient satisfaction. This survey aims at assessing the relationship between patient satisfaction and accreditation status.

DESIGN

Between January and May 2007, 4 weeks after their discharge, 78 508 patients from 328 departments in 73 hospitals received a validated questionnaire. Data from 36 777 patients (response rate 55%) were available for analyses.

MAIN OUTCOME MEASURES

Recommendation rate was used as primary endpoint, which was available from 35 945 patients. To address the clustering of patients within hospitals, we applied univariate and multivariable generalized estimating equations. As covariates we used 'gender' and 'age' at the patient level and the 'number of beds' and 'hospital teaching status' at the hospital level.

RESULTS

Overall and not addressing the clustering, 66.3% of all the patients recommend their hospital to others. This recommendation, however, was not related to the accreditation status in the univariate analyses (odds ratio (OR) for accreditation ('yes') and recommendation ('yes') 0.99, 95% confidence interval (CI) 0.85-1.16, P= 0.92). This result was similar in the multivariable regression model adjusted for clustering (OR = 0.98, 95% CI 0.84-1.13, P= 0.74).

CONCLUSIONS

Our results support the notion that accreditation is not linked to measurable better quality of care as perceived by the patient. Hospital accreditation may represent a step towards total quality management, but may not be a key factor to quality of care measured by the patient's willingness to recommend.

[Information or confusion. A formal quantitative analysis of ophthalmology ward rounds]

BACKGROUND

The daily ward round is the main opportunity for communicative interaction between physician and patient during a patient's hospital stay. We analysed to what extent the round was capable of fulfilling the patients' needs for information and emotional support, using the ophthalmologic ward of a university hospital as an example.

MATERIAL AND METHODS

For a period of 4 months in 2006, doctor-patient-interactions in an ophthalmologic ward round were recorded with a dictating machine. Fifty physician-patient interactions between 50 patients and five different physicians were selected according to uniform criteria. After the recordings were transcribed, the interactions were evaluated using formal quantitative speech analysis. We examined the patients' subjective perceptions by means of a standardised questionnaire.

RESULTS

The average doctor-patient interaction lasted just under 4 min. The formal quantitative analysis of the effective verbal communication between physician and patient indicated an asymmetry to the advantage of the physician, who spoke 73% of the words (Chi 245.48 words). The patient remained rather incommunicative during the course of the conversation. Medical terms were used in only 0.53% of the direct doctor-patient dialogue. The ward round conversation was characterised by numerous personnel internal dialogues. During much of the rounds (46% of the time), the patients were unable to participate actively in the conversations. As a result, information could not reach the patients. Requests to speak were initiated 83% of the time by the physicians and only 33% of the time by the patients. Nevertheless, the patients indicated high (22%) and very high (66%) satisfaction with the ward rounds.

CONCLUSIONS

In the future, the ophthalmologic ward round should satisfy the criteria of patient-centric conversation. Therefore, the informational value of the daily ward round must be increased, and organisational and structural changes must be made to promote direct conversation between the patient and the eye specialist. A team conference before and after the physician-patient interaction would allow a focus on team-referred and patient-referred interests within the ward round.

[Patient satisfaction in the outpatient department--a pilot study for customer satisfaction in ENT]

BACKGROUND

Customer satisfaction in German hospitals is becoming more important because of increasing competition in the healthcare market. Because the majority of patients with ear-nose-throat (ENT) problems are treated in an outpatient setting, this competition is not only taking place among hospitals but also among specialists in private practices. To assess patient preferences, reliable and valid questionnaires are necessary, which so far exist only for inpatients. The aim of the study was to develop an instrument with which to discover areas for potential improvement of the outpatient department.

MATERIAL AND METHODS

The questionnaire was developed according to the guidelines of the EORTC and tested in a prestudy. During the time of observation, 98 patients were available, of whom 79 could be included in the study. The return rate was 71%. Of these patients, 18 were female and 38 male; the median age was 56 years. There were no differences between the study group and the yearly clinic average in terms of age, gender, or ratio of tumor patients.

RESULTS

Patients mainly complained about waiting times in the outpatient department and diagnostic units as well as high patient turnover. Concerning positive aspects, patients mentioned the medical competence of the treating physicians; concerning negative aspects, the building infrastructure was noted.

CONCLUSION

The questionnaire showed sufficient psychometric properties and helped find areas for improvement in the outpatient department. However, a complete picture of the department will be feasible only with repeated measures, especially when taking steps to improve the department's processes.

Which gynecological and obstetric patients want to attend psychosomatic services?

OBJECTIVE

The aim of this study is to explore the wish of gynecological and obstetric inpatients to attend psychosomatic services. Predictors influencing this wish are evaluated.

METHOD

Three groups of patients participated in the study. The groups consisted of patients diagnosed with malignant gynecological diseases (n = 175), benign gynecological diseases (n = 302), and obstetric diseases (n = 238). The following domains were assessed in a cross-sectional design: symptoms of anxiety and depression (HADS), physical complaints (GBB-24), health-related quality of life (SF-12), and the wish to attend psychosomatic services.

RESULTS

34% of the participants indicated that they wanted to attend psychosomatic services during their stay in the hospital. The group of patients diagnosed with malignant gynecological diseases had the highest proportion of women who stated that wish (43%). Multiple logistic regression models showed that former psychotherapeutic experiences as well as low psychological quality of life predicted the wish to attend psychosomatic services in patients diagnosed with malignant gynecological or obstetric diseases.

CONCLUSION

It was shown that a considerable proportion of patients wanted to attend psychosomatic care during their hospitalization. Contrary to physical and sociodemographic variables, psychological factors were significant predictors of the inpatient's wish to attend psychosomatic services. This suggests that the subjective estimation of impairments is a major predictor of the wish to attend psychosomatic care.

Social desirability in the measuring of patient satisfaction after treatment of coloproctologic disorders: on shortcomings of general bipolar satisfaction scales for quality management

BACKGROUND AND AIMS

Within the field of medicine, much attention is being paid to quality management, whereby patient satisfaction plays a major role. In order to measure this construct, usually rather general, bipolar rating scales are applied. However, these scales are often susceptible to social desirability biases.

PATIENTS-METHODS

Coloproctological patients were asked to complete a questionnaire with ratings of satisfaction and anxiety at two different points of measurement: One group while in treatment (N = 86) and a second group approximately 1 year after their treatment (N = 328).

RESULTS

Even when controlling for relevant demographic influences, a clear decrease in intensity of the evaluation ratings is shown when the survey was administered 1 year after release from hospital as compared to during the patients' stay in hospital. For generally formulated scales of patient satisfaction, social desirability constitutes a significant bias.

CONCLUSION

The usual conceptualization of a bipolar continuum of patient satisfaction or dissatisfaction must be renounced. Instead, questionnaires might be constructed in three steps which investigate problem dimensions at a medium level of concreteness. Only in this way can quality management gain credibility and trust within as well as beyond the field of medicine.