Quality improvement techniques to improve patient satisfaction

Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE)

BACKGROUND

Patient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers.

PURPOSE

Given the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging.

METHODS

A 2⁶ balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets.

RESULTS

210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored.

CONCLUSIONS

Similar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies.

PRACTICE IMPLICATIONS

Patient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).

Patients' satisfaction with quality of care in general hospitals in Ebonyi State, Nigeria, using SERVQUAL theory

BACKGROUND

Patient satisfaction is an essential parameter in the assessment of quality of care and healthcare facility performance.

OBJECTIVE

To investigate patients' satisfaction with quality of care in general hospitals in Ebonyi State, South East, Nigeria, using the SERVQUAL.

METHODS

A cross-sectional descriptive study design was employed on a sample of 400 patients using a 27-item structured open-ended patients' satisfaction questionnaire with a multi-stage cluster sampling technique. Patients included in the study were those who must have come for an outpatient clinic within the period, be 18 years and above, and those who gave consent to participate. Of 400 questionnaires administered, 396 (99%) were retrieved. SPSS version 20 was used for data analysis. Descriptive statistics, such as frequencies, percentages, mean score (x), and standard deviation, were employed for interpretation.

RESULTS

Out of 396 patients, 156 (39.4%) were male and 240 (60.6%) were females. Most patients were 18-39 years (233 (58.8%)), had secondary education (139 (35.1%)), married (221 (55.8%)), earned <18,000 (170(42.9%)), and were traders (136 (34.3%)). Patients were satisfied with tangibility (2.57 ± 0.99) and reliability (2.84 ± 0.95) and very satisfied with responsiveness (3.06 ± 0.63), assurance (3.07 ± 0.63), and empathy (3.12 ± 0.57).

CONCLUSIONS

Patients were satisfied with the quality of care. However, satisfaction was highest with empathy and lowest with tangibility. Thus, managers should focus their quality improvement efforts on areas of the neat appearance of health workers, waiting facilities for attendants and patients, and hygienic conditions at the hospital. Also, biannual assessment of patients' satisfaction should be done and the results generated use judiciously to provide a platform for health sector reform.

Improving healthcare service quality through performance management

PURPOSE

Healthcare service quality in the USA has gained importance under value-based payment models. Providing feedback to front-line staff is a vital component of managing service performance, but complex organizational dynamics can prevent effective communication. This work explored the performance management of appointment desk staff at Mayo Clinic Arizona, identified barriers to effective management and sought to standardize the process for monitoring service performance.

DESIGN/METHODOLOGY/APPROACH

Multiple data sources, including qualitative inquiry with 31 employees from the primary care and surgery departments, were used. The research was conducted in two phases - facilitated roundtable discussions with supervisors and semi-structured interviews with supervisors and staff six months after implementation of service standards. Participants were probed for attitudes about the service standards and supervisor feedback after implementation.

FINDINGS

While all staff indicated a positive work environment, there was an unexpected and pervasive negative stigma surrounding individual feedback from one's supervisor. Half the participants indicated there had been no individual feedback regarding the service standards from the supervisor. Presenting service standards in a simple, one-page format, signed by both supervisor and the patient service representative (PSR), was well received.

ORIGINALITY/VALUE

Combining rapid-cycle quality improvement methodology with qualitative inquiry allowed efficient development of role-specific service standards and quick evaluation of their implementation. This unique approach for improving healthcare service quality and identifying barriers to providing individual feedback may be useful to organizations navigating a more value- and consumer-driven healthcare market.

Factors contributing towards patient's choice of a hospital clinic from the patients' and managers' perspective

Introduction

Given the competitive nature of the health market and the multiplicity of factors that may contribute towards patient’s choices of a hospital, patients’ needs and preferences for a hospital must be considered in the planning and decision making of hospitals and health care organizations. This study aimed to identify the factors that contribute to patient’s choices of a clinic and the importance of each factor.

Methods

A mixed-method approach was used to collect quantitative and qualitative data in two phases. The study was conducted in a hospital clinic in 2014. Qualitative data were collected by face-to-face semi-structured interviews of a sample of 22 managers and heads of outpatient wards. The self-administered questionnaire designed for this study collected quantitative data from a stratified random sample of 381 patients referred to this clinic. The qualitative data were analyzed by a system of coding, while parametrical statistical analyses were conducted to analyze the quantitative data using the independent-samples t-test and ANOVA in SPSS software, version 21.0.

Results

The qualitative data indicated that there were 21 factors that may contribute to patient’s choices of a clinic, and these factors were classified into six categories, i.e., facilities and physical assets, physicians and employees, location and place, services, price, and promotion. Among the 16 questions studied in the quantitative questionnaire, the highest and lowest means were related to “appropriate clinic environment” (2.47 ± 0.58) and “advertising through TV and radio, the Internet, newspapers, etc.” (1.77 ± 0.75), respectively. There were significant associations between “having experienced and responsive personnel, including physicians and employees” and the patient’s gender and frequency of referrals, between “belonging to the Armed Forces” and the patient’s age and frequency of referrals, between “advertising through TV and radio, the Internet, newspapers, etc.” and shifts and frequency of referrals, between “inadequate facilities and poor quality of services provided in other health care organizations of the Armed Forces” and “adornment and good behavior of staff” and shifts (p < 0.05).

Conclusion

The most significant contributing factors to attract patients were the “physicians and employees,” and “the clinic’s environment.” Therefore, it is essential for clinic managers and heads of outpatient wards to focus on and strengthen these two factors. Also, since the means of the factors were better in the morning shift, the employees should perform their duties properly and consistently in all shifts.

Measuring the quality of provided services for patients with chronic kidney disease

Background:

The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction.

Objectives:

This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014.

Patients and Methods:

This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test.

Results:

The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P < 0.001).

Conclusions:

Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and comments and use their feedback to solve the workplace problems and improve the quality of provided services. In addition, training the health staff to meet the patients' emotional needs and expectations is suggested.

Mothers' satisfaction with two systems of providing care to their hospitalized children

Background:

Despite the paramount importance of the patient’s satisfaction, there are limited data on mothers’ satisfaction with the nursing care provided to their children in Iranian clinical settings.

Objectives:

This study aimed to evaluate mothers’ satisfaction with two systems of providing care to their hospitalized children.

Patients and Methods:

This research was a two-group quasi-experimental study. Primarily, the basics of the case method and the functional care delivery systems were educated to the practicing nurses of the study setting. Each system was implemented independently. After the implementation of each system, 200 mothers whose children were hospitalized in the pediatric care ward of Shahid Beheshti Hospital, Kashan, Iran, were invited to respond to the 28 -item Pediatric Family Satisfaction Questionnaire. Study data were analyzed by SPSS v. 16.0.

Results:

Results were indicative of mothers’ satisfaction with medical care delivered by case method as 13.2 ± 5.2 and by functional method as 13.17 ± 5.56. Also, no significant difference was seen between two groups (P = 0.4). Mothers’ satisfaction with nursing care delivered by case method was 17.7 ± 4.43 and by functional method was 13.33 ± 5.69 and there was a significant difference between two groups (P = 0.004). Mothers’ satisfaction with accommodations by case method was 16.78 ± 4.07 and by functional method was 17.9 ± 6.67 with a significant difference between two groups (P = 0.06).

Conclusions:

Improving the quality of care is associated with higher patient’s satisfaction. Accordingly, developing and implementing programs for improving nurses’ communication and clinical skills can improve both care quality and patient outcomes.

Assessing the influence of switching barriers on patients' expectations and tolerance zone

PURPOSE

The purpose of this paper is to look at the influence of switching barriers on patients' private general practitioner (GP) service expectations and tolerance zone

DESIGN/METHODOLOGY/APPROACH

From 750 questionnaires distributed to a convenience sample, 257 were completed and returned, yielding a 34 per cent response rate.

FINDINGS

There was a significant association between switching barriers and what patients expected from their GPs. Switching barriers did not have a significant association with the tolerance zone.

PRACTICAL IMPLICATIONS

Private GPs can develop strategies to overcome switching barriers. For example, they can develop personal relationships with their patients, re-familiarise themselves with the patient's medical history before the consultation and provide better services to patients who perceive high switching barriers and hence higher adequate expectations.

ORIGINALITY/VALUE

This study contributes to the existing literature relating to healthcare service quality.

Inpatient satisfaction: an analysis of Malaysian public hospitals

Purpose

The purpose of this paper is to provide an empirical analysis on inpatient satisfaction in Malaysian public hospitals.

Design/methodology/approach

A self‐administered questionnaire was the main data collection method. Altogether, 23 hospitals throughout Peninsular Malaysia participated in the survey. Cluster sampling was used in the selection of the respondent hospitals, while convenience sampling was used in administering the survey.

Findings

Three factors of inpatient satisfaction were extracted, which were clinical and physical dimensions of service, and additional facilities for patients and family members. Inpatient satisfaction was found to be higher for the clinical dimension than for the physical dimension. Overall, inpatient satisfaction was high, as reflected by the high mean score of the variables, although caution was expressed in interpreting the findings, particularly the low expectations of patients to begin with.

Research limitations/implications

The research was limited to inpatients of Malaysian public hospitals. A thorough evaluation of the nation's public healthcare delivery system would need to include outpatient services as well.

Originality/value

The paper provides an empirical analysis on inpatient satisfaction in Malaysian public hospitals. This allows policy makers to evaluate the level of public healthcare delivery service in the country and therefore assist in policy decision‐making and implementation.

Quality of health care in the US managed care system: comparing and highlighting successful states

PURPOSE

This paper aims to examine the issue of quality of care in the US managed care system and to compare state-level policies and programs. Specifically, it aims to describe five states which are making the most quality of care improvements.

DESIGN/METHODOLOGY/APPROACH

This study examines the literature to identify states' care quality rankings. Additionally, five state case studies are presented to illustrate various programs approach to quality.

FINDINGS

The paper finds that some states are better than others in their strategies to enhance quality of care. California, Florida, Maryland, Minnesota and Rhode Island are considered among the best. Thus, their programs are described.

RESEARCH LIMITATIONS/IMPLICATIONS

From a research perspective the study brings a renewed focus on various methods in which states invest to improve residents' quality of care.

PRACTICAL IMPLICATIONS

From a practical standpoint, since quality of care is an important topic and interesting to all stakeholders in health care--policymakers, consumers, providers, and payers--readers can use the study's results to compare states' strategies and develop new ways to increase quality.

ORIGINALITY/VALUE

This study's value lies in the way it helps states to compare their performance over time and against other states as they make improvements to enhance quality.