Each human being is unique and no two
individuals are the same in their demeanor. This unproven fact becomes
most evident when an individual becomes ill. In this current era of
consumerism, people are highly conscious and knowledgeable about
services they can expect from a merchant, and there are a number of
public initiatives to make them understand what to expect, in a service
or a product. Meeting such expectations, on the part of the merchant,
results in customer satisfaction, which is the highest goal of a service
or a product. This satisfaction could be brand-driven,
technology-driven or due to the influence of other factors.
In healthcare too, patient satisfaction
or meeting a patient’s expectations, is one of the major goals of any
healthcare provider, and this is determined by the patient’s experiences
during the duration of the patient’s interaction with the healthcare
provider. The most challenging job for a healthcare provider is to
attain patient satisfaction. This article sets out to discuss the
determinants of customer satisfaction in a healthcare setting.
There is no mutually agreed definition
of what is patient satisfaction. The University of New South Wales,
Australia, (2009) worked out a definition to conduct research on
‘Complaints and patient satisfaction: a comprehensive review of the
literature’. According to this definition, patient satisfaction is
defined as the degree to which the patient’s desired expectations, goals
and or preferences are met by the healthcare provider and/or service.
Determinants of patient satisfaction
A number of studies have been conducted
on the topic of ‘how to make the patient really satisfied or what makes
the hospital stay for a patient a better experience’. A survey was
conducted by Brown, Sandoval, Levinton, and Blackstien-Hirsch (2005) to
unveil the most efficient ways of improving satisfaction in emergency
departments. A questionnaire on patient satisfaction, mailed to 20,500
patients who visited 123 Emergency Departments (EDs), was used to
develop ordinal logistic regression models for overall quality of care,
overall medical treatment, willingness to recommend the ED to others,
and willingness to return to the same ED. The survey found out that the
four main predictors are “perceived waiting time to receive treatment,”
“courtesy of the nursing staff,” “courtesy of the physicians,” and
“thoroughness of the physicians.”
Another retrospective study was
conducted in France by Boyer, Antoniotti, Sapin, Doddoli, Thomas,
Raccah, and Auquier, (2003), with the objective of looking for the
relationship between a patient’s satisfaction and the quality of care,
in two diseases (diabetes, lung cancer), and which was evaluated by the
French-validated Questionnaire of Satisfaction of Hospitalized patients
(QSH). Quality of care is measured by some objective indicators, in
accordance with recognized guidelines. The results surprisingly found
that there is a negative correlation between accreditation and patient
satisfaction (r = – 0.23; p < 0.05) and that the least-satisfied
patients are not those who have the worst quality of care. Furthermore, a
link has been highlighted between the “specific” quality of care and
the satisfaction with nurses, but not with the doctors (p > 0.05).
Based on the literature, the
determinants in most of the studies considered few or all from the
following: “thoroughness of the physicians”, “perceived waiting time to
receive treatment”, “technology used in care”, “accreditation by the
international bodies”, “key attributes of staff behavior”, “handling
complaints by the nurses”, “courtesy of the nursing staff”, and
“courtesy of the physicians”. Researchers have found it very difficult
to measure patient satisfaction.
What factor highly contributes to patient satisfaction? Nursing care!
Many a times, how a
patient feels in hospital is not merely based on the quality or
complexity of treatment even though this decides patient outcome, as
quality of care is a nebulous concept for the patient, and varies from
person to person. However, some of studies have shown up nursing service
as the strongest determinant of patient satisfaction. Al-Mailam (2005)
conducted a study in Kuwait to determine the extent of patient
satisfaction with the care provided at the hospital, at all levels, and
to correlate patients’ satisfaction with nursing care in particular,
with their overall satisfaction. 420 patients participated in the
survey. The results found out that the extent of overall patient
satisfaction with the quality of care provided at the hospital was found
to be quite high (Excellent, 74.7%; Very good, 23.7%). Individually,
nursing care received the maximum patient satisfaction ratings
(Excellent, 91.9%; Very good, 3.9%). A positive correlation (r = 0.31, P
= .01) was noted between the patients’ perception of nursing care and
their overall satisfaction with the medical care provided at the
hospital. Significant positive correlation (r = 0.36, P = .01) was also
found between overall patient satisfaction and their reported intentions
of returning and recommending the hospital to others. The study
concluded that overall patient satisfaction is linked with quality
nursing care, which, in turn, depends on the quality of leadership
practiced at the institution.
Similarly, another study has been
conducted in US by Otani and Kurz (2004), with the primary objective of
finding out which attributes play a more important role in increasing
patient satisfaction and behavioral intentions to return to and
recommend the hospital; using a comprehensive set of healthcare
attributes. This study found that among six attributes, nursing care
showed the largest parameter estimate for the patient satisfaction and
behavioral intentions models. Thus, simply improving the nursing care
attribute seems to be the most effective action to enhance patient
satisfaction and behavioral intentions.
By understanding and acknowledging the
fact that empowering nursing will benefit hospitals and raise the level
of satisfaction of patients, healthcare facilities worldwide have
started to implement nursing-focused policies and to provide a pivotal
role for nurses. Studies have also reinforced the importance of having
nurses sit in on all interviews for potential new employees, as well as
sit on policy and procedures committees, and contribute to complaint
management system designs (Cohen, Delaney and Boston 1994, “Patient
complaints: guidance for nurses.” Nursing Standard, 1992).
All these revelations highlight the
importance of nursing as a key player in patient satisfaction and
recommend the widening scope of operation and the role of nurses in
healthcare institutions. This is a good indication of the growth
opportunity for nurses, but at the same time it stresses on the
importance of an individual nurse’s competency and all-round skills,
over and above bedside procedures.
Challenges in meeting patient expectation
According to the National Advisory
Council on Nurse Education and Practices 2010 report, to the U.S.
Department of Health and Human Services, the medical knowledge-base that
had previously been doubling every five to eight years is expected to
begin doubling every year. Nurses simply will not be able to keep up
with this freshly generated information without an advanced education
and a system supporting life-long learning. Meeting patient expectations
is considered the biggest challenge of nurses in future. At time when
medical knowledge, technology and patient expectations are changing
fast, continuing education and learning, and practicing life-long
self-learning skills are the only one way to achieve the level of an
ideal nurse; one who is skilled enough to guarantee patient satisfaction
in the modern era.
- Center for Clinical Governance Research in Health, University of New South Wales (2009). Complaints and patient satisfaction: a comprehensive review of the literature. [Report] retrieved on 17 June 2014 from http://www.health.vic.gov.au/clinicalengagement/downloads/pasp/literature_review_patient_satisfaction_and_complaints.pdf
- Lyder C (2012). Viewpoint: Why nurses will require a stronger back in 2012: Six key challenges facing the nursing community. February. Vol. 7 No. 2. Retrieved on 18 June 2014 from http://www.americannursetoday.com/article.aspx?id=8742&fid=8714
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