Meeting Patient Expectations: Determinants and a Nurse’s Role

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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Nursing As An Attractive Career Option For Men

Nursing, in modern times, has not been perceived as a profession to be pursued by men; as a vocation, perhaps, through a religious order. You may find it surprising, though, that until the late 1800s nursing was a service primarily rendered by men.

It wasn’t until Florence Nightingale started advocating professional nursing care at the frontline, during the Crimean War (1853 – 1856), did women nurses start making their presence felt on battlefields, in Europe. In the USA, men were still performing a majority of the nursing duties during the American Civil War (1862 – 1865). It was during World War I (1914 – 1918), and the demand for able-bodied men, that governments started mandating “only women” for nursing services.

This mandate became so well entrenched that, even as late as 1980 men were not allowed admission into a majority of the nursing colleges in the USA. Today, although there aren’t any restrictions to men entering the nursing profession, the percentage of men in nursing is still very small (9 – 10%); thanks to the historical legacy, and to (Western) societal perceptions formed during this period when most of nursing was out of bounds to men.

With the projected acute shortage of nurses in the developed world, nursing is now, more than ever, an extremely attractive career option for men; coming at a time when traditional sources of blue-collar male employment, such as manufacturing and construction, are drying up on account of increased productivity or greater mechanization. Overcoming this shortage will require potential employers to increase wages significantly higher than the inflation rate, as mentioned in a previous blog.

So, the demand and the wages render nursing an attractive career for men (and women too), but what are the issues to keep in mind while opting for a career in nursing?

• The first is, of course, the perception that nursing is a woman’s job. Going against this stereotype will require a good deal of character and resolution, especially when explaining the choice to one’s near and dear, and to friends. Overcoming this perceptual obstacle is half the battle won.
• There are few male role models in nursing, for men choosing to join the profession, given the near-historical absence of men from this profession. So, advice, from a male perspective, on handling academic and professional pressure, specializations to opt for, etc. is hard to come by.
• Choosing the right specialization is important. Women-specific specializations, e.g. Obstetrics & Gynecology, can be avoided, and during one’s career there may be situations when female patients may be more comfortable being taken care of by a female nurse. That said, male nurses tend to like specializations such as Anesthesia, Emergency & Trauma, Critical Care, Flight nursing, Oncology, Orthopedics, Psychiatry, Education, and Nursing management, to name a few.
• Discrimination against male nurses, in the workplace, may be gradually fading but a male nurse should be prepared for it. Such discrimination may manifest itself solely on account of gender, or on account of relationship with the physician, or even on account of communication issues with female counterparts. In many cases discrimination is perceived and not practised, because the male nurse is operating in an unfamiliar situation where he is a (gender) minority.

It’s not all caution and taking care, though. There are a few advantages to being a male nurse: especially around patients who are violent or aggressive, or when physical strength is required (to lift or support a patient). And, strangely enough, at least in the USA, although men represent less than a tenth of the nursing population, they earn more their women counterparts in the same roles. This anomaly has been explained through the fact that male nurses tend to be better qualified than their female counterparts, for the same roles.

When it comes down to making a decision, it should be noted that nursing is a professional vocation, and any man opting for it as a career will first need to decide on whether he is going to find satisfaction and contentment in caring for an unwell fellow human being. If the answer is yes, then the issues outlined above will easily be resolved. If not, the career may not turn out to be as attractive as the salary promises.

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Bringing Information Technology to Indian Nursing – Global Best Practices

Nursing is changing worldwide, as technology becomes more sophisticated and percolates into more practices within the nursing discipline. Having said that, there is an imperative need to introduce information technology in the Indian nursing system. At present, Indian nurses are unable to cope with work pressure due to the quantum of data generated in each of the cases they handle. This volume of data manifests itself in heavy paperwork, which nurses, attached to hospitals, are mandated to complete, to the detriment of their core nursing functions (Ball et al, 2000). In addition, Ball et al (2000) state that cost-cutting, at healthcare institutions, and consumerism have also created more pressure on nurses today.

Malpractice crises have forced nurses to focus more on complete and detailed nursing documentation. It is here that the adoption of information technology will significantly ease a nurse’s workload. Digital documentation and instant access to up-to-date information on a patient’s history, test results, and physician notes saves energy (that is otherwise spent duplicating documentation)and time (that is otherwise spent chasing down relevant documents in other departments). Not with standing the demonstrated benefits, rolling out an information technology platform is not easy and requires determination and perseverance from the implementers. The problem with introducing information technology is that, like in other fields, many nurses are resistant to any change in the existing system: especially, older generation nurses. Change, even if beneficial, is not always welcomed by the beneficiaries of such change.

Advances in biomedical technology and the use of sophisticated electronic equipment is already creating stress among nurses. Further compounding the stress, Ball et al (2000) argue that it is unfortunate that beneficiary nurses are not adequately involved in the selection and implementation of the information technology platform. Consequently, core nursing functions suffer too. The solution is to roll out information technology platforms in the nursing field, with the co-option and co-operation of the nursing staff. Indian nurses have to learn practices such as electronic recording and become more technologically savvy, so that their productivity can be improved and quality standards in delivering nursing care improved.

Marquis and Huston (2006) state that there are three reasons for change: firstly, to solve a problem or issue; secondly, to improve quality; and, thirdly, to decrease unnecessary workload for the particular working group. In the case of implementing information technology in nursing care, in India, all the three criteria are fulfilled: the problem of poor quality nursing care; addressing this problem using IT platforms; and in doing so, improve the efficiency and effectiveness of the nursing staff through the reduction in unnecessary paperwork.

Many developed countries such as Canada, UK, and USA have already implemented information technology in nursing field. Even in India, several corporate hospitals have started to utilize information technology. Having said that, there is still huge scope for Indian nurses to further benefit from information technology, in ways  which will reduce their workload even more. Needless to say, there will be, initially, stress and resistance to change; but as times rolls on, nurses will gain familiarity of any such new IT systems. IT is one global best practice that needs to be adopted by Indian nursing forthwith.

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