Patient satisfaction

Patient satisfaction is a concept developed in social research that describes the satisfaction of patients with the services they use in the healthcare system. Specifically, patient satisfaction is understood as the difference between the quality of medical care expected by the patient and the quality they perceive as part of their care.

Theoretical references

It is assumed that the patient develops an expectation regarding different performance aspects of his medical treatment a priori and evaluates these on the basis of his experiences and experiences. The resulting balance of actual and target performance leads to either satisfaction (expectations were lower than perceived performance) or dissatisfaction (expectations were higher than perceived performance). This approach is borrowed from customer satisfaction research and has its origins in the disconfirmation paradigm. If these origins are transferred to the healthcare sector, medical care services can be categorized using the following dimensions:

• Structural quality
• Process quality
• Result quality
• Social quality

In practice, this repeatedly leads to the accusation that the patient is not exclusively a customer and that his role as a co-producer of the medical service must be perceived.

Partial aspects

The construct patient satisfaction represents a collective term for all services that a patient perceives during his hospital stay and with which he is satisfied or dissatisfied. These services are typically grouped into three areas:

• Medical services
• Nursing services
• "Hotel" services

In turn, these three areas must be considered as cumulative assessments of various sub-areas. In a historical meta-analysis of 221 research papers, Hall and Dornan found a range from one to twelve viewpoints that were used to operationalize patient satisfaction. You name, among other things, humanity, knowledge, technical competence, bureaucratic processes and the success of the treatment. Cleary names in his work the dimensions "the personal aspects of care, the technical quality of care, accessibility and availability of care, continuity of care, patient convenience, physical settings, financial considerations and efficacy". In their “critical inventory”, Jacob and Bengel provide an overview of the various dimensions that are used to measure patient satisfaction. They point out that, despite any differentiation, consideration should also be given to the significance and importance of various aspects or dimensions of the perceived performance for the overall satisfaction of the patients. What is meant by this is that the satisfaction with the so-called hotel services in relation to the satisfaction with the perceived medical service is difficult to compare. If a patient does not experience his stay in a hospital as curing or at least not as pain-relieving, an appealing ambience in the rooms and waiting rooms does not significantly increase satisfaction with the hospital. In addition to satisfaction with the specific services, the importance of the assessed dimensions from the patient's point of view also plays a decisive role.

Measurement

There are different ways of measuring patient satisfaction. Basically, a distinction can be made between questioning current patients (in-house questionnaire) or patients who have already been discharged and questionnaires or surveys .

When interviewing current patients, the interview date is of particular importance. Surveys at the beginning of the hospital stay can mean that the interviewed patient cannot adequately assess all dimensions. If the patient is only interviewed at the end of his hospital stay, it is known that his judgment tends to be more positive than during his stay ( halo effect : the positive experience of the discharge situation improves the personal memories in retrospect). When interviewing former patients, one goes into the area of memory errors . Individual experiences may be overrated or weakened, and overall there may be distortions. On the other hand, only discharged patients can provide useful feedback on the discharge process and related aspects. In addition, in statistical comparisons there is no significant difference between the judgment of current and former patients. For these reasons, a commercial provider of patient satisfaction surveys suggests carrying out a key date-based multiple survey with current patients and carrying out this through a postal survey of former patients who have not left the hospital for more than 4 weeks. By reference date, this means that on a (pre-) determined day, all patients in a participating ward are interviewed, provided that they are physically and psychologically able to do so. This approach leads to the fact that the patient's current length of stay is mixed up at random and there is no bias in the interview date . This key date survey is repeated until a predetermined number of questionnaires has been distributed.

A patient survey with questionnaires has the advantage that patients can answer the questions anonymously and do not have to fear negative consequences in their further hospital stay because of their judgment. In contrast to interviews, questionnaires are more economical, faster in terms of time and are perceived by patients as more voluntary. However, certain medical conditions can prevent some patients from being able to complete questionnaires. These then either have to be deliberately excluded from the survey or they must also be interviewed.

Tablet-based patient surveys enable direct electronic recording and evaluation of the patient survey. These electronic systems simplify and facilitate the implementation and evaluation of the patient satisfaction survey considerably.

Data

According to the results of the GEDA additional survey "Information behavior and self-determination of citizens and patients" from 2009, the majority of those questioned stated that they were very satisfied with the contacts in the health care system. Men are overall more satisfied than women.

Satisfaction with last contact in healthcare

	very satisfied	satisfied	little satisfied	not at all satisfied
total	26.2%	61.5%	11.1%	1.2%
Women	26.7%	59.9%	11.4%	2.0%
Men	25.9%	63.0%	10.7%	0.4%

literature

• M. Avis, M. Bond, A. Arthur: Satisfying solutions? A review of some unresolved issues in the measurement of patient satisfaction. In: Journal of Advanced Nursing. 22, 1995, pp. 316-322.
• PD Cleary: Patient Satisfaction as an Indicator of Quality Care. In: Inquiry. 25, 1988, pp. 25-36.
• W. Duer, W. Grossmann, H. Schmied: Patient satisfaction and patient expectation in the hospital. In: M. Bullinger, U. Ravens-Sieberer, J. Siegrist (Eds.): Quality of life research from a medical psychological and sociological perspective. Hogrefe, Göttingen 2000, pp. 222-243.
• YES. Hall, M.-C. Dornan: Meta-Analysis of satisfaction with medical care: Description of Research Domain and Analysis of overal satisfaction levels. In: Social Science & Medicine. 27 (6), 1988, pp. 637-644.
• G.-E. Hardy, M.-A. West, F. Hill: Components and predictors of patient satisfaction. In: British Journal of Health Psychology. 1 (Part 1), 1996, pp. 65-85.
• G. Jacob, J. Bengel: The construct of patient satisfaction: A critical inventory; The construct of client satisfaction: A critical review. In: Journal-for-Clinical-Psychology, -Psychiatrie-and-Psychotherapy. 48 (3), 2000, pp. 280-301.
• A. Leimkuehler: Patient Satisfaction - Artifact or Social Fact? Patient satisfaction: Artifact or social fact? In: Der-Nervenarzt. 67 (9), 1996, pp. 765-773.
• W. Satzinger: Patient surveys as an instrument of QM in hospitals. In: K. Zapotoczky, A. Grausgruber, T. Mechtler (eds.): Health in focus. 1996.
• J. Schmidt, F. Lamprecht, WW Wittmann: Satisfaction with inpatient care. Development of a questionnaire and first validity studies. In: Psychother med Psychol. 39, 1989, pp. 248-255.
• W. Zinn: Patient surveys based on the model of the research group Metrics. In: W. Satzinger, A. Trojan, P. Kellermann-Mühlhoff (ed.): Patient surveys in hospitals. Asgard Verlag, Sankt Augustin 2001.
• W. Zinn, R. Schena: patient survey in hospitals. In: The hospital. Volume 1, W. Kohlhammer, Stuttgart 2000.

Individual evidence

1. ↑ M. Bickel: Willingness of general practitioners for technical innovations, using the example of the German health system. (PDF; 1.6 MB), Bachelor thesis, 2012, Faculty of Economics, Technical University of Munich.
2. ↑ ^{a b} K. Horch, L. Ryl, B. Hintzpeter, ML Dierks: Competence and Sovereignty in Health Care - The User Perspective. (= GBE compact. 2, 2011). Edited by the Robert Koch Institute Berlin.
3. ↑ Questionnaire in the procedure database at iqpr - Institute for Quality Assurance in Prevention and Rehabilitation GmbH .