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.