Factors determining inpatient satisfaction with care
Introduction
Respect for patients’ needs and wishes is central to any humane health care system. Providers wishing to meet those needs more effectively have shown growing interest in the use of patient evaluations and reports as a complement to other methods of quality assessment and assurance (Cleary et al., 1991). Increasing attention has been paid to the assessment of patient satisfaction with care. Furthermore, the patients’ own evaluations of their experiences in the hospital have been used to improve the quality of care in English-speaking countries (Calnan et al., 1994; Epstein, Laine, Farber, Nelson, & Davidoff, 1996; Hays & Ware, 1986; Williams, 1994). Indeed, patient satisfaction is widely considered as an integral part of the quality of care. Pascoe (1983) has defined it as a health care recipient's reaction to salient aspects of his or her experience of a service. In his formulation, satisfaction is assumed to consist of a cognitive evaluation and an emotional reaction to the structure, process and outcome of services. For Donabedian (1980), client satisfaction is a fundamentally important measure of the quality of care because it offers information on the provider's success at meeting those expectations of most relevance to the client. Measures of satisfaction are, therefore, important tools for research, administration and planning. Patient satisfaction can also be used to evaluate the process of care (Carey & Seibert, 1993; Etter, Perneger, & Rougemont, 1996; Fitzpatrick (1991a), Fitzpatrick (1991b); Guadagnoli & Cleary, 1995; Kane, Maciejewski, & Finch, 1997; Lasek, Barkley, Harper, & Rosenthal, 1997; Linn et al., 1995; Ross, Steward, & Sinacore, 1995; Williams, 1994) as greater satisfaction may be associated with superior compliance, improved attendance at return visits and better outcomes (Cleary, Keroy, Karapanos, & McMullen, 1989).
Previous studies have tended to report very high levels of overall satisfaction during hospitalization, often reaching 90% or more (Williams, 1994; Victorian public hospitals, 1995). Factors associated with satisfaction are thought to include the structure, process and outcome of care as well as patient sociodemographic, physical and psychological status, and attitudes and expectations concerning medical care (Cleary & McNeil, 1988; Minnick, Roberts, Young, Kleinpell, & Marcantonio, 1997; Williams, 1994). Results, however, are inconsistent and sometimes contradictory, other than the finding that older patients consistently tend to report higher levels of satisfaction than do younger ones (Calnan et al., 1994; Cleary & McNeil, 1988; Cleary et al., 1989; Ware & Berwick, 1990). Although numerous hospitals have developed ongoing programs for the routine assessment of patient perceptions of the quality of care, and many inpatient satisfaction surveys have been published (Rubin, 1990), none in France has been devoted to factors that may affect level of satisfaction, especially in a single, prospective study.
The objective of the present study was to identify factors associated with satisfaction among inpatients receiving medical or surgical care for cardiovascular, respiratory, urinary and locomotor system diseases.
Some factors such as those related to hospital stay (e.g. amenities in the patient's room or in the service) or those related to the organization and provision of services (e.g. number of inpatients, index of care load per physician or per nurse) are alterable by health providers/managers who wish to intervene and monitor programs aimed at improving the quality of care.
Some other factors such as patient characteristics (e.g. age, sex) are not alterable. However, their role might be important to investigate for two reasons. One is the need to adjust for these factors for benchmarking when comparing hospitals, services and specialties. The second concerns making it possible for providers to target patients at risk for worse experiences.
Section snippets
Sample and procedure
The study population consisted of inpatients discharged from 12 medical and surgical services specializing in cardiovascular, respiratory, urinary and locomotor system diseases at the Nancy University Hospital Center (20.1% of all inpatients). The investigation was conducted between April 1997 and May 1998. Nancy University Hospital is a public hospital located in northeast France. In 1997, it had 2474 beds, with 74% occupancy rate, 76,012 admissions and 608,462 hospitalization days. Some 92%
Characteristics of the sample
The sample comprised respondents with respiratory diseases (31.3%), cardiovascular diseases (22.1%), urinary diseases (15.8%) and locomotor system diseases (30.8%). A total of 77% were admitted to medical services.
Mean age of subjects was 56.2 years, and 63% were male. Forty-seven percent were educated to below high school level, 42% had a high school education and 11% had received college or graduate diplomas. Two-thirds of respondents were not working, and 15% lived alone. About 18% were
Main findings
Seventeen variables describing patient and service characteristics were significant factors in at least one satisfaction dimension equation, and variables that appeared in more than one dimension equation were consistent in their directions of influence. Patient characteristics (demographics, health and patient stay) were the strongest predictors of the level of satisfaction. Satisfaction was not related to specialty ward. The two most consistent factors associated with a higher satisfaction
Conclusions and recommendations
This study demonstrates that information about patient satisfaction with their care may be collected in a way that is acceptable to both patients and health care providers/managers. Using polychotomous logistic regression has proved useful and appropriate for analyzing determinants of satisfaction level. Information of the kind provided here, based on quantitative and qualitative data, reveals the specific areas in which care may be improved or is already very good.
We recommend that health care
Acknowledgements
This study was funded by a 1996 PHRC grant (Programme Hospitalier de Recherche Clinique) from the French Health Ministry. T.P.L. Nguyen was supported by a grant from the French Foreign Office. Approval was given by the Regional Ethics Committee.
The authors would like to thank the research team of Clinical Epidemiology and Evaluation, the physicians and nurses of the study services, and the administrative staff of CHU Nancy for their help with organization. They would also like to thank all the
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