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PubMed2004

Outsourcing of primary care: satisfaction level in the Israeli Defense Forces.

OBJECTIVE: To examine the effect of outsourcing primary care services on satisfaction levels among career soldiers in the Israeli Defense Forces (IDF). METHODS: Data were acquired via self-administered satisfaction questionnaires during the visits of soldiers and civilians to primary care clinics in military bases, hospitals, and HMO settings. Multivariable analyses (GLM) used the SAS statistical program. RESULTS: Two hundred thirty civilians and 618 soldiers (200 in hospital clinics, 277 in military clinics, and 141 in HMO clinics) completed 848 questionnaires. Gender did not influence satisfaction level (alpha < 0.05). Age and rank influenced two parameters: surroundings (p = 0.0277) and availability of the medical service (p = 0.0368). Location (hospital clinic, HMO clinic, and military clinic) was the primary variable influencing and predicting satisfaction level (11.6%). "Quality of medical care" predicts only 4% of satisfaction level. Soldiers in HMO settings expressed a higher degree of satisfaction particularly in availability of service, quality of service, general satisfaction, and courtesy. CONCLUSIONS: Career soldiers in Israel value all aspects of primary care given by a civilian HMO and are willing to accept a change (outsourcing primary care to a civilian provider). As a result, decision makers should expand the provision of these services to all career soldiers in Israel. Outsourcing of medical services can serve as a model to military corps worldwide.

Adult↗
PubMed1999

Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial.

BACKGROUND: Although substantial resources have been invested in communication skills training for clinicians, little research has been done to test the actual effect of such training on patient satisfaction. OBJECTIVE: To determine whether clinicians' exposure to a widely used communication skills training program increased patient satisfaction with ambulatory medical care visits. DESIGN: Randomized, controlled trial. SETTING: A not-for-profit group-model health maintenance organization in Portland, Oregon. PARTICIPANTS: 69 primary care physicians, surgeons, medical subspecialists, physician assistants, and nurse practitioners from the Permanente Medical Group of the Northwest. INTERVENTION: "Thriving in a Busy Practice: Physician-Patient Communication," a communication skills training program consisting of two 4-hour interactive workshops. Between workshops, participants audiotaped office visits and studied the audiotapes. MEASUREMENTS: Change in mean overall score on the Art of Medicine survey (HealthCare Research, Inc., Denver, Colorado), which measures patients' satisfaction with clinicians' communication behaviors, and global visit satisfaction. RESULTS: Although participating clinicians' self-reported ratings of their communication skills moderately improved, communication skills training did not improve patient satisfaction scores. The mean score on the Art of Medicine survey improved more in the control group (0.072 [95% CI, -0.010 to 0.154]) than in the intervention group (0.030 [CI, -0.060 to 0.1201). CONCLUSIONS: "Thriving in a Busy Practice: Physician-Patient Communication," a typical continuing medical education program geared toward developing clinicians' communication skills, is not effective in improving general patient satisfaction. To improve global visit satisfaction, communication skills training programs may need to be longer and more intensive, teach a broader range of skills, and provide ongoing performance feedback.

Adult↗
PubMed1992

Satisfaction of recent University of British Columbia dietetics graduates with undergraduate education and current job.

This study was designed to investigate the career status of recent University of British Columbia (UBC) dietetics graduates and their satisfaction with undergraduate education and current job. All graduates from the UBC Dietetics Program between 1978-1987, inclusive (n = 238), were mailed questionnaires. Information was sought regarding success in obtaining a dietetic internship, current employment status, job satisfaction, and satisfaction with undergraduate education. Questionnaires were returned by 67% (n = 130) of those who received them. Approximately 83% were eventually successful in obtaining an internship. Most respondents (68.5%) were employed as dietitian/nutritionists, and 69% of those who were employed worked full-time. Those who interned had significantly higher salaries than those who did not. A measure of overall job satisfaction revealed that 89.6% were satisfied to very satisfied with their present job, and scores on the Brayfield-Rothe Index of Job Satisfaction revealed no differences between those who did and did not intern. With regard to undergraduate education, respondents were most satisfied with library resources, class size and quality of teaching, and least satisfied with internship opportunities. Those who had interned were significantly more satisfied with their undergraduate education than were those who had not. We conclude that success in obtaining a dietetic internship affects salary and satisfaction with undergraduate education, but does not affect job satisfaction.

Attitude of Health Personnel↗
PubMed1992

The components of satisfaction with outpatient pharmacy services.

The true objective of a pharmacy manager is not just to measure satisfaction, but to improve it by identifying and meeting the needs of the patient. This study was undertaken with the objective of determining the relevant components of outpatient pharmacy service which impact the patient's perception of satisfaction, and to develop an on-going instrument to track satisfaction with pharmacy services over time. A survey was mailed to 391 outpatients. Simple correlation was used to identify the salient components of patient satisfaction. Multiple regression was used to determine the relative contribution of each of these components to overall satisfaction. Principle components analysis (PCA) provided the basis for delineating the underlying dimensions of which patient satisfaction is comprised. The two most meaningful factors derived from these data can be defined as professional communication and the physical and emotional well-being of the patient. By understanding the dynamics of the components of satisfaction, pharmacy managers can emphasize those areas which will produce a more satisfied patient, repeat patronage, and enhanced viability for the pharmacy.

Factor Analysis, Statistical↗
PubMed1997

Measuring patient satisfaction: a post-visit survey vs a general membership survey.

OBJECTIVE: To explore the implications of alternative survey approaches for measuring patient satisfaction among members of an HMO. DESIGN: Comparisons of findings on patient satisfaction from two different mail surveys conducted in 1994 of HMO members: a post-visit survey and a general membership survey. SETTING: Kaiser Permanente, Northwest Region (KPNW). PARTICIPANTS: Two random samples of KPNW members: 7680 members surveyed shortly after an HMO office visit; 2142 members from the general KPNW membership roster. MAIN OUTCOME MEASURES: Patient or member ratings of satisfaction with various aspects of services received from physicians, other clinicians, and non-clinician staff, as well as the overall level of satisfaction with the care and service provided by KPNW. RESULTS: Satisfaction is greater for all aspects of care when patients are reporting on specific visits than when members are generalizing about the care they receive from KPNW. But the pattern of satisfaction is highly consistent across the two surveys. Among the sociodemographic characteristics of patients and members, age is the best predictor of satisfaction. CONCLUSIONS: Both surveys have value for managing, monitoring, and evaluating HMOs. The member survey probably reflects something of the reputation of the HMO while the patient survey mirrors more its current functional status. The member survey is probably more useful for managing and monitoring the health care system (which in turn will create its future reputation), but the visit survey provides valuable information for those purchasers and individuals making choices among contemporary health care options.

Demography↗
PubMed1997

Charting patient satisfaction.

The importance of maintaining high levels of patient satisfaction has been well researched and thoroughly documented. Patient satisfaction can be measured, changed, controlled, and managed effectively to aid in improvement quality. Nevertheless, little research has been conducted to determine how patient satisfaction affects quality or how satisfaction strategies affect patients' perceptions. The authors of this study view patient satisfaction as a value-added component. They present a statistical process control-chart method that can help implement and evaluate a CQI strategy for improving patient satisfaction. The study illustrates how to measure patient satisfaction, create control charts, interpret the results, and develop administrative applications aimed at fulfilling a CQI strategy.

Data Collection↗
PubMed1989

Factors affecting the job satisfaction of respiratory therapists who work in adult general and critical care: a multivariate study.

UNLABELLED: The development of an expanded understanding of employees' reaction to their job may be important for improvement in the quality of work life and of services rendered. We sought to determine the factors, or rewards, that significantly affect respiratory therapists' job satisfaction. METHOD: Questionnaires designed to elicit responses related to job satisfaction and demographic information were mailed to a random sample of registered respiratory therapists in 9 southeastern states. The Job Descriptive Index (JDI) was used to measure facets of and total job satisfaction. The independent variables used were: Satisfaction with Work on the Job, Supervision, Promotion Opportunities, Pay, and People on the Job. RESULTS: Satisfaction with Work on the Job (p = 0.0001, F = 39.1) and with Supervision (p = 0.005, F = 8.48) were the only variables that significantly affected the job satisfaction scores of respiratory therapists. CONCLUSION: Because satisfaction with work on the job and supervision seem to be rewards therapists consider important, managers need to evaluate those factors in their own organization in relation to their possible impact upon staff members.

Critical Care↗
PubMed1998

Does length of hospital stay during labor and delivery influence patient satisfaction? Results from a regional study.

OBJECTIVE: To examine the relationship between patients' satisfaction with hospital obstetric care, length of stay, and patients' perceived appropriateness of the length of stay. STUDY DESIGN: A cross-sectional study. PATIENTS AND METHODS: We surveyed 27,789 women (a 58% response rate) discharged after labor and delivery from 18 hospitals in a large metropolitan region from 1992 through 1994. Patient satisfaction was assessed using the Patient Judgment System, a previously validated instrument. Our analysis focused on four scales evaluating specific aspects of care (physician care, nursing care, provision of information, and preparation for discharge) and two single-item indicators of satisfaction (overall quality and willingness to return to the hospital). RESULTS: Patients with shorter lengths of stay were more likely (P < 0.001) to perceive their stays as "too short." In addition, the six measures of satisfaction were lower (P < 0.001) in patients who perceived their stays as too short. However, the hypothesized lower satisfaction in patients with shorter stays was not observed; differences in satisfaction according to length of stay were small and of questionable practical significance. CONCLUSION: The findings suggest that patients' satisfaction with obstetric care may not depend on the absolute duration of stay but rather on whether patients perceive the length of stay to be adequate. The results are timely because of recent legislation that mandates minimum hospital stays for labor and delivery.

Adult↗
PubMed1999

Capitation and its effects on physician satisfaction.

OBJECTIVE: Capitation is an increasingly common method of paying physicians, but few data exist on its impact on physician satisfaction. This study examines the perceived effects of capitation on physician satisfaction at a large, academic medical center. STUDY DESIGN: Survey of physicians at a single, tertiary care hospital. METHODS: Physicians in a physician hospital organization were surveyed at an urban teaching hospital which received capitation for 5% of patients at the time of the survey but was preparing for a sharp increase in capitation. We used a 5-point Likert scale to assess physicians' satisfaction with their practice, and to compare satisfaction under fee-for-service and expected satisfaction under capitation. RESULTS: Of the 734 physicians surveyed, 147 were excluded because they had no direct patient care responsibilities. Of the remaining 587 physicians, 363 replied, giving a response rate of 62%. Overall, 57% of physicians were satisfied with their practice. Compared to their satisfaction under fee-for-service reimbursement, they were much less satisfied with their ability to care for capitated patients (17 of 19 questions, p < 0.05). The greatest differences were for freedom to order necessary tests and freedom to obtain referrals (0.9 and 0.8 on the 5-point scale, respectively, both p < 0.0001). Multiple logistic regression analyses revealed four independent predictors of overall satisfaction: patient load (OR = 2.7, 95% CI = 1.9-3.9), efficiency in resource utilization (OR = 1.5, 95% CI = 1.1-2.1), perceived employment stability (OR = 1.7, 95% CI = 1.3-2.2), and control over clinical time schedule (OR = 1.6, 95% CI = 1.2-2.0). CONCLUSIONS: Physicians initially encountering capitation payment have strong negative perceptions about it, even for areas in which some policy experts expect capitation to benefit patient care. Physician education and focusing on management relations may help smooth the transition to capitated reimbursement.

Academic Medical Centers↗
PubMed1999

Factors influencing satisfaction for family practice residency faculty.

BACKGROUND AND OBJECTIVES: Prior published family medicine faculty satisfaction survey results were performed in 1975, 1984, and 1989. The current survey identified specific factors that contribute to family medicine faculty satisfaction and career decision making. METHODS: We mailed a self-administered questionnaire to a proportionate random sample of family medicine faculty of residency programs identified by a pre-survey of programs. The eight-page survey explored 60 professional, scheduling, compensation, and regional factors as they related to overall satisfaction and career plans. The survey also explored 59 similar factors related to the initial decision to enter academic family medicine. RESULTS: Of 383 respondents (59.2% response rate), 93% felt satisfied overall with their faculty roles. Eighty-six percent felt appreciated in their current program, and 94% reported a positive sense of professional challenge. Satisfaction, appreciation, and challenge were strongly intercorrelated and were also positively related to whether the faculty surveyed planned to stay in their current position. The opportunity to mentor residents, the ability to keep more up to date with medical information, and income level stood out as being the most significant of all the factors in predicting overall satisfaction. CONCLUSIONS: The faculty surveyed indicated high levels of satisfaction, feeling appreciated, and professional challenge. The results of this cross-sectional survey identify factors most related to satisfaction and the initial decision to enter academic family medicine.

Attitude of Health Personnel↗
PubMedDate not supplied

Patients' satisfaction and their perception of the pharmacist.

OBJECTIVE: To explore the relationships between patients' satisfaction and (1) the level of pharmaceutical care services received, (2) patients' perceptions of the personal attention paid to them by the pharmacist, and (3) patients' perceptions of the pharmacist's ability to help them manage their asthma and prevent asthma-related problems. DESIGN: Exploratory study using mail or telephone survey methods. PATIENTS OR OTHER PARTICIPANTS: Asthma patients (n = 250) enrolled in one of two Florida managed care organizations. MAIN OUTCOME MEASURES: Predictor variables were level of pharmaceutical care and patients' perceptions of personal attention and their pharmacist's ability to help them control their asthma. Outcome variable was patients' overall satisfaction with the care they received from their pharmacist. RESULTS: The direct causal effects of level of care (standardized regression coefficient, beta = 0.07) and patients' perception of pharmacists' ability to help (beta = 0.01) on satisfaction were nonsignificant. Only personal attention had a significant direct path coefficient to patient satisfaction (beta = 0.63). Although the level of care was associated with patient satisfaction (r = 0.32), its direct effect was not significant because of its joint association (r = 0.27) with personal attention. Patients' satisfaction was associated with the level of pharmaceutical care and their perception of the pharmacist's ability to help them with their asthma. However, personal attention from the pharmacist was most influential. CONCLUSION: Patients may be less able to judge the technical quality of the care they receive, but they do judge their social interaction with the pharmacist. Pharmacy professionals must increase patients' awareness of the value of pharmaceutical care services and make it important to their judgment of satisfaction.

Asthma↗
PubMed1999

U.S. service members' satisfaction with family dental care.

This paper reports on U.S. service members' satisfaction with family dental care. The data come from a 26-site survey of active duty Army, Navy, Marine, and Air Force personnel conducted from April 1994 to January 1995. Of 12,050 respondents (81% response rate) to a prestratified, random sample, 4,412 had at least one child younger than age 21 or a nonmilitary spouse and answered 16 questions on satisfaction with family dental care. We derived simple distributions and an overall composite satisfaction score using factor analysis. Composite scores, transformed into a continuous variable with a mean of 100 and a standard deviation of 10, were regressed on respondent demographic and other factors to determine which factors influence overall satisfaction. Descriptive results show high satisfaction with family dental care. Regression results show that overall satisfaction varies with sex, branch of service, perceived barriers to dental care, and family dental insurance status. Because this survey was conducted before the change to the current dental insurance contractor, these findings may not reflect current service members' satisfaction with family dental care.

Adult↗
PubMed2000

An instrument to measure patient satisfaction with healthcare in an observational database: results of a validation study using data from CaPSURE.

OBJECTIVE: To validate a satisfaction measure for use in longitudinal, prospective studies of patient care. STUDY DESIGN: Patients with biopsy-confirmed prostate cancer (n = 228) who were enrolled in CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) completed a self-administered questionnaire that included a health-related quality-of-life and satisfaction measure. A subset of patients completed the questionnaire again within 30 days. METHODS: The satisfaction measure contained 6 individual subscales: overall satisfaction with care, contact with providers, confidence in providers, communication skills, humaneness, and a summary scale. Six items surveyed patients' willingness to participate in decision making (participatory style), and these were averaged into a single score. Variability, reliability, stability, and validity were evaluated. RESULTS: Responses to the items varied substantially. The overall satisfaction scale demonstrated good internal consistency reliability (Cronbach alpha = 0.82) and moderate test-retest reliability (0.62), and it could discriminate between groups of individuals expected to differ with regard to satisfaction (by age and disease stage). Subscale internal consistency reliability (0.37-0.54) and stability (0.38-0.63) were weaker, suggesting that only a single scale should be reported. The participatory scale performed poorly and could not be recommended for future use. CONCLUSION: The overall satisfaction measure developed for this study demonstrated good reliability and validity and should be useful in other population-based studies in conjunction with other outcome measures.

Aged↗
PubMed2000

[Measuring patient satisfaction in inpatient gynecology: significant quality improvements].

In the present study a validated questionnaire was used to measure patient satisfaction in a clinic of gynecology in a regional hospital. The goal was to assess problems, to solve them, and to increase patient satisfaction. A 50-item questionnaire was applied to assess satisfaction scores of 60 gynecology patients in 1996, and of 185 patients in 1998/99. The overall degree of patient satisfaction amounted to 74.2 +/- 22.7% increasing two years later to 78.0 +/- 25.8%. This represents a significant improvement and can be considered as success to improve quality. A significant increase of the satisfaction scores was obtained in four domains: 1. Information about the planned intervention, 2. courtesy and willingness to explain the procedures of the anesthesiologists, 3. cleanliness and 4. comfort of room. The present study confirms that validated assessment of patient satisfaction allows to identify problems and to solve them with appropriate corrective measures. This results in an increase of patient satisfaction.

Female↗
PubMed2001

Patient satisfaction with the comprehensive care model of dental care delivery.

In the summer of 1997, the College of Dentistry, The Ohio State University, changed its predoctoral clinics from the traditional model to the comprehensive care (CC) model. Although the CC model is considered the better model for delivery of care, from the patient perspective it has not been previously evaluated. The purpose of this study was to compare the two dental care delivery systems--the traditional model and the CC model--using patient satisfaction. The Dental Satisfaction Questionnaire (DSQ) developed by the Rand Corporation was used to assess patient satisfaction. The questionnaire consists of nineteen items, measuring overall satisfaction and subscales of access, pain management, and quality. The questionnaire was self-administered to active and recall patients in the summers of 1997 and 1998 to evaluate satisfaction with care in the traditional and CC models respectively. The completed DSQ was returned by 119 respondents in 1997 and 116 respondents in 1998. There were no significant differences in age. gender, and self-rated general and oral health of patients using the two delivery systems. No statistically significant differences were seen in the overall Dental Satisfaction Index and the sub-scales of access, pain management, and quality of care. Statistically significant differences were observed on only two of the nineteen individual items. We conclude that there was no difference in satisfaction levels of our patients between the two dental care delivery models.

Analysis of Variance↗
PubMed2002

Culture, personality, and subjective well-being: integrating process models of life satisfaction.

The authors examined the interplay of personality and cultural factors in the prediction of the affective (hedonic balance) and the cognitive (life satisfaction) components of subjective well-being (SWB). They predicted that the influence of personality on life satisfaction is mediated by hedonic balance and that the relation between hedonic balance and life satisfaction is moderated by culture. As a consequence, they predicted that the influence of personality on life satisfaction is also moderated by culture. Participants from 2 individualistic cultures (United States, Germany) and 3 collectivistic cultures (Japan, Mexico, Ghana) completed measures of Extraversion, Neuroticism, hedonic balance, and life satisfaction. As predicted, Extraversion and Neuroticism influenced hedonic balance to the same degree in all cultures, and hedonic balance was a stronger predictor of life satisfaction in individualistic than in collectivistic cultures. The influence of Extraversion and Neuroticism on life satisfaction was largely mediated by hedonic balance. The results suggest that the influence of personality on the emotional component of SWB is pancultural, whereas the influence of personality on the cognitive component of SWB is moderated by culture.

Adult↗
PubMed2002

Scale to measure patient satisfaction with physical therapy.

BACKGROUND AND PURPOSE: Patient satisfaction can be one indicator of quality of care. In this study, a patient satisfaction questionnaire for physical therapy was developed. SUBJECTS: The subjects were a consecutive sample of 1,024 patients who received physical therapy between January and March 1999 at a teaching hospital in Geneva, Switzerland. METHODS: A cross-sectional mail survey was conducted in which a structured questionnaire measuring patient satisfaction with various aspects of physical therapy followed by open-ended questions was sent to the subjects. RESULTS: Overall, 528 of 1,024 patients (52%) responded (patient demographics for 501 respondents who provided demographic data: mean years of age=58.6, SD=18.9, range=15-95; 258 men, 243 women). Factor analysis was used to identify main domains of satisfaction, and a scale was constructed to measure satisfaction with each dimension: treatment subscale (5 items), admission subscale (3 items), logistics subscale (4 items), and a global assessment subscale (2 items). All subscales had good acceptability and small floor and ceiling effects. Internal consistency coefficients varied between.77 and.90, indicating good reliability for all subscales. Scale validity was supported by a logical grouping of items into subscales, according to their content, and by correlations of satisfaction scores with the patient's intention to recommend the facility and with the number of positive and negative comments to open-ended questions. Younger patients were less satisfied than older patients for 2 of the subscales (admission and logistics). DISCUSSION AND CONCLUSION: The 14-item instrument is a promising tool for the evaluation of patient satisfaction with physical therapy in both inpatients and outpatients.

Adolescent↗
PubMed2002

Understanding changes in primary care clinicians' satisfaction from depression care activities during adoption of selective serotonin reuptake inhibitors.

OBJECTIVES: To describe how primary care clinicians' perceptions about depression care as a clinical activity changed during the adoption of selective serotonin reuptake inhibitors (SSRIs) in their health maintenance organization (HMO). STUDY DESIGN: Prospective study of change in primary care clinicians' level of satisfaction from depression care activities from time 1 (mid-1993) to time 2 (early 1995). METHODS: Study subjects were internal medicine and family practice physicians, physician assistants, and nurse practitioners (n = 196) in a large, not-for-profit group-model HMO. We modeled level of satisfaction from depression care activities at time 2 as a function of changes in depression-care-related attitudes and perceptions over the study period, controlling for time 1 level of satisfaction and personal and professional characteristics. RESULTS: Overall satisfaction showed a small, statistically significant improvement over the study period. Time 2 satisfaction was a function of improved perceptions about the feasibility of primary care treatment of depression, which in turn were related to improved perceptions about the effectiveness of drug treatment. The relevance of clinicians' perceptions about their own depression care skills declined concomitantly. CONCLUSIONS: The adoption of SSRIs in the HMO was associated with improvement in primary care clinicians' perceptions about their ability to successfully treat depression (especially using pharmacology) and in their overall satisfaction from depression care activities. Future research should address whether reliance on SSRIs replaces the use of other depression treatment modalities, and if so, how this reliance affects patient outcomes and satisfaction and overall healthcare costs.

Attitude of Health Personnel↗