Needs of patients

One of the primary factors which affect the quality of patient survey responses and their applicability in different action plans is the lack of supporting values (Davies & Cleary 2005, p. 425). In other words, patient surveys can hardly serve a reliable tool of quality improvement, unless health care facilities are able to adjust their organisational culture to the needs of patients. Unclear management structure and complicated organisational hierarchy prevent patients from communicating their needs directly to hospital management. As a result, many of these issues remain unnoticed.

In this context, not only the lack of administrative support, but competing priorities contribute into the emergence of the major controversies in health care quality improvement. “Competing priorities that detract from an organisational focus on patient centred care are financial goals, the number of patients to be seen, and major restructuring” (Davies & Cleary 2005, p. 426). These findings are also supported by Scott and Smith (1994), who state that priority areas are the sources of major concerns and may turn into a serious obstacle on a hospital’s way to using patient surveys as quality improvement tools.

Generally, physicians and clinical professionals tend to misinterpret the results of patient surveys, and thus distort the true structure of quality priorities in medical care. The category which makes patients the least satisfied is not always the one they would like to improve, due to the fact that patient surveys rarely ask patients to compare several different categories or services (Scott & Smith 1994). The lack of comparability, and as a result, the overwhelming subjectivity of patient surveys are the two factors that decrease the extent to which patient surveys can be used as a tool of quality improvement in health care.

“Deciding what is priority by choosing the category with the lowest score also ignores the resource costs and effectiveness of improving satisfaction in each category” (Scott & Smith 1994, p. 355). From the organisational viewpoint, defensiveness and resistance to change, the lack of appropriate assistance infrastructure, and the lack of professional evaluation skills decrease the scope of patient surveys applicability in QA environments (Davies & Cleary 2005).

The above mentioned issues are further aggravated by the lack of expertise (physicians cannot analyse and use survey results), delays in obtaining feedback from patients (very often, the delays from data collection to analysis makes it impossible to react to the emerging issues in a timely manner), uncertainty over effective interventions, and lack of cost effectiveness (Davies & Cleary 2005). All these barriers negatively affect the use of patient satisfaction surveys for quality improvement purposes.

Physicians and hospital management appear unprepared to developing and implementing long-term quality assurance strategies, making patient surveys increasingly ineffective. That is why, patient satisfaction surveys will not become a reliable quality measurement tool, unless hospital management and staff are able to broaden the context of all quality assurance and improvement initiatives and to integrate patient satisfaction surveys into a larger quality improvement context, with sufficient expertise, reliable assistance infrastructure, and timely feedback in its basis.

Given the unlimited potential which patient surveys carry in them, they are likely to become the primary tools of quality improvement in health care, only if all discussed issues are resolved. Conclusion The growing pool of research suggests that patient satisfaction surveys are potentially effective and unbiased instruments of quality improvement in healthcare. However, only a few studies have researched the obstacles on the way to using patient surveys in QA.

The problem is that hospital management and staff tend to limit the scope of quality improvement strategies to patient satisfaction surveys, while effective and timely quality improvement also requires analytical expertise, sufficient assistance infrastructure, and a clear set of quality improvement priorities and supporting values. Unless these elements are integrated into all QA assurance initiatives, patient surveys will remain a highly ineffective and unreliable tool of quality improvement in all clinical settings.

References Andrzejewski, N & Lagua, RT 1997, ‘Use of a customer satisfaction survey by health care regulators: a tool for Total Quality Management’, Public Health Reports, vol. 112, p. 206-210. Boyer, L, Francois, P, Doutre, E, Weil, G & Labarere, J 2006, ‘Perception and use of the results of patient satisfaction surveys by care providers in a French teaching hospital’, International Journal for Quality in Health Care, vol. 18, no. 5, p. 359-364.

Cheraghi-Sohi, S & Bower, P 2008, ‘Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review’, BMC Health Services Research, vol. 8, no. 179, p. 1-10. Davies, E & Cleary, PD 2005, ‘Hearing the patient’s voice? Factors affecting the use of patient survey data in quality improvement’, Qual Saf Health Care, vol. 14, p. 428-432.

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