For decades, patient satisfaction surveys have served effective and reliable sources of patient-based information with regard to the quality of health care services. The need for obtaining customer feedback was justified by the increasing competition in medical care markets and the growing medical facilities’ concerns about retaining and expanding their market presence. With time, medical professionals have come to realise the issues that emerged in terms of using patient satisfaction surveys as the tools of continuous quality improvement.
Now, when the quality of medical care determines profitability and continuity of businesses in health care markets, patient surveys become an increasingly important source of information, but their use as an effective quality improvement tool remains problematic. The problem is not in that patient satisfaction surveys lack objectivity and validity; the problem is in the lack of professionalism and the appropriate quality improvement infrastructure. These factors substantially narrow the scope of patient surveys’ usability in quality improvement strategies.
Patient satisfaction surveys: why use? The use of patient satisfaction surveys signifies the growing patient participation in quality improvement processes that currently occur in health care. “Patients can be a valuable resource in helping practices formulate patient-led action plans for improvement following the results of their patient surveys” (Greco et al 2006, p. 495). As a result, more and more hospitals and related medical facilities come closer to realise the unlimited information and competitive potential, which patient satisfaction surveys carry in them.
Since the middle of the 1980s and up to the present time, patient satisfaction surveys have been gradually becoming the leading tool of knowledge and information about the quality of medical care in various types of clinical settings. However, as medical facilities were increasingly interested in using patient surveys as a tool of quality improvement, the rates of patient response gradually declined (Kahn et al 2003). Those controversies were the results of the inherent patient skepticism and the decreasing trust toward the value and usability of survey information in health care.
In the light of “high prevalence of suboptimal response rates across many settings in which health status and quality are assessed highlight the importance of considering the characteristics of patients who do not respond to follow-up surveys” (Kahn et al 2003, p. 1579), hospitals kept to an opinion that patient satisfaction surveys could be an effective tool of quality promotion in highly competitive healthcare markets.
Even under the pressure of suboptimal response rates, many of them reported the overwhelming benefits and the positive impact of patient satisfaction surveys on the quality improvement processes and initiatives. Certainly, patient satisfaction surveys are the important tools of making patients involved into various types of health care services. Contemporary medicine is moving away from prescriptive principles, turning into a collaborative set of medical services, where doctor roles are no longer limited to being a depositary of professional medical and pharmaceutical information.
The structure of health care services is changing in ways, which promote patient participation, and “patients are more likely to be conceptualised as active decision makers, rather than passive recipients of decisions made by others” (Draper, Cohen & Buchan 2001, p. 463). From the viewpoint of collaborative and participatory medicine, the use of patient satisfaction surveys is the necessary mechanism needed to improve the quality of health care in the long-term period.
Care providers are extremely optimistic in their evaluation of patient satisfaction surveys and their use in quality assurance initiatives. Boyer et al (2006) conclude that 94% of health care providers consider patients able to judge the quality of health care in relational, organisational, and environmental dimensions. Although many patients lack appropriate knowledge and expertise needed to evaluate the technical aspects of health care, they nevertheless impact organisation, practice, and delivery of health care services.
“In QA environment, a patient satisfaction survey is used to identify problem areas that can be rectified through feedback and change” (Scott & Smith 1994, p. 354). In Australia, patient satisfaction surveys are used in hospital accreditation, while the U. K. promotes patient surveys as the tool of regular internal audits (Scott & Smith 1994, p. 354). Despite the difficulties which physicians may encounter in their desire to interpret and use the results of various patient surveys, these remain the most widely spread informal instrument of quality improvement.