PATIENT SATISFACTIONPATIENT SATISFACTION

Dr. Nyunt Nyunt Wai Dr. Nyunt Nyunt Wai Senior Medical Superintedent (S.P.H)Senior Medical Superintedent (S.P.H)

(16.3.2016)(16.3.2016)

QUALITY IN HEALTH CAREQUALITY IN HEALTH CARE

ANDAND

Patient satisfactionPatient satisfaction• The degree to which the individual regards the health care health care

serviceservice or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.useful, effective, or beneficial.

What is patient satisfactionWhat is patient satisfaction- - and what can we do about it?and what can we do about it?

Evolution of patient-centrednessEvolution of patient-centredness

• Increased lay knowledge and self-help• Increased awareness of professional falliability and

diagnostic uncertainty• Rise in scepticism about medicine/science• Awareness of wider influences on health• Shift in focus from acute to chronic conditions• Wide variation in clinical practice• Pressure to increase accountability• Pressure to democratise public health systems• Shift from objective to subjective medicine

TOTAL QUALITY MANAGEMENT

Why is patient satisfaction Why is patient satisfaction important?important?

• Public accountability• Quality improvement

– Macro-level:• system performance management• benchmarking• competition/contestability through markets

– Micro-level:• feedback to professionals and managers• acceptability of processes / social model of health

Client Centered Health CareClient Centered Health Care

Client centered approach often require a shift in attitude

In client centered care, client (patient) customers are first and foremost (total quality management)

To ensure client safety and maintain quality of care

Explain range of methods available

Discuss the efficacy & adverse effect of treatments method

CUSTOMER (PATIENT)

NURSE & TECHNICIAN

DOCTORDOCTORCUSTOMER (PATIENT)

NURSE & TECHNICIAN

DOCTORDOCTORIMPO

RTA

NC

EIM

POR

TAN

CE

IMPO

RTA

NC

EIM

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TAN

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TRADITIONAL MANAGEMENTTRADITIONAL MANAGEMENT TOTAL QUALITY MANAGEMENTTOTAL QUALITY MANAGEMENT

THE INVERTED PYRAMID OF CONTROLTHE INVERTED PYRAMID OF CONTROL

What Do Patients Want? Respect and recognitionRespect and recognition Patients to be treated with respect and friendlinessPatients to be treated with respect and friendliness

UnderstandingUnderstandingPatients value individualized service and prefer provider Patients value individualized service and prefer provider who try to understand the real situationwho try to understand the real situation

Emphatic ListeningEmphatic Listening Five levels of ListeningFive levels of Listening1. Ignoring1. Ignoring2. Pretending2. Pretending3. Selective listening3. Selective listening4. Attentive listening4. Attentive listening5. Emphathic listening: the highest form of listening.5. Emphathic listening: the highest form of listening.

Complete and accurate informationComplete and accurate information Patients want complete & accurate information about their Patients want complete & accurate information about their

disease, treatment and outcomedisease, treatment and outcome

Technical competenceTechnical competence • Patients want to know technical Patients want to know technical competence of providerscompetence of providers

AccessAccess• A convenient action and prompt serviceA convenient action and prompt service are neededare needed

FairnessFairness• Patients want provider to offer thorough Patients want provider to offer thorough explanations and examination to everyone alikeexplanations and examination to everyone alike

ResultsResults• A quality product or service at a fair priceA quality product or service at a fair price• SatisfactionSatisfaction

Patients’ rights and providers' needsPatients’ rights and providers' needs Patients’ rightsPatients’ rights

InformationInformation about the disease about the disease AccessAccess to all service delivery systems and health care to all service delivery systems and health care

providersproviders ChoiceChoice of adopting, switching or discontinuing methods of adopting, switching or discontinuing methods SafelySafely in practice of treatments in practice of treatments PrivacyPrivacy during discussion & physical examination during discussion & physical examination ConfidentialityConfidentiality of all personal informationof all personal information To be treated with To be treated with dignitydignity courtesy , consideration and courtesy , consideration and

attentivenessattentiveness ComfortComfort while receiving treatment while receiving treatment ContinuityContinuity of care for as long as the client desire of care for as long as the client desire To To expressexpress their opinion about the quality of services receive their opinion about the quality of services receive

TrainingTraining on technical and communication skill on technical and communication skill InformationInformation on technical issue ,updated regularly on technical issue ,updated regularly InfrastructureInfrastructure, including appropriate physical facilities and , including appropriate physical facilities and

efficient organizationefficient organization SupplySupply of proper medicine of proper medicine GuidanceGuidance from service guidelines ,checklist and supervision from service guidelines ,checklist and supervision Back upBack up from other providers and level of care from other providers and level of care Respect and recognitionRespect and recognition from co-workers, managers, clients from co-workers, managers, clients

and communityand community EncouragementEncouragement to provide good quality of careto provide good quality of care FeedbackFeedback from managers to supervisors, other service from managers to supervisors, other service

provider and patientprovider and patient Self-expressionSelf-expression so that managers consider their views when so that managers consider their views when

making discussion.making discussion.

Providers’ needsProviders’ needs

A theoretical model of patient satisfaction

Expectations

Disconfirmation

Satisfaction

Emotions

Attributionof cause

Equity

Perceived attributeperformance

COGNITIVE

AFFECTIVE

CONCEPTUAL MODELCONCEPTUAL MODEL

Socio-EconomicFactors of Patients

Education

Occupation

Income

Utilization of Hospital

SATISFACTION OF PATIENTS

GoodInterpersonalRelationship

Prompt andEfficient

Treatment

Amenities of Adequate Quality

Patient's Choice

Revenue

FACTORS INFLUENCING PATIENT SATISFACTIONFACTORS INFLUENCING PATIENT SATISFACTION

PATIENTSATISFACTION

Quality& Competency of

providers

Availability & Skillof Health Care

Providers

Effectiveness of CareAppropriateness of Care

Continuity of Care

Information &

Explanation

InterpersonalRelation

WaitingTime

Financial Expense(Out of Pocket)

Fairness

SafetySecurity

Convenientof Service

PleasantSurroundings

Amenities

SupportingMachine & Equipments

Material&

Drug Supplies

Efficiency of Outcome

Quality Health CareQuality Health Care

Quality health care consists of proper performance according Quality health care consists of proper performance according to the standard of intervention of that are known to be safe, that are to the standard of intervention of that are known to be safe, that are affordable to society and in question and that have the ability to affordable to society and in question and that have the ability to produce an impact on mortality ,morbidity and malnutrition.produce an impact on mortality ,morbidity and malnutrition.

Quality means offering the greatest health benefits, with the Quality means offering the greatest health benefits, with the least health risk, to the greatest number of people, given to the least health risk, to the greatest number of people, given to the available resourcesavailable resources

Benefit of good qualityBenefit of good quality • Safety & effectivenessSafety & effectiveness• Client satisfactionClient satisfaction • Job satisfaction for providersJob satisfaction for providers• Better program reputation and competitivenessBetter program reputation and competitiveness• Expanded access to servicesExpanded access to services

Quality definitions - generalQuality definitions - general

1. Doing the right thing

On the right rime

In the right way

At the right place

On the first time

2. Aiming to Excellency toward the customer

3. The ability of “surprise” the customer

Definitions 1Definitions 1

QC – Quality Control QC – Quality Control –assessment (evaluation) of the level

of existing performance – measuring.

QA – Quality Assurance QA – Quality Assurance –activity of bridge – the gap between

observed quality & expected quality.

Definitions 2Definitions 2

TQM – Total QualityTQM – Total Quality Management.Management.

CQI – Continuous Quality ImprovementCQI – Continuous Quality Improvement- prospective continuous process

involving all staff, that leads to higher performance, outputs & outcomes.

Provider Perspective ( Service Oriented )Provider Perspective ( Service Oriented )- Safety- Effectives- Technical Competence

Administrator Perspective ( Target Oriented )Administrator Perspective ( Target Oriented )- Technical Competence- Effectives- Efficiency- Accessibility

Patients Perspective ( Satisfaction OrientedPatients Perspective ( Satisfaction Oriented )- Safety- Effectives- Efficiency- Accessibility- Inter Personal Relation- Continuity - Amenities

Quality means different things to different peopleQuality means different things to different people

PatientPatient

ProviderProvider AdministratorAdministrator

Customer SatisfactionCustomer Satisfaction

ComplaintsManagement

MonthlyFeedback

Customer ServiceLevel Trending Surveys

Complaints Trending & Analysis Report by

DQM on Quarterly basis

Compilation of FeedbackBy Communications

Department

Customer Service levelTrending survey Conducted

onQuarterly Basis byCorporate Affairs

Discussion at MonthlyFeedback Meeting with

CEO

Implementation Of actionplans by Departments

Implementation Of actionplans by Departments

Process owners present action plans / results at Management Meeting

Process owners present action plans / results at Management Meeting

Process owners present action plans / results at Management Meeting

review

Methodology for survey

a. The structured questionnaires (feed back

forms)

b. Discharge interviews

c. Suggestion/Complaint boxes

d. Periodic meetings with the public

Evaluation Through Patient Satisfaction SurveyEvaluation Through Patient Satisfaction Survey

- Simple to understand, with yes or no type answers (or)

- Multiple answers (very good/ good/ fair/ satisfactory/poor)

- For ticking the appropriate one- Survey should cover outpatients /inpatients- Details of patient name, R/N, ward, D.O.A,

D.O.D- Signed by the patient

a.The structured Questionnairesa.The structured Questionnaires

- Face to face interviews- Important feedback is known immediately- At the right level for initiating timely action

eg.Discharge Parade in S.P.H by medico.social worker

b. Discharge Interviewsb. Discharge Interviews

- Very useful feedback from the patients/relatives/visitors.

- Boxes placed at reception,OPD,waiting areas, wards, X-ray Dept, Lab, Blood Bank,…..ect..

- Opened every day/once a week/month at fixed timing

- Put up to the management for further action

c. Complaint/Suggestion Boxesc. Complaint/Suggestion Boxes

- Scheduled after due announcements- The community gets the message the hospital

is sincere about improving the services- Suggestions/Points from the public

discussed to understand noted down for action

- Record of meetings,important points discussed and follow up action,should be maintained

d. Periodic Meetings With The Publicd. Periodic Meetings With The Public

- Processed at the earliest- Involve the collection,compiling,analysis,Investigations- To find out likes/dislikes (or) expectations of the

patients- to improve the services to meet the patients’

requirements- Positive feedback/Negative feedback- Speed of processing the feedback is important for

prompt action and right impact- To understand the true value of the feedback and

derive the right conclusions

Processing of the survey feedbackProcessing of the survey feedback

- Communication to the respondent in writing/telephone/personal interview

- Ensuring that a corrective action has been implemented

Feedback to the respondents about the action takenFeedback to the respondents about the action taken

Dissemination of Information to the staffDissemination of Information to the staff- The purpose of survey would be defeated if

the staff are not given the feedback at the earliest possible

- Not given the feedback at the earliest possible- Detailed action plan for eliminating the

deficiencies- In the periodic staff meetings communicated

publically

- Discussed in detail in the presence of all the heads of

department (SMO meeting)

- Policy decisions , Resource allocation

- Reviewed and targets reset for the next period.

Periodic (Quarterly) Review of the Satisfaction LevelPeriodic (Quarterly) Review of the Satisfaction Level

- Feedback from the patients/public, through an on

going program of patient satisfaction survey

- Very effective tool for improvement of quality of

services and level of satisfaction of patients

SummarySummary

Sanpya Hospital ThingangyunSanpya Hospital Thingangyun

Suggestion BoxesSuggestion Boxes

Discharge ParadeDischarge Parade

Discharge InterviewsDischarge Interviews

8 Ways to Improve Patient Satisfaction, 8 Ways to Improve Patient Satisfaction,

Patient Experience And (By The Way) Patient Experience And (By The Way)

HCAHPS ScoresHCAHPS Scores

(Hospital Consumer Assessment of (Hospital Consumer Assessment of

Healthcare Providers and Systems)Healthcare Providers and Systems)

1.1. If you want to stem patient dissatisfaction, If you want to stem patient dissatisfaction,

stop giving off cues of indifference and stop giving off cues of indifference and

uncaring.uncaring.

2.2. Strive actively to experience your care the Strive actively to experience your care the

way that your patients do.way that your patients do.

3.3. Get every employee thinking about purpose, Get every employee thinking about purpose,

not just functions.not just functions.

4. “Sorry” may be the hardest word, but it’s a 4. “Sorry” may be the hardest word, but it’s a

word that everyone on your team needs to word that everyone on your team needs to

learn.learn.

5. Teach your employees-every single one-5. Teach your employees-every single one-

how to handle a patient or family member’s how to handle a patient or family member’s

complaint or concern.complaint or concern.

6. If you want to improve,strive to create a 6. If you want to improve,strive to create a

blame-free environment.blame-free environment.

7. Understand that improving patient 7. Understand that improving patient

satisfaction is about systems just as much satisfaction is about systems just as much

as it is about smiles.as it is about smiles.

8. Benchmark outside healthcare.8. Benchmark outside healthcare.

Horses for courses

• Micro-level: service quality improvement– professionals and managers need to know where

to focus (ratings) and how to improve services (reports)

– need information on what is important, as well as the most satisfying/dissatisfying

• Macro-level: public accountability– need for a parsimonious set of indicators– evidence (limited) of superiority of ratings

KEY POINTS•• Physicians can find ways to improve the

doctor-patient relationship by examining what works in other fields, such as sales.

• When patients trust their physician, they are more likely to adhere to treatment plans and follow advice.

• Effective listening and inquiry will help you uncover patients' real needs and goals.

Concluding commentsConcluding comments• To decide on the value of patient judgements, there

is a need to know:– causes of satisfaction and dissatisfactioncauses of satisfaction and dissatisfaction– meanings and importance of quality in health caremeanings and importance of quality in health care

• In attempting to solve apparent methodological problems, a focus on reports alone raises problems of an ethical and political nature

• Need to embrace subjectivity and work to understand it to create patient-centred servicesto create patient-centred services and and a coherent theory of patient satisfactiona coherent theory of patient satisfaction

Dr. Nyunt Nyunt WaiDr. Nyunt Nyunt Wai Senior Medical Superintedent (S.P.H)Senior Medical Superintedent (S.P.H)