Assessing Patient Satisfaction: Implications for South Australian Public Hospitals

Article excerpt

Abstract

This paper reports on the results from 2620 South Australians who participated in the 2003 Patient Evaluation of Hospital Services. Patients were found to be generally satisfied with the care, services and amenities provided, with a statewide overall score of 86.3. Satisfaction was lowest in the patients' assessment of their involvement in their own care and treatment. Three demographic factors (younger age, female sex or tertiary education) predicted lower levels of satisfaction in the multivariate analysis, whereas living with others, non-emergency admission or admission to smaller hospitals were found to predict higher satisfaction. Despite administrative and organisational difficulties, and limited current evidence of increased quality or satisfaction, it is considered important to continue satisfaction research with the goal of encouraging the development of action plans for improvement of care, services and amenities.

Aust Health Rev 2005: 29(4): 439-446

FOR OVER TWENTY YEARS, satisfaction surveys have been employed by hospital systems to measure patient perceptions of care, service and amenities. However, much of the early research in this field failed to clearly define the construct. Most researchers1-4 agreed that satisfaction is a multidimensional construct consisting of: patient perception regarding the level of staff interpersonal skill and technical competence; patient access to, the availability and outcome of care and services; continuity of care; and assessment of the hospital's residential environment. Satisfaction levels do not always equate to quality of care, as they are moderated by a combination of interpersonal factors, current and former experiences, expectations, and personal and societal values.4,5 Theories proposed in patient-satisfaction research suggest that there are direct relationships between satisfaction, expectations and outcomes.3

When assessing satisfaction survey results, consideration should be given to factors associated with satisfaction scores. Research on socio-demographic characteristics has shown that most are generally considered to be poor predictors of inpatient satisfaction.6,7 However, the strongest and most consistent finding is for age, with a positive relationship between increasing age and higher levels of satisfaction.1,6-10 Lower educational level is also linked to higher satisfaction levels, however this relationship is weaker.1,7 Results for other demographic variables such as sex, income, marital status, and race tend to be inconsistent.1,4,8,9

Individual health status and hospital characteristics have also been assessed to determine whether these contributed to higher or lower satisfaction levels. Positive relationships between health status and patient satisfaction levels have been reported.7,9,11 However, some have reported this relationship holds for women only,8 while others suggested this relationship existed for mental, but not for physical, health.12 Increased hospital size was found to be negatively related to patient satisfaction.9 This finding is thought, at least in part, to be due to the differential casemix of these hospitals.13

We believe that given the lack of published literature on satisfaction in a cross-section of acute care patients in Australia, and with results from patient satisfaction surveys becoming more widely available to patients and health administrators on the Internet and other forms of media,14,15 it is important to understand the personal and institutional factors that influence satisfaction ratings. The South Australian Patient Evaluation of Hospital Services is ideally placed to inform this area of research. This paper measures satisfaction with hospital care, services and amenities in public hospitals in South Australia from the South Australian Patient Evaluation of Hospital Services. Further, it aims to identify personal, health and hospital characteristics that contribute independently to patient evaluations of hospital services in SA. …