Patient Satisfaction: The Australian Patient Perspective
Henderson, Amanda, Caplan, Gideon, Daniel, Ann, Australian Health Review
The literature reveals little Australian academic study of the phenomenon of patient satisfaction and identifies several problems in current research practice. A theoretical discussion about the phenomenon of 'patient satisfaction' is for the most part absent, the rigour in the methods applied is often dubious, a definition of patient satisfaction is not agreed and the patient experience is often not the focus of research. To address some of these issues inductive research was conducted with Australian patients to explore what they considered important for patient satisfaction to exist. A series of 52 interviews were conducted with twenty elective surgery patients in an Australian teaching hospital. Patients were interviewed on admission to hospital, within one week of discharge from hospital and between six and eight weeks after discharge. Research with patients identified 16 themes that were important to make a patient's hospital stay satisfactory. Qualitative data have provided a foundation to better understand what 'patient satisfaction' means in its everyday use. Such an approach is faithful to the concerns and priorities of the patients who are the users of health care services.
Despite the fact that patient satisfaction research has been conducted for decades, several issues still exist. Aharony and Strasser (1993) identify the following problems in patient satisfaction research: an absence of theoretical discussion about the phenomenon of 'patient satisfaction', no standardised approach, few comparative studies, and a lack of consensus by medical staff that satisfaction is an assessment of quality of care. Carr-Hill (1992) documents many of the methodological issues that have plagued patient satisfaction studies including: inadequate underlying patient satisfaction theory, who is interviewed-choice of populationtiming of interviews, data collection methods, the evaluation and rating methods, characteristics of samples are rarely compared and the reliability of results. While many gaps are reported to exist in the methods used to research patient satisfaction there is also little known about what effect results have on organisations. After reviewing 221 patient satisfaction studies, Hall and Dornan (1988) concluded that little was known about how the data collected were actually used. In part it seems there is no direct correlation between patient satisfaction and improved outcomes (Aharony & Strasser, 1993). Following their extensive review of patient satisfaction literature, Draper and Hill (1995) conclude that there is a lack of expertise in design, execution and little evidence of action on results in current patient satisfaction research. They also report that while there has been considerable research on people's views of health services in the United Kingdom and the United States since the 1970s, there has been little comparable research completed in Australia (Draper & Hill, 1995).
Whose perspective is being measured in patient satisfaction research is rarely clarified. Carr-Hill (1992, p.245) observes that the questionnaire method, which is the most commonly used method to obtain information about patient satisfaction, '...obtains replies to a series ofpre-set questions, not the patients' considered (or spontaneous) views on the issues which concern them whether as current users or as members of the public.' The patients' priorities are often omitted and questions are fashioned by the health practitioners' perceptions and definitions of good practice. One assumption has been that patients do not have either the knowledge or expertise to evaluate their care. Aharony and Strasser (1993) suggest that those who doubt the value of quality indicators, such as patient satisfaction, believe that patients lack expert knowledge to assess the technical competence of medical staff. However, patient satisfaction is one dimension used to measure the quality of health care delivery in Australian hospitals and, unlike measuring health outcomes, (which obviously benefit from some technical skill in their evaluation) patient satisfaction does not require previous expert knowledge or skills. …