GUIDELINES FOR PATIENT SATISFACTION QUESTIONNAIRE WP7

Transcription

1 DAYSAFE is co-funded by the European Commission under the Programme of the Community Action in the field of Public Health Grant Agreement DELIVERABLE N 9 GUIDELINES FOR PATIENT SATISFACTION QUESTIONNAIRE WP7 Period covered: from M29 to M36 Month of delivery: M Submission date: 30 November 2013

2 Work Package Leader: National Institute for Health and Disability Insurance NIHDI Belgium Participating Countries: Belgium AZ Sint-Augustinus vzw - GZA Denmark Association of Danish Regions - ADR France Haute Autorité de Santé - HAS France Agence Nationale d Appui à la Performance - ANAP Hungary Europ-Med KFT - EUROPMED Italy Agenzia Nazionale per i Servizi Sanitari Regionali - AGE.NA.S Italy Azienda Ospedaliera di Padova - AOP Norway Martina Hansens Hospital MHH Portugal Administração Regional de Saude do Norte, IP ARSN Portugal Centro Hospitalar do Porto, EPE CHP Romania County Emergency Hospital, Timisoara - SCJUT Spain Catalan Agency for Health Information, Assessment and Quality - CAHIAQ 2

3 Collaborating Partner: International Association for Ambulatory Surgery IAAS * Australian Day Surgery Assocation, ADSC Ambulatory Surgery Center Assocation, ASC Belgian Association of Ambulatory Surgery, BAAS British Association of Day Surgery, BADS Danish Association of Day Surgery, DSDK Dutch Association of Day Care & Short Stay, NVDK Finnish Ambulatory Anaesthesiologists, SUOPA French Association of Ambulatory Surgery, AFCA German Association for Ambulatory Surgery, BAO Hong Kong Association of Ambulatory Surgery, HKADS Hungarian Association of Ambulatory Surgery, HAAS Indian Association of Day Surgery, IADS Norwegian Day Surgery Association, NORDAF Portuguese Association of Ambulatory Surgery, APCA Society of Ambulatory Anaesthesia, SAMBA Spanish Association of Major Ambulatory Surgery, ASECMA Swedish Association of Day Surgery, SADS * The IAAS is an international scientific society whose membership brings together the National Societies representing all professional figures involved in the day surgery process from all over the world. 3

4 INDEX 1 HOW TO MEASURE PATIENT SATISFACTION Pag. 5 2 REFERENCES Pag. 9 Appendix A Available instruments: Pag. 11 the WARWICK PATIENT EXPERIENCE NETWORK Pag. 12 the PATIENT SATISFACTION QUESTIONNAIRE (PSQ) Pag. 23 Long-Form PSQ-III Pag. 24 Short-Form PSQ-18 Pag. 29 4

5 1 HOW TO MEASURE PATIENT SATISFACTION Most industries delivering services or products have been paying attention to customer satisfaction for decades. Health care is the only large industry that for years has left the customer out of it, on the belief that patients do not have the knowledge and skills to understand what is going on inside themselves and between them and the providers. The medical culture maintains that health care is unique and the only people trained well enough to really understand what is supposed to happen are the doctors. But this stance does not make any sense from a moral, ethical, political, and professional viewpoint. In a democratic society where most conditions are chronic and need strong involvement of patients, some of whom are highly educated, paying no attention to the opinions of the patients, and stating that their expectations are extraneous to clinical thinking is akin to live bogged down in a remote past, secluded from the flow of history. The rationale behind the decision to adopt a patient survey has multiple motives. Patient satisfaction surveys allow healthcare managers and providers to identify areas and topics for services improvement, which should result in better outcomes, both in terms of patients more pleased by the care they received, and in terms of recovered health status. These surveys have also a symbolic meaning, signalling the staff and the community that the leadership invests in quality, and therefore measures, learn about, and improve it. Another good reason to carry out patient satisfaction surveys is goodwill, i.e. the importance to gain the support of actual and potential users. Finally, surveys will also reveal practice's successes, and bring about positive reinforcement which boosts morale and willingness to do even better. In other words, the process of improving quality, can also contribute to move away from a paralyzing blame culture. Topics which should be considered for investigation include: Patient as active participant; Responsiveness of services; Customization; Continuity of care and relationships; Lived experience; Communication; Information and Support. A key principle in developing a questionnaire is Keep it simple. This means limiting your questions to the top three issues regarding: a) provision of quality health care; 5

6 b) accessibility to care; c) interaction between patients and healthcare organization and to considerate and respectful conduct with patients. The survey questions should cover each of the three areas: quality issues (i.e., how far are patients satisfied with their medical care?), access issues (i.e., how easy is to make an appointment or get a referral?), and interpersonal issues (i.e., are the physicians and staff caring and compassionate?). A survey questionnaire should be brief, clear and consistent. An in-house survey can be valid and reliable if some basic rules are followed. They entail staff-related costs, such as the time spent designing the survey instrument, selecting a sample, preparing the survey for mailing, tabulating the responses and analyzing the data. The main physical costs of a survey include paper, printing and postage. If the organization does not have in-house know-how, experts and healthcare research firms can provide tested survey questionnaires and handle the entire survey process, including data analysis. In any case, feedback to providers should be offered with the assistance of an external consultant, whose judgement can be more acceptable to staff and more balanced. A patient satisfaction survey should be carried out only if the context is ready to take coherent action with the information collected, i.e. it has embraced quality improvement and patient centeredness as core values and goals. Conducting a survey without following up on the results, might create more damage than doing nothing, i.e. worsen frustration among healthcare providers and intensify disaffection among users. Staff should be kept well informed about the process from the very beginning, letting them know approaches to sense-making and acting on the results. Improvement cannot be achieved through improvisation, or a magic wonder. Organizational leaders, managers and staff should be knowledgeable with improvement strategies, such as PDSA cycles and/or lean and six sigma techniques. Acting on every suggestion offered by patients is impractical. Issues and problems causing dissatisfaction should be prioritized together with solutions. The latter should be brought together in a coherent strategy, averting a piecemeal approach which might only have a limited impact or, possibly, as systems theory suggests, a paradoxically harmful effect. 6

7 A frequent concern of patients is waiting time in the ambulatories. A useful step toward a solution is adopting a time-analysis worksheet, which tracks patients' visits by the minute for the time a patient arrived at the office, entered the exam room, was greeted by the doctor and so on. This information allows the physicians and staff to see how they are spending their time and identify possible sources of delays. Patients tend to consider waiting time as at least or even more important than competent medical care, which is counterintuitive for most healthcare providers. Most patients place access issues at the top of their list of what makes them satisfied. The essential question, i.e. Overall, how satisfied are you with your physician? should also be asked. This is important because organizations and external stakeholders need a key summary of performance from the perspective of patients. Questions should be carefully worded, brief, easy to understand and focused. It is of the outmost importance to avoid asking biased, vague, or leading questions, or queries that incorporate two or more questions. The use of scales should be consistent, i.e. most questions on a patient satisfaction survey should be answered using a single scale, such as 10-point scales, or Likert scales (e.g., five points ranging from strongly agree to strongly disagree to strongly agree or from excellent to poor ). The latter represents the most generally used and accepted scale. At least a couple of open-ended questions should be included, like What do you like best about our practice? or What are we doing especially well? and What can we do to improve? Qualitative data from verbatim comments are very rich providing invaluable insight concerning the how and why of patients satisfaction or discontent. When examining the results, combining responses together into broad categories, for example bringing together scores for excellent and very good into one category called satisfied, should be avoided because it dilutes information. Instead a weighted score should be calculated based on each respondent score. This means, if a Likert scale has been adopted, five points for each person who said excellent, four points for very good, three points for good and so on. Socio-demographic data will help understanding which groups of patients raised a certain topic. Interviewees should be kept anonymous, because they are more likely to answer survey questions honestly if they believe their identity is protected. Patients should be able to complete their surveys in private and return them without fear of being identified. 7

8 In some cases, patients may want to provide their names, in order for a staff member to contact them about their comments or concerns, and they should be allowed to do so. Feedback from patients can be seek through various tools: phone surveys, written surveys, focus groups and personal interviews. Most practices will want to use written surveys, which tend to be the most cost-effective and reliable approach. With a written survey, practices have the option of creating a questionnaire from scratch or using a product that is already been developed by an outside vendor. Most experts recommend the latter because the product has likely been tested and validated. Doing it in-house is possible, but it is time-consuming, taxing on the practice's internal staff, and requires solid expertise. Statistical reliability, i.e. repeatability of results, is a key issue, once the instrument has been validated. Sample selection should be randomized, for example one patient every fifth starting from a random selection, and size should be large enough to allow a reasonable statistical power. Even if more costly, mailing surveys constitute a preferable option than handing them out in the office. Physically handling the surveys and being able to influence which patients receive them can introduce systematic error. Staff might be tempted to skip an irritated patient and substitute him/her with the next one, which would introduce bias. Using a drop box is not a good idea either because it is too often ignored. Data analysis and, above all, sense making represent the most difficult steps of the survey process. Strong expertise in database-management and analytic skills are preconditions for carrying out a solid investigation. However, these are still not enough without professionals who have direct experience of services delivery and a capacity to conceptualize this topic and explain the implications of the results. Otherwise an organization runs the risk to end up with a stack of surveys that are never analyzed adequately. 8

9 2 REFERENCES Abramowitz S., Cote A., Berry E. (1987), Analyzing patient satisfaction: a multianalytic approach. Qual rev Bull, Vol. 13: Arah O. A., Westert G. P., Hurst J., Klazinga N. S. (2006), A conceptual framework for the OECD Health Care Quality Indicators Project. International Journal for Quality in Health Care; Vol. 18: Brown A.D., Sandoval G.A., Murray M. (2008), Comparing patient reports about hospital care across a Canadian US border, International Journal for quality in Health Care; Vol. 20 (2): Bruster S, Jarman B, Bosanquet N, Weston D, Erens R, Delblanco T. (1994), National survey of hospital patients. BMJ; Vol. 309: Calnan M. (1988), Towards a conceptual framework of lay evaluation of health care. Soc Sci Med; Vol. 27: Charles C., Gauld M., Chambers L., O'BrienB., Haynes R.B., Labelle R. (1994), How was your hospital stay? Patients' reports about their care in Canadian hospitals. CAN MED ASSOC J; Vol. 150 (11): Cheng S., Yang M., Chiang T. (2003), Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care, International Journal for Quality in Health Care; Vol. 15 (4): Cleary PD (1999), The increasing importance of patient surveys. British Medical Journal, Vol. 319: Coulter A. (2006), Trends in patients experience of the NHS. Picker Institute Europe. Coulter A., Fitzpatrick R., Cornowell J. (2009), The point of care. Measures of patients experience in hospital: purpose, methods and uses. The King s fund, July. Coulter A., Jenkinson J. (2005), European patients views on the responsiveness of health systems and healthcare providers. European Journal of Public Health; Vol. 15: Crow R., Gage H., Hampson S., Hart J., Kimber A., Storey L., Thomas H. (2002), The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature, Health Technology Assessment; Vol. 6 (32). 9

10 González N., Quintana J.M., Bilbao A., Escobar A., Aizpuru F., Thompson A., Esteban C., San Sebastián J. A., De La Sierra E. (2005), Development and validation of an in-patient satisfaction questionnaire, International Journal for Quality in Health Care; Vol. 17 (6): Guldvog B. (1999), Can patient satisfaction improve health among patients with angina pectoris? International Journal for Quality in Health Care; 11: Hudak P.L., McKeever P., Wright J.G. (2003), The metaphor of patient as customers: implication for measuring satisfaction, Journal of Clinical Epidemiology, Vol. 56: Jenkinson C., Coulter A., Bruster S. (2002), The picker patient experience questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health care; Vol. 14: Pilpel D. (1996), Hospitalized patients satisfaction with caregivers conduct and physical surroundings. J Gen Intern Med; Vol. 11: Shackley P., Ryan M. (1994), What is the Role of the Consumer in Health Care? Journal of Social Policy, Vol. 23: Sitzia J, Wood N. (1997), Patient satisfaction: a review of issues and concepts. Social, Science and Medicine; Vol. 45 (12): Westaway M. S., Rheeder P., Van Zyl D. G., Seager J. R. (2003), Interpersonal and organizational dimensions of patient satisfaction: the moderating effects of health status. International Journal for Quality in Health Care, Vol. 15 (4): World Health Organization (2000), The World Health Report Health Systems: improving performance. Geneva. 10

11 Appendix A Available instruments: the Warwick Patient Experience Network and Patient Satisfaction Questionnaire (PSQ) 11

12 THE WARWICK PATIENT EXPERIENCE NETWORK UK and US healthcare and academic institutions have developed survey instruments, which are widely used beyond their respective borders. Two of these are included below, together with abridged comments, which explain their meaning and use. Developing and Implementing NICE Guidance on Patient Experience Table of contents 1. Introduction 2. The need for guidance 3. Warwick Patient Experiences Framework 4. NICE Guidance 5. NICE Quality Standard 6. Importance of patient involvement in guideline development 7. Implementing the NICE guidance on patient experience 8. NICE Implementation Support 9. Collaborative patient and public involvement in implementation 10. Conclusions 11. References Sophie Staniszewska, RCN Research Institute, University of Warwick, with Ian Bullock, Liz Avital, Norma O Flynn, National Clinical Guidelines Centre, Royal College of Physicians Introduction Patient experience has become a key component of good quality care, reflecting a long tradition of research and policy initiatives, which have emphasised the importance of patient-centred care. The article considers the research and policy context that have driven patient experience up the agenda, summarises the development of the Warwick Patient Experience Framework, before presenting the development and discussing the implementation of the NICE guidance and quality standards, which are published as Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult NHS Services. 12

13 The guidance and quality standards are the first of their type and as such represent a landmark in the history of patient experience initiatives, with potential international transferability to other healthcare providers. Background The development of interest in patient experience has a long history, originating in the 1950 s and 1960 s in the United States, the UK and other countries. Early studies explored concepts such as patient satisfaction, less commonly used now to capture patient evaluations of care, with its limitations more fully understood The importance of patient perspectives was recognised as early as 1974 by the eminent epidemiologist Richard Doll, who emphasised the importance of evaluating the social acceptability of care, alongside evaluations of clinical effectiveness and economic efficiency. He stated There is no point providing a health service that is effective and cheap, if no-one wants it, emphasising the importance of finding out what patients think about their care6. Early research gradually expanded into a significant body of international research, which now contains a range of approaches to evaluating patient experience7. As other papers in this Journal demonstrate, patient experience as a field of research and practice has truly come of age. Although patient experience is recognised as important, conceptual and methodological challenges exist. A common problem is the normative effect, where patients evaluate their care positively, even when their care has been poor, leading to a possible underestimation of such care. There is still an important need to develop instruments, which are able to mitigate some of these social effects and so capture the full range of positive and negative evaluations of care.8 Warwick Patient Experiences Framework The development of the guidance included a review of existing patient experience frameworks. It was not always clear how well patient experience frameworks were supported by research evidence, or the extent to which the frameworks reflect patient-identified experiences, as opposed to those identified by researchers and clinicians (14, 16). As a result, a scoping study was commissioned to develop a framework with very clear links to the evidence base, capturing generic themes and sub-themes of experiences (for example, different aspects of information provision). The framework was then tested 13

14 for its validity and acceptability by the guideline development group, including six patient representatives. The scoping study aimed to: Identify generic themes and sub-themes of patient experience in three clinical areas: cardiovascular disease, diabetes and cancer, all areas of significant disease burden. Use the themes and sub-themes identified in the three clinical areas to develop an overall generic patient experiences framework that has relevance for all patients. NICE then produced an evidence table of generic themes and sub-themes for each clinical area. A thematic synthesis was carried out which drew the themes together into one overarching generic framework (16). It is important to recognise that this scoping study was a focused thematic qualitative overview, as a pragmatic review of the literature was needed given the timescale of guideline development. Some elements of systematic reviewing were adopted (for example, development of search strategies, identification of papers through inclusion and exclusion criteria and extraction of data from papers (Centre for Reviews and Dissemination Guidance 2009). The full methods and results are reported elsewhere (14,16). Table 1 shows the key dimensions developed for the Warwick Patient Experiences Framework. Table 1 The Warwick Patient Experiences Framework: Generic theme Patient as active participant Responsiveness of services - an individualised approach Continuity of care and relationships Lived experience Communication Information Support A full description of each dimension is included elsewhere (14,16). These themes provided an architecture around which the content of the patient experience guideline was developed. This is described more fully in the next section. 14

15 NICE Guidance To develop the guidelines, NICE recruited a Guideline Development Group (GDG) consisting of healthcare professionals and patients. In developing the Patient Experiences Guidance, the GDG drew on a range of evidence and information in order to establish what is important to patients when considering their experience of healthcare (14). In addition to the scoping study which produced the Warwick Patient Experience Framework, key sources were: 1. Review of existing patient experience frameworks 2. Review of NHS survey results 3. Review of existing NICE recommendations related to patient experience 4. Systematic reviews of the literature on prioritised topic areas Drawing on these sources, the GDG worked in collaboration to achieve consensus through the development of specific recommendations which took into account: Existing NICE recommendations related to patient experience in the area they wish to make generic recommendations Selected systematic literature reviews for specific interventions that may improve patient experience (14) See Figure 1 for a graphical representation of the synthesis of evidence, taken from NICE Guidance. 15

16 Figure 1 A summary of evidence sources for the development of the Patient Experiences Guidance 16

17 Through a process of consensus, the GDG further refined the dimensions contained within the Warwick Patient Experience Framework to generate the final high level themes, which framed the Guidance to ensure it was structured in a way that focused on practical recommendations for professionals. The dimensions in the NICE Guidance are: Knowing the patient as an individual Essential requirements of care Tailoring healthcare services for each patient Continuity of care and relationships Enabling patients to actively participate in their care Within each of these dimensions, a set of recommendations was developed. A detailed description of each of these dimensions and their accompanying recommendations is contained in the Guidance (14). NICE Quality Standard The quality standard defines best practice for the delivery of excellent patient experience. The intention is to deliver specific, concise statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care (14). By nature these statements are aspirational. The aim of this quality standard is to provide the NHS with clear commissioning guidance on the components of a good patient experience, embedding this as a key priority within the commissioning outcomes framework. The quality standard gives evidence-based statements for commissioners that provide the foundation for a cultural shift towards a truly patient-centred service. 17

18 Table 2. NICE Quality Standard on Patient Experiences No. Quality statements 1 Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty. 2 Patients experience effective interactions with staff who have demonstrated competency in relevant communication skills. 3 Patients are introduced to all healthcare professionals involved in their care, and are made aware of the roles and responsibilities of the members of the healthcare team. 4 Patients have opportunities to discuss their health beliefs, concerns and preferences to inform their individualised care. 5 Patients are supported by healthcare professionals to understand relevant treatment options, including benefits, risks and potential consequences. 6 Patients are actively involved in shared decision making and supported by healthcare professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them. 7 Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported. 8 Patients are made aware that they can ask for a second opinion. 9 Patients experience care that is tailored to their needs and personal preferences, taking into account their circumstances, their ability to access services and their coexisting conditions. 10 Patients have their physical and psychological needs regularly assessed and addressed, including nutrition, hydration, pain relief, personal hygiene and anxiety. 11 Patients experience continuity of care delivered, whenever possible, by the same healthcare professional or team throughout a single episode of care. 12 Patients experience coordinated care with clear and accurate information exchange between relevant health and social care professionals. 13 Patients preferences for sharing information with their partner, family members and/or carers are established, respected and reviewed throughout their care. 14 Patients are made aware of who to contact, how to contact them and when to make contact about their ongoing healthcare needs. 18

19 Importance of patient involvement in guideline development The Patient and Public Involvement Programme (PPIP) at NICE provides advice and support to NICE on patient, carer and public involvement. The PPIP currently works with NICE to develop opportunities for involving patients, carers and members of the public across all NICE s work programmes. The Patient Experience Guidance Development Group included six patient representatives, significantly more than usual in guideline development. While NICE processes were followed, some elements were adapted. Because of the particular focus of the guidance and the large number of patients involved, INVOLVE ways of working were used to support the development of a collaborative and respectful working style, which valued all contributions to the process. Implementing the NICE guidance on patient experience The existence of NICE Guidance on patient experience does not automatically guarantee adoption and implementation. As Seers et al (17) state despite significant investment, translating research in to healthcare decision making and practice remains a considerable challenge. Seers et al (17) point to numerous examples of attempts to implement evidence into practice; with mixed success. Such uneven progress in implementing evidence in practice relates to the complexity of the process, which can involve change at many levels and depends on a range of factors that can influence uptake (18). The complexity of implementation can be even more challenging when, like the NICE Patient Experiences Guidance and Quality Standard, the guidance is complex and contains an extensive range of required changes, including those at individual, organisational and at professional level. NICE Implementation Support To support implementation, NICE has established a programme which works alongside guideline developers, the communications team and field based teams to ensure the guidance is disseminated throughout the NHS, local government and the wider community. The Implementation team also provide tools to support implementation of NICE Guidance. NICE produced a document which provides support for commissioners and others using the NICE guidance and quality standard on patient experience in adult NHS services (19). This provides information about patient experience, the policy context, why it is important, 19

20 how it can be measured and how commissioners can incorporate it into all aspects of commissioning, including contract management, service delivery and incentive schemes. NICE encourage commissioners to use the Patient Experience Guidance in a range of ways. For example, it can be used as one of the factors used to judge tenders for services (19). Commissioners could ask for evidence that demonstrates that the provider has systems in place for collecting and using information about patient experience. Commissioners could use some or all of the NICE guidance and quality statements in their contracts, and stipulate the frequency for gathering and reporting measures with providers (19). NICE also state that commissioners should audit local practice and can incentivise improvements to patient experience by using the CQUIN scheme. They should ensure that all CQUIN schemes have a focus on patient experience. Commissioners could also ensure that providers collect information about patient experience across the whole service pathway, from referral to post-discharge. Commissioners should also describe how to manage examples of poor patient experience. Providers and commissioners ought to be made aware of any problems so that they can take action to improve services (19). Such support provides practical advice for embedding the NICE Guidance. Any commissioner or provider involved in embedding the NICE Guidance within their organisation must draw on the implementation evidence base in developing their strategy, in recognition of the complexity involved in changing practice (17, 20-23). One way forward would be to draw on existing implementation frameworks to provide a context for thinking through key elements of an implementation strategy. A range of implementation frameworks exist (20). One of the key frameworks is the Promoting Action on Research Implementation in Health Services (PARIHS) framework, which demonstrates the complex interplay of a number of factors that influence the successful implementation of evidence in practice (20-23). Successful implementation is represented as a function of the nature of evidence being implemented, the context in which implementation takes place, and the way in which that process is facilitated. The PARIHS framework has been used by others as a heuristic to guide implementation efforts at the point of care delivery (17) and so has important applicability for the NICE Patient Experiences Guidance. Ideally, the PARIHS framework would be used within a research study to test different ways of implementing the NICE Patient Experiences Guidance, in order to identify the most effective forms of implementation. In the absence of such formal research studies, the core thinking which 20

21 underpins the PARIHS framework may be useful for practitioners, commissioners and providers when they plan their implementation strategy. Even being aware of the three key concepts of the PARIHS framework, evidence, context and facilitation could provide an initial conceptual structure to underpin the development of an implementation strategy. Collaborative patient and public involvement in implementation The NICE Patient Experience Guidance was developed on the basis of collaborative involvement which aims to ensure true partnership and equal power in discussions and decision-making at a local level, ensuring everyone has the opportunity to shape thinking and debate. This approach can also be used in the implementation of research evidence or guidance. We would propose a collaborative form of patient and public involvement is used in the development of implementation strategies locally. Patients and patient organisations have a vital role to play in developing such strategies and in implementing them in a range of ways, including at an individual level when they have a consultation with their doctor or nurse. Conclusions The NICE Patient Experience Guidance and Quality Standard provides a unique opportunity to implement cultural, attitudinal and behavioural changes in healthcare provision, in order to provide the best possible experience for all patients. We hope to encourage others to contribute to the debate about the most effective forms of implementation and to work together to create truly patient-centred care. 21

22 References 1. Carr-Hill R: The Measurement of Patient Satisfaction. J Pub Health Med 1992;14(3): Fitzpatrick R. Scope and Measurement of Patient Satisfaction. In: Fitzpatrick R, Hopkins A, editors. Measurement of Patients Satisfaction with their Care. London: Royal College of Physicians, p Pascoe G. Patient Satisfaction in Primary Care: a Literature Review and Analysis. Eval Prog Plann 1983;6: Strasser S, Aharony L, Greenberger D. The Patient Satisfaction Process: Moving Toward a Comprehensive Model. Med Care Rev 1993;50: Williams B. Patient Satisfaction: A Valid Concept? Soc Sci Med 1944;38: Doll R: Surveillance and Monitoring. Int J Epidemiol Dec;3(4): Crow R, Gage H, Hampson S et al: The Measurement of Satisfaction with Healthcare: Implications for Practice from a Systematic Review of the Literature. Health Technol Assess 2002;6: Staniszewska S, Henderson L: The Complexity of Patient Evaluation The Influence of Contextual Factors and the Importance of Engagement. Journal of Advanced Nursing, 2005, 49 (6):

23 THE PATIENT SATISFACTION QUESTIONNAIRE (PSQ) The Patient Satisfaction Questionnaire (PSQ), consisting of 80 items, originally developed by Ware and his colleagues (Ware, Snyder, and Wright, 1976), and a more recent version of the questionnaire, i.e. the PSQ-III, are available below. The PSQ-III is a 50-item survey that taps global satisfaction with medical care as well as satisfaction with six aspects of care: technical quality, interpersonal manner, communication, financial aspects of care, time spent with doctor, and accessibility of care. More detailed information can be found at including a note on scoring the PSQ-III. It provides background information, results of psychometric analyses, and scoring rules for measures constructed from the periodic satisfaction surveys. The PSQ-18 is a short form version that retains many characteristics of its full-length counterpart. The PSQ sub-scales show acceptable internal consistency reliability. Furthermore, corresponding PSQ-18 and PSQ-III subscales are substantially correlate with one another. The PSQ-18 may be appropriate for use in situations where the need for brevity precludes administration of the full-length PSQ-III. The PSQ-18 takes approximately 3-4 minutes to complete. 23

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