Mar 16, 2015 - David Sugarbaker, MS, MPH .... Bell M, Fiszdon J, Richardson R, Lysaker P, Bryson G. Are self-reports valid for schizophrenia patients with ...
What's Driving Patient Satisfaction in Inpatient Hospitals? - Print Article
7/19/16, 12:40 PM
Doug Cort, PhD David Sugarbaker, MS, MPH Scott Zeller, MD
March 16, 2015
What's Driving Patient Satisfaction in Inpatient Hospitals? Share this content: facebook twitter linkedin google Comments Print Patient satisfaction is widely recognized as a central indicator of service quality and care received by patients.1,2 Thus, patient satisfaction surveys are often used for benchmarking purposes at hospital, state, and national levels.3,4 In conjunction with other measures, health care organizations commonly use patient satisfaction outcome data to justify the implementation of quality improvement programs.2 At state, national and international levels, patient satisfaction data are gradually influencing major shifts in health care policy and quality of care reforms in medical and psychiatric settings.3,4
What's Driving Patient Satisfaction in Inpatient Hospitals?
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What's Driving Patient Satisfaction in Inpatient Hospitals? - Print Article
7/19/16, 12:40 PM
As a subjective quality indicator, patient satisfaction reflects “the extent to which services gratify the patient's wants, wishes or desires for treatment,” 5 from the patient's perspective. Thus, patient satisfaction data places patients' personal treatment needs and perspectives in the foreground with objective indices of successful treatment outcome, for example, symptom improvement.2,4,6 To those concerned with improving mental health care quality, patient satisfaction –– as a focus of research, a patientreported clinical outcome,7 and a predictor of good prognosis8–– should be of great interest. It seems likely that patient satisfaction will be an important measure in research aimed at improving the quality of mental health care. Yet, among providers of psychiatric inpatient care, skeptical opinions about the validity, reliability, and utility of inpatient satisfaction data are widespread.
Skepticism About Inpatient Satisfaction Psychiatric health care providers frequently presuppose that inpatient satisfaction data, especially when gathered from inpatients with psychotic disorders, are unreliable and invalid due to poor insight, a characteristic feature of the illness.7 Ostensibly this perspective is plausible: A patient who lacks awareness of his or her mental illness would have difficulty grasping the purpose and necessity of psychiatric treatment and accurately self-assessing treatment effects.9 In this way, poor insight complicates the measurement of patient satisfaction.7 However, although poor insight complicates the measurement of inpatient satisfaction, it doesn't invalidate it.3,7,9 In fact, there is good evidence to the contrary. Psychiatric hospitals that have implemented satisfaction surveys are finding that psychiatric inpatients can tell them if and to what extent they are satisfied. Poor insight, though, may frequently prevent inpatients from identifying why they are satisfied, or articulating a coherent rationale for their satisfaction ratings.9 Further complicating the measurement of satisfaction is that it may depend as much on the characteristics of staff and quality services delivered as on the illness and personality characteristics of the patients receiving care.5,8 Provide any ten psychiatric inpatients the same quality services from the same staff, and self-reported satisfaction scores may vary from one extreme to the other. High variance between and within study findings on inpatient satisfaction6 has been frequently reported and seems to have http://www.psychiatryadvisor.com/whats-driving-patient-satisfaction-in-inpatient-hospitals/printarticle/403746/
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What's Driving Patient Satisfaction in Inpatient Hospitals? - Print Article
7/19/16, 12:40 PM
left many researchers and inpatient clinicians unsatisfied with just knowing if and to what extent inpatients are satisfied; they want to know why. To understand the determinants of inpatient satisfaction, researchers have found they must look beyond satisfaction surveys to explore the underlying patient, illness, and treatment related variables linked to patient satisfaction.7
Identifying and Understanding the Determinants of Inpatient Satisfaction Identifying and understanding the relationships between patient, illness, and treatment variables and patient satisfaction may, in some settings, be a prohibitively costly and time-consuming endeavor. Yet currently, at John George Psychiatric Hospital in San Leandro, Calif., clinical psychology doctoral students are undertaking research in this area as part of their clinical training.
Along with the capability to access patient data from electronic medical records (EMRs), these researchers are also conducting clinical interviews with inpatients, at admission and at discharge, using the Brief Psychiatric Rating Scale Expanded Version (BPRS-E)10 and administer a 10 item self-report satisfaction measure, the Rome Opinion Questionnaire for Psychiatric Wards (ROQPW), to these same inpatients at discharge.11 While the BPRS-E has been shown to be sensitive to symptom changes over the course of an acute psychiatric admission,12 the ROQPW consists of three factors that measure the professional qualities of staff, information received by the patient, and the physical environment of the unit.11 The John George Hospital sample (N = 125, so far) comprises inpatients diagnosed with affective and non-affective psychotic disorders. At admission to John George Hospital, the mean BPRS-E total score for the sample is suggestive of severe psychopathology,13 while the mean BPRS-E change score demonstrates significant symptom improvement.14 At discharge, the mean BPRS-E total score signifies sub-acuity and is similar to BPRS-E scores reported in studies of outpatient populations with psychotic disorders.14 Continue Reading Below While the John George sample was highly satisfied as measured by the ROQSW total score, the general trend shows that total satisfaction does not correlate with BPRS-E admission or discharge total scores. Furthermore, overall symptom improvement, one of the most trusted outcome measures of successful treatment, was not significantly associated the total mean ROQSW satisfaction score at discharge. As the data reduction process unfolds, the researchers are finding that the determinants of inpatient satisfaction are complex and multidimensional.
Conclusions Researchers will continue to uncover the determinants of satisfaction by dismantling satisfaction data in large samples and then testing satisfaction components for associations with patient, illness, treatment and provider variables, easily stored and accessed in EMRs. Determinants of satisfaction are likely broad, ranging from characteristics of the patients, providers, treatment processes, and therapeutic relationships, to the ward atmosphere, the clinical built environment, and social phenomena, such as mental illness stigma. After decades of research on patient satisfaction, we have just begun to make strides in understanding the complex underpinnings of satisfaction among psychiatric inpatients. What we do know is that patient satisfaction is associated with numerous positive health outcomes, including quality of life and good prognosis.8 As a construct, the meaning of patient satisfaction is not yet fully understood. However, we are confident it will be revealed as researchers continue to uncover the http://www.psychiatryadvisor.com/whats-driving-patient-satisfaction-in-inpatient-hospitals/printarticle/403746/
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What's Driving Patient Satisfaction in Inpatient Hospitals? - Print Article
7/19/16, 12:40 PM
underlying determinants of patient satisfaction. David Sugarbaker, MS, MPH, is a clinical psychology doctoral candidate at Stanford University and a clinical intern at John George Psychiatric Hospital. Doug Cort, PhD, is a psychologist in private practice in Vallejo, Calif. Scott Zeller, MD, is Chief of Psychiatric Emergency Services at Alameda Health System in Oakland, California, and past president of the American Association for Emergency Psychiatry. He is also a member of the Psychiatry Advisor editorial board.
References 1. Glorimar O. Examining patients' perceptions of care to identify opportunities for quality improvement in psychiatric inpatient hospitals. The Patient – Patient Centered Outcomes Research. 2014;7(3):301–312. 2. Shipley K, et al. Patient satisfaction: A valid index of quality of care in a psychiatric service. Acta Psychiatrica Scandinavica. 2000; 101(4):330–333. 3. Eisen SV, et al. Assessing consumer perceptions of inpatient psychiatric treatment: The perceptions of care survey. Joint Commission Journal on Quality Improvement. 2002; 28:510–526. 4. Ozaltin E, et al. How does satisfaction with the health-care system relate to patient experience? Bulletin of the World Health Organization. 2009;87(4):271–278. 5. Lebow JL. Research assessing consumer satisfaction with mental health treatment: A review of findings. Evaluation and Program Planning. 1983;6(3–4):211–236. 6. Gebhardt S, et al. Patient satisfaction and clinical parameters in psychiatric inpatients—the prevailing role of symptom severity and pharmacologic disturbances. Comprehensive Psychiatry. 2013; 54(1):53–60. 7. Nordon C, et al. Determinants of treatment satisfaction of schizophrenia patients: Results from the ESPASS study. Schizophrenia Research. 2012; 139(1–3):211–217. 8. Berghofer G, et al. Satisfaction of inpatients and outpatients with staff, environment, and other patients. Psychiatric Services. 2001;52:104–106. 9. Bell M, Fiszdon J, Richardson R, Lysaker P, Bryson G. Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments. Psychiatry Research. 2007;30:37–46. 10. Overall JE and Gorham DR. The brief psychiatric rating scale. Psychological Reports. 1962; 10:799–812. 11. Gigantesco A, et al. Quality of psychiatric care: validation of an instrument for measuring inpatient opinion. International Journal for Quality in Health Care. 2003; 15:173–78. 12. Lieberman PB, et al. Dimensions and predictors of change during brief psychiatric hospitalization. General Hospital Psychiatry. 1993; 15:316–324. 13. Colasanti A, et al. Symptom dimensions as predictors of clinical outcome, duration of hospitalization, and aggressive behaviours in acutely hospitalized patients with psychotic exacerbation. Clinical Practice Epidemiology Mental Health. 2010; 6:72–78. 14. Barnes AL, et al. Health-Related Quality of Life and Overall Life Satisfaction in People with Serious Mental Illness. Schizophrenia Research and Treatment. 2012; 2012:245103. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Your use of this website constitutes acceptance of Haymarket Media's Privacy Policy and Terms & Conditions
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