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1.1 Background Patient satisfaction (or customer satisfaction) is a term that is widely used with reference to health care. Identified as an integral factor in the evaluation of health care, the inclusion of ‘patient satisfaction’ measurements and interpretation can easily go unquestioned. In fact, quality of care reforms and health care delivery in developed countries such as the United States of America and Europe allow for an increasingly important role of patient satisfaction as an indicator (Bleich, Ö zaltin, & Murray, 2009). However, at the hospital level, many clinicians appear unconvinced of the usefulness of satisfaction measures. Since clinicians are often more concerned about treatment outcomes, their skepticism may be attributed to the belief that other indicators of healthcare quality such as how patients feel about the cost and/or accessibility of services, the food, interpersonal relationships and overall satisfaction levels are administrative issues (Hudak & Wright, 2000). Over the years, health care managers have utilized various methods, from complaint boxes to satisfaction surveys, to gather information that can be used to improve patient satisfaction. There have been many patient satisfaction studies that utilized patient satisfaction surveys, even if the focus may have been different than it is today. Some studies attempted to learn who, for example, would be more satisfied (Otani, Herrmann, & Kurz, 2011). Despite the increased focus on satisfaction as an outcome measure and the growing body of research to support it, satisfaction has remained difficult to compartmentalize. Although numerous satisfaction surveys have been developed, most with acceptable psychometric properties, it remains largely unknown the factors patients use to consider themselves satisfied (Jackson, Chamberlin, & Kroenke, 2001). Patients’ satisfaction with health care in comparison to their experience is increasing in its importance. Likewise, according to Bleich et al. (2009), the continued interest in comparing people’s satisfaction with the health system across different countries and time periods suggests the need to distinguish the relationship between them. Otani et al. (2011) suggested that it is likely that a positive experience with important factors will result in a good satisfaction overall. Conversely, if the patient had a negative experience with important factors, the overall satisfaction will be bad. The extent to which a patient’s experience explains his or her satisfaction with the health-care system remains unclear. Some experiences may very well be more influential than others to the patient in forming their overall satisfaction level.
Taipei Medical University School of Health Care Administration Master’s Thesis Patient satisfaction with inpatient services at the national referral hospital of Belize Graduate Student: Tisa C. Grant Advisor: Che-Ming Yang, M.D., J.D., Ph.D. June, 2012 I ACKNOWLEDGEMENTS I give thanks to God for the completion of this thesis requirement, for grace, mercy, and guidance throughout my time at Taipei Medical University, and for all the people and opportunities He has placed in my path on this academic journey. I have been blessed and the names are too numerous to mention. I can only hope that each individual knows who he/she is, the profound difference each made and that my sincere gratitude has been sufficiently and appropriately expressed to each one. To my advisor, Dr. Che-Ming Yang, and my committee members, thank you for your guidance, your patience, and for being firm but kind. To the management and staff of Karl Heusner Memorial Hospital (KHMH) and the survey respondents, without your help this simply would not have been possible and I thank you! To my family and dear friends for their support of this aspiration, their reassurances, assistance, encouragement and patience to the very end of this milestone, I give my heartfelt thank you. II ABSTRACT Title of thesis: Patient satisfaction with inpatient services at the national referral hospital of Belize Author: Tisa C. Grant Thesis advised by: Che-Ming Yang, M.D., J.D., Ph.D. Background - The Ministry of Health in Belize has implemented several policies and service level agreements to improve patient satisfaction country wide. Although these initiatives rely on results to appropriately measure patients’ satisfaction with the quality of care, the extent to which a patient’s experience explains his or her satisfaction with the health-care system remains unclear. Objectives - Despite what may appear to be the general consensus on health care services provided nationally, some health care experiences may very well be more influential than others to the patient in forming their overall satisfaction level. The objective of this study is to ascertain the effects that specific variables have on patients’ overall evaluation of hospital care and their intention to recommend the hospital. Methods - The HCAHPS Survey was self-administered at the national referral hospital of Belize to inpatients. Simple and multiple step-wise linear regression models were used to identify the predictor factors of patient satisfaction using, separately, the two dependent variables: “Overall evaluation of hospital care” and the “Intention to recommend the hospital”, controlling for age, gender, ethnicity, education and perceived health. Results - It was found that patient’s highest priority was communication with nurses and doctors encompassing courtesy and respect, taking the time to explain things, and listening to the patients carefully. Discussion - From the patient’s perspective, the quality of care must include not only the quality of medical care provided but also the quality of caring associated with it. Health-care managers and other decision makers may need to remind their nurses and staff members that patients are III experiencing an intensely critical and emotional moment, and thus, they need to provide patient- centered care Keywords: Patient satisfaction, inpatient, Belize, developing country IV TABLE OF CONTENT ACKNOWLEDGEMENTS I ABSTRACT II TABLE OF CONTENT IV LIST OF TABLES VI LIST OF FIGURES VII CHAPTER 1: INTRODUCTION 1 1.1 Background 1 1.2 Belize: The Healthcare System and the People 2 1.3 Statement of the Problem 5 1.4 Significance of the Study 8 1.5 Research Objectives 10 CHAPTER II: LITERATURE REVIEW 11 2.1 Definition of Patient Satisfaction 11 2.2 Development of HCAHPS Survey Instrument 12 2.3 Determinants of Patient Satisfaction 14 2.4 Clinical Staff Influence on Patient Satisfaction 15 2.5 Patient Demographic and Patient Satisfaction 16 2.6 Summary 17 CHAPTER III: METHODOLOGY 18 3.1 Conceptual Framework 18 3.2 Operational Definitions of Variables 19 3.3 Hypotheses 23 3.4 Survey Instrument 25 3.5 Study Setting 26 3.6 Study Sample 27 3.7 Data Source and Collection 28 3.8 Data Analyses 29 3.9 Ethical Consideration 34 V CHAPTER 4: RESULTS 35 4.1 Samples’ characteristics 35 4.2 Descriptions of the variables 35 4.2.1 Categorical variables description for ‘Overall evaluation of Hospital Care’ 35 4.2.3 Mean age difference between “Overall Evaluation of Hospital” and “Care Intention to recommend” 36 4.3 Univariate and multivariate analysis for predicting “Overall evaluation of hospital care” 42 4.4 Univariate and multivariate analysis for predicting “Intention to recommend” 45 CHAPTER 5: DISCUSSION 48 5.1 Hospital care factors as predictors of patient satisfaction 48 5.2 Implications of patient demographics on patient satisfaction 50 5.3 Perceived health as a predictor of satisfaction 52 5.5 Recommendations 54 5.6 Implications for further research 55 5.7 Conclusion 57 APPENDIXES 63 Appendix I – HCAHPS Survey Instrument 63 Appendix II – Ethical Approval Request Letter 70 Appendix III – Ethical Approval Letter 71 Appendix IV – Patient Consent Form 72 [...]... affects patients’ overall evaluation of hospital care Hypothesis 6 Demographics affect patients’ overall evaluation of hospital care Hypothesis 7 Self-perceived health affects patients’ overall evaluation of hospital care Hypothesis 8 Communication with nurses affects patients’ intention to recommend Hypothesis 9 Communication with doctors affects patients’ intention to recommend Hypothesis 10 The responsiveness... variables Hypothesis 1 Communication with nurses affects patients’ overall evaluation of hospital care Hypothesis 2 Communication with doctors affects patients’ overall evaluation of hospital care Hypothesis 3 The responsiveness of hospital staff affects patients’ overall evaluation of hospital care Hypothesis 4 Staff care affects patients’ overall evaluation of hospital care Hypothesis 5 The hospital... far to ultimately improve the health care services received by patients, 8 and by extension, their satisfaction All quality improvement efforts without an evaluation process to measure success are futile and who better can confirm their satisfaction but the patients themselves This survey will set the stage for future inpatient satisfaction surveys and studies at the National referral hospital and influence... global satisfaction (Danielsen et al., 2010) On the contrary, Bleich et al (2009) study of the relationship between satisfaction with the health-care system and patient experience revealed that the latter explains about 10% of the variation of patient satisfaction However, it is believed that most of the variation is explained by factors unrelated to patient experience such as patient expectations... interpersonal relationships and overall satisfaction levels are administrative issues (Hudak & Wright, 2000) Over the years, health care managers have utilized various methods, from complaint boxes to satisfaction surveys, to gather information that can be used to improve patient satisfaction There have been many patient satisfaction studies that utilized patient satisfaction surveys, even if the focus may have... part of patient satisfaction Under the ‘Quality Management Standards”, level one of subsection 2.2.1 – Quality Leadership - the inpatient facility should carry out activities intended to evaluate the quality of care The quality of professional performance, within the establishment, can be demonstrated and guaranteed by the use of patient satisfaction surveys, department specific surveys, and others Administering... definition and measurements that accurately captures patient preferences and what influences them Some studies utilize patients’ demographic variables such as age and gender but these variables are not for a manager who wants to improve on their service quality and patient satisfaction Other studies focus on health attributes and the overall patient satisfaction Others yet, found that certain attributes, such... and to protect patient s dignity through the provision of respectful care These added interpersonal skills are intended to support the complaint mechanism and to assure patients satisfaction Ensuring that patients are informed of, understand, and act when they believe their rights have been violated; as well as, ensuring that patients understand that they too have a responsibility for their health care,... evaluation of hospital care and their intention to recommend the national referral hospital of Belize 10 CHAPTER II: LITERATURE REVIEW 2.1 Definition of Patient Satisfaction The ultimate validation of quality care is patient satisfaction (Donabedian, 1997) In today’s health care realm, patient satisfaction is an important quality outcome indicator of health care, particularly in the hospital setting The. .. health status, and personality 14 2.4 Clinical Staff Influence on Patient Satisfaction Clinician negativity is believed to be associated with lower patient satisfaction, however, (Henry et al., 2012) found this result was more consistent for patient nurse interactions than patient physician interactions Yellen et al (2002) suggests that nursing influence in patient satisfaction is a particularly important . complaint boxes to satisfaction surveys, to gather information that can be used to improve patient satisfaction. There have been many patient satisfaction studies that utilized patient satisfaction. School of Health Care Administration Master’s Thesis Patient satisfaction with inpatient services at the national referral hospital of Belize Graduate Student: Tisa C. Grant Advisor:. improve patient satisfaction country wide. Although these initiatives rely on results to appropriately measure patients’ satisfaction with the quality of care, the extent to which a patient s