An evaluation of a patient satisfaction survey: validity and reliability

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Abstract

Patient reports about their medical care can be an important component of quality assessment of medical services. Recently, many medical centers and health care providers have focused their attention to a consumer oriented evaluation and assessment of services. Research literature indicates that the assessment of quality of care from the patient’s perspective has been operationalized as patient satisfaction. The purpose of this report is to evaluate a southern medical center’s External Patient Satisfaction Survey instrument for validity and reliability and provide a basis that providers might use routinely and systematically to assess the quality of medical care. This article reports on the initial appraisal of content validity, factor structure, and estimated internal consistency reliability of the instrument.

Introduction

Managed health care has produced competition among providers on the basis of service level with patient satisfaction serving as an important indicator. From a clinical perspective, patient satisfaction is considered an integral and critical part of quality care (Bowman et al., 1992, Clearly et al., 1989, Ruggeri et al., 1996, van Campen et al., 1995). The interest in patient satisfaction has caused many health care providers to revisit the quality of patient satisfaction reporting and the means of obtaining satisfaction information in their organizations. Research is needed to accurately assess patient satisfaction that provides a consumer viewpoint for health care managers and clinicians who must make decisions about how to structure the care of patients (Dull et al., 1994, Russell, 1994).

Review articles assessing patient satisfaction and quality of care peaked in 1983 (van Campen et al., 1995). Reviewers identified critical problems involving the theory of patient satisfaction and the psychometric properties of existing instruments that lead to poor results. Subsequent researchers addressed these weaknesses by focusing on theory development or instrument development (Carey & Seibert, 1993, Clearly et al., 1989, Meterko & Rubin, 1990, Ruggeri et al., 1996, Williams, 1994). Theory research attempted to identify the construct of “patient satisfaction’ and discover what patients mean when they report satisfaction with medical services (Williams, 1994). Strategies for instrument development and refinement focused on choosing core items based on previous research of existing instruments and development of specific items from patient focus group interviews. According to Bowman et al. (1992), present consumer oriented instruments are very basic in design and measure only specific areas of health care, and therefore, have limited use. Further, there have been minimal efforts in the refinement and evaluation of psychometric properties of instruments using different modes of administration, such as mail and telephone surveys.

Nevertheless, research evaluating patient satisfaction surveys and psychometric properties is advancing (Dull et al., 1994). Professionals have recognized that a systematic and consumer oriented perspective toward patient viewpoints about the level of care can result in feedback useful for promoting higher quality standards of patient care. The development and use of valid and reliable instruments that report patient feedback is necessary to accurately identify the construct of “patient satisfaction”. The purpose of this study is to evaluate a southern medical center’s External Patient Satisfaction Survey (EPSS) instrument and to discuss how health care practitioners might use these results for routine and systematic assessment of the quality of medical care.

Section snippets

Research setting

The 281 bed medical center is located in the southern region of the United States. The medical center has a primary market area which includes a metropolitan statistical area of approximately 190,000 people and a surrounding rural population of approximately 135,000 people. The population is of poor health status due to a high poverty level combined with a low educational level. In-patient admissions to the medical center exceed 10,000 patients annually.

An “internal” survey process has been

Content analysis

The first step in evaluating the content validity of the EPSS was to consult current published sources associated with patient satisfaction measurement in order to identify perceptions about specific aspects of the service delivery process. Williams (1994) suggested that evaluation from the public sector includes a “consumerist ethos” rationale that recognizes the consumer “… as the central figure of accountability in all public services…” and that research into patient satisfaction has an “…

Discussion

The results of the content validity analysis indicated that the EPSS compared well to three other existing questionnaires and their respective evaluations. The nursing and doctor categories were the most notable when comparing all four studies. The three remaining categories: discharge, billing, and food/cleanliness compared most strongly in Cleary et al. (1989) and the present study. The factor analysis of this study seems to further confirm that physician’s care and nursing care are vital

Conclusions

The EPSS is currently being evaluated as part of an ongoing research program for content validity, factor analysis, and internal consistency of the instrument. The medical center’s response to the present evaluation of the EPSS has been to reconsider the way that their clinical department managers develop response plans to patient satisfaction data in light of the relationships suggested in the content validity and factor analysis. Investigation will continue with a focus on such areas as the

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