In healthcare industry, the satisfaction of the patients is the most important thing as they are the priority and the main reason why the industry came to be. According to Kravitz (1998, p. 280), reports on measurement of patient satisfaction are now included in hospital and health plan quality reports. To be able to measure patient satisfaction, research works are being conducted. The methods of gathering and treating data that are needed for the research endeavor vary. Generally, there are three dimensions that are considered in research types.
A research may be basic or applied, exploratory or confirmatory, quantitative or qualitative, or mixed type. To attain these dimensions or purposes of research, different methodologies are utilized. In this assignment, the different methods and methodologies used in theoretical- and empirical-based literatures were critically reviewed. Generally, the purpose of this assignment is to gather, collate, and evaluate published literatures relating to measuring patient satisfaction in healthcare. Specifically, this assignment was conducted to (a. ) assess critically the methods and methodologies in research about the measurement of patient satisfaction, (b. ) identify the common factors that influence patient satisfaction, and (c. ) provide guidance and recommendations to future research.
2. 0 Search Strategy and Selection Process The search was primarily based on electronic databases and journal archives using the keywords: patient satisfaction. The databases and journal archives of PubMed, Medline, Emerald, Biomed Central, Wiley InterScience, Academic Emergency Medicine, Journal of Advanced Nursing and Academic Medical Centre were used.
To better facilitate the search process, inclusion criteria were set. The search was delimited to articles published in English and issued from the year 1990 to 2009. The research articles were evaluated by summarizing and discussing the methods and methodologies, data collection and analysis, findings, ethical and reliability/validity issues, and limitations. For a better facilitation of data sorting and review, data according to critical appraisal were entered into a grid. The quality of each paper and its significance to the study was outlined.
A total of 16 literatures matched the criteria but one article was removed from this review as its focus is on the development of a patient satisfaction survey. 3. 0 Overview of the Literature For years, healthcare is regarded as a basic need of humanity. It is also one of the booming businesses in this world today. However, whether to address health problems as a need or to make money quality health management is always considered and prioritized. Thus, research became a partner of health management to be able to measure patient satisfaction and attain quality improvement and assurance.
Patients are the only ones who can rightly evaluate the service quality of a certain healthcare institution; therefore, their satisfaction is the measuring factor as it enhances the reputation and status of a health care institution. By understanding the factors affecting the satisfaction of the service recipients, the healthcare providers can improve their interventions and even influence the perception of the patients regarding the quality of service being provided. 3. 1 Patient satisfaction One of the most extensively studied aspects in the healthcare industry is on patient satisfaction.
Badri et al (2009, p. 384) stated that patient satisfaction is accounted as an important thing in planning, implementing, and evaluating delivery of healthcare service, especially that meeting the client’s needs create healthcare standards, which are vital in high quality care. Thus, considerable efforts have been put into developing survey instruments to measure it. However, there is only few theoretical or conceptual development of the patient satisfaction concept that many are critical in using such survey tools (Gill & White, 2009).
In the studies that were utilized in this assignment, different factors and varied settings were found linked to patient satisfaction. Therefore, there were also different patient satisfaction measurement tools that were used to address the research problems of the respective researchers. From their findings, it can be concluded that the factors can be grouped into two, namely: technical dimension or core, and process or functional dimension.
Technical dimension or core is the procedural acuity of the service providers, which embodies the reliability dimension in Parasuraman et al’s SERVQUAL instrument, while process or functional dimension refers to how the service was provided and it also contains the SERVQUAL dimensions of Assurance, Tangibles, Empathy and Responsiveness (Elleuch, 2007). Other factors such as waiting time, physical appearance and hospital facilities, duration of consultation, were also expounded in some articles.
Due to differences in research methods used in and the purposes of the studies, no direct comparisons or over-all generalisations on the determinants of patient satisfaction can be directly deduced from the literatures taken as a whole. In addition, the reviewed articles discussed patient satisfactions in diverse medical fields such as psychiatric, oncology, nursing care, tertiary care, clinical consultation and healthcare in general. There were studies discussing patient satisfaction linking with hospital quality improvement, with quality of life, communication and provider reputation.
Moreover, the articles that were used in this assignment related how patient satisfaction varies across cultures like Japanese, Chinese, Lebanese, Arabian, Italian, the rest of the Western World. Despite the lack of studies developing and testing comprehensive models for capturing causality among various constructs, majority of the chosen literatures conclude that there is evidence that several constructs make up overall quality and satisfaction models (Alaloola & Albedaiwi, 2008; Badri et al, 2008). 4. 0 Critique of the Methods and Methodologies
This section critically discusses and critics the different research methods, data collection tools, practical findings, and limitations found from the analysis or review of the 15 different articles that met the inclusion criteria set in this assignment. 4. 1 Research methods Of the 15 articles that met the inclusive criteria, 78. 57% (n=11) are quantitative research that measure variables using numeric scales, 14. 29% (n=2) qualitative that are based on unstructured interview transcripts or direct behaviour observation of subjects, and 7. 14% (n=1) triangulation using both quantitative and qualitative methods.
Specifically, five research methods were utilized: Correlation (n=6), Descriptive (n=4), Non-experimental (n=1), Longitudinal (n=1), Cross-Sectional (n=10). The qualitative research works are both literature reviews. Basing from the evaluation, all articles used mixed method approach; none of these used a single approach. This specific type of research method includes studies that have more than one type of research method reported. 4. 1.
1 Correlation method Correlation research method is a tool for the researcher as a first step prior to experimentation or when experiments cannot be conducted; association or co-variation of two or more variables is considered in this type of research (Baalbaki et al, 2008). This methodology was used in related articles which has been done by Elleuch (2007, pp. 692-705), Lis et al (2009, pp. 1-11), Li et al (2008, pp. 411-427), Shilling et al (2003, pp. 599-611), Tam (2007, pp. 732-745), and Zandbelt et al (2004, pp.
1088–1095). According to Cherry (2010), correlation method are used to determine relationships between variables, which may result to a positive correlation, a negative correlation, and no correlation. An advantage of this method is that it allows predictions and easy proving of a positive or negative correlation or relationship between the variables (Cherry, 2010). Such method is used in studies that measure patient satisfaction as it easily shows the relationship of factors related to it.
However, correlation studies do not imply cause and effect relationship between the variables (Cherry, 2010). Further, correlation studies can be done by mere observation, survey, or archival research (Cherry, 2010). 4. 1. 2 Descriptive method Descriptive research methodology was used in the articles of Alaloola and Albedaiwi (2007, pp. 630-637), Baalbaki et al (2008, pp. 47-62), Bjorngaard et al (2009, pp. 1-9), and O’Regan Connoly and Ryan (2008, pp. 525-534). McNabb (n. d. ) explained that this kind of method can either be used in quantitative or qualitative studies.
Its main purpose is to describe or explain the data and their characteristics that the researcher wants to explore or have a better clarification or understanding (McNabb, n. d. ). Descriptive method is used in measuring patient satisfaction as it is considered to be highly accurate, making use of probability sampling, measures of central tendencies, frequencies, and other statistical calculations (McNabb, n. d. ). Like correlation method, descriptive method has no hand in gathering causes behind a situation. Descriptive studies can either be done through survey forms/field studies or observation.
4. 1. 3 Non-experimental method Without manipulating independent variables, researchers can observe a certain phenomenon. This kind of research method is called non-experimental. Some of the main reasons why this method is used include ethical issues in manipulating some variables especially those concerning human characteristics or independent variables to experimental manipulation or randomization, impracticality to conduct a true experiment, and more realistic in exploring natural phenomena in more natural manner and the need to scope out the experimental one (KovacsBurns, 2005).
This method was used by Larabee et al (2004, pp. 254–268). 4. 1. 4 Longitudinal method Tam and Fallowfield (2007, pp. 599-611) used longitudinal research method. This kind of methodology signifies “a distinct form of research design that is typically used to map change in business and management research” (Bryman and Bell, 2007). It aims to discover relationships between unrelated variables that affect “same group of individuals over an extended period of time” (Gratton & Jones, 2004). 4. 1.
5 Cross-sectional method Bryman and Bell (2007, p. 55) defines cross-sectional research method as the “collection of data on more than one case and at the single point in time in order to collect a body of quantitative or quantifiable data in connection with two or more variables, which are then examined to detect patterns of association’. This method uses different groups of people who differ in interest variable but share other characteristics like socioeconomic status, educational background and ethnicity.
While longitudinal method involve taking multiple measures over an extended period of time, cross-sectional research is focused on finding relationships between variables at a particular point in time (Gratton & Jones, 2004). Ten articles that met the inclusion criteria used the cross-sectional method. 4. 1. 6 Literature review Critical literature review is always needed in research works. In qualitative ones, literature review is one of the most preferred methods. This method involves accounts of what has been published on a certain topic by accredited scholars and researchers.
Literature reviews are defined through guiding concepts which may include the problem and the research objective. The two qualitative researches included in this review, Wagner and Bear (2008, pp. 692–701) and Gill and White (2009, pp. 8-19), have used literature review. 4. 2 Data collection From the analysis of the 15 chosen articles, it can be noted that all the quantitative articles used the questionnaire as the main data collection tool: 58. 34% (7/12) used the structured interview wherein the questionnaires were handed over to the subjects face-to-face; 8.
33% applied self-completion questionnaire which was sent by mail; 8. 33% used both methods (mixed); and 25% (n=3) failed to specify the data collection tool used. Most researchers use questionnaire as data gathering tool because of its advantages over other data collection tools. Bryman and Bell (2007, p. 246) stated that questionnaire as a tool in gathering data is “relatively inexpensive, quicker to administer and convenience for respondents. ” Also, questionnaires most often elicit homogeneous responses which make the research data easier to compile and analyze.
The common problem however in this tool is that, its standardized answers sometimes may be misinterpreted by the participants. Thus to test the question’s understandability, researchers who use this tool have to pilot or conduct the questions on a small group of respondents. Moreover, Bryman and Bell (2007, p. 246) believed that “structured interviews can be used in conjunction with self-completion questionnaires to gain understanding of the perspectives of different groups of participants.
” Organizing surveys are needed such that the needed information are highlighted to provide adequate data to support the hypotheses of the researcher. Questionnaires are usually kept to a reasonable length to avoid fatigue among the respondents and prevent increase in the drop-out rate (Tam, 2007). In most of the published articles used in this assignment, it can be noted that the surveys most often than not include common service delivery themes which affect patient satisfaction.
The typical services of healthcare personnel include interpersonal skills, communication skills, knowledge of procedures, attention to the patient, and willingness to help. Some of the articles also include in their surveys questions about the physical facilities of the healthcare institution such as general cleanliness, examination room, comfort of the waiting area, and availability of these facilities. Other studies had also sought technical service ratings for healthcare personnel like physicians, nurses and ancillary personnel (Trout et al, 2000).
This assignment also presents that face-to-face or interdepartmental surveys showed more responses as compared to mailed surveys. From the collated data, there are 90%, 88%, 87%, 79% and 63% responses from face-to-face approaches against 37% and 10% from mail. Both methods have advantages and disadvantages over the other. Interdepartmental or face-to-face interactions are arguably associated with biases related to the reactions of the respondents while in front of an interviewer as the former tend to please the latter.
On the other hand, mailed surveys tend to give bias on the selection of samples as patients without permanent or active address will be left out of the selection process (Trout et al, 2000). Considering the time frame of the data gathering process, most studies were done within few days after patients received the healthcare services and some were conducted within three weeks, depending on the hypothesis of the investigator. For example, if the investigator wants to focus on factors that result in patient satisfaction upon receiving the service, he should conduct the survey as close to the patient’s release as possible (Trout et al, 2000).
Meanwhile, Likert-type scales, which utilize closed questions or score from 1-5 with 1 indicating strongly disagree and 5 strongly agree, were also used as data gathering tool in some of the chosen articles (Bryman & Bell, 2007, p. 249). In the review of the 15 literatures, Likert-type scales are the most common approach in measuring responses. Alternatively, visual analogue scale was also employed. No significant variances among studies using different approaches were exhibited.