Erik Riiskjær

Patient surveys—A key to organizational change?

OBJECTIVE The objective was to investigate whether semi-customized patient satisfaction surveys are seen as useful by hospital management, and to explore their possible effects on quality improvement over time at a low organizational level. METHODS Data were collected from three sources: (1) patient surveys administered in eight public hospitals with a total of 2200 beds in a Danish county; (2) questionnaires completed by the hospital and clinical department managers; and (3) data from the countys Management Information System. RESULTS Patient satisfaction surveys were widely accepted as a tool for change. Bad results seemed to be an incentive for improvement unless hindered by fluctuation in patient turnover. Acceptance of the patient surveys as a way to generate change diminished over time. CONCLUSION Patient surveys may be an incentive for change if: (1) they have sufficient validity; (2) feedback is detailed on an organizational level and the units have significantly lower scores than comparable units; and (3) there are obvious actions to address the problems. PRACTICAL IMPLICATIONS Both qualitative and quantitative results should be analyzed for small organizational units within hospitals. Perceived usefulness of the surveys may be increased by involving medical professionals in the design and evaluation of the survey system.

Semi-customizing patient surveys: linking results and organizational conditions

OBJECTIVE The study investigated the needs and consequences of semi-customizing patient satisfaction surveys to low organizational levels and explored whether patient satisfaction was correlated with local organizational conditions. DESIGN From 1999 to 2006, the County of Aarhus carried out 398 surveys during four rounds in eight hospitals. To explain differences between the wards, data on the 40 wards with the best and the 40 wards with the worst evaluations (identified by patient surveys) were compared with the data from job satisfaction surveys and management information systems. SETTING Eight public hospitals in a Danish county. PARTICIPANTS 32,809 inpatients and 1842 nurses on 84 wards. MAIN OUTCOME MEASURE Optimal organizational level for measuring patient satisfaction and correlations between overall patient satisfaction and organizational context. RESULTS In all, 71.4% of the departments chose to have the survey results specified at the subunit level or for specific diagnostic groups. Substantial differences in patient satisfaction between wards are illustrated. On the wards with the highest improvement potential, we found significantly higher occupancy rates, acute rates, rates of sickness absenteeism, staff perceptions of high workload and low experience of professionalism. CONCLUSIONS The study confirmed that departments desired individual, detailed descriptions of the results. Differences in patient satisfaction were associated with differences in organizational conditions. Establishing a link between patient satisfaction and organizational variables broadens the quality development focus to include more than simply analysis of specific questions. Semi-customizing patient surveys are recommended.