Liz Gill

A critical review of patient satisfaction

– This paper aims to review the patient satisfaction literature, specifically meta‐analyses, which critically analyses its theory and use; then to present evidence for perceived service quality as a separate and more advanced construct., – Papers that judiciously review the development and application of patient satisfaction were identified; along with studies addressing the conceptual and methodological deficiencies associated with the concept; and the current perceived service quality theory., – Patient satisfaction has been extensively studied and considerable effort has gone into developing survey instruments to measure it. However, most reviews have been critical of its use, since there is rarely any theoretical or conceptual development of the patient satisfaction concept. The construct has little standardisation, low reliability and uncertain validity. It continues to be used interchangeably with, and as a proxy for, perceived service quality, which is a conceptually different and superior construct., – The persistent use of patient satisfaction to evaluate the clients perception of the quality of a health service is seriously flawed. The key to solving this dilemma may be for the healthcare sector to focus on perceived health service quality by considering the specific concepts and models that can be found in the services marketing literature. This literature offers more advanced consumer theories which are better differentiated and tested than existing healthcare satisfaction models., – The paper points out that there is an urgent need for differentiation and standardisation of satisfaction and service quality definitions and constructs, and argues for research to focus on measuring perceived health service quality.

Treating frailty-a practical guide

Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people.

Service co‐creation in community‐based aged healthcare

Purpose – The purpose of the paper is to identify and describe the themes underlying four concepts: client orientation, client involvement, provider empowerment, and client empowerment, which have been reported in the literature as influencing service participant interaction in the formation of a service. The meaning that service participants assign to each of those themes is also to be examined.Design/methodology/approach – Triadic studies were undertaken in two separate locations with three discrete community‐based service networks, purposively recruited from the same aged healthcare organisation. Using a phenomological approach, 29 individual semi‐structured in‐depth interviews with managers, providers, and clients were conducted. Inductive and deductive analysis was used to identify the emerging themes and their meaning for each participant category.Findings – Key themes were identified for each concept, but the meaning ascribed to each theme was found to differ between the participant categories. It ...

How do customers and pharmacists experience generic substitution

Purpose – The substitution of generic prescription medicines for branded medicines is being practiced in most westernised countries, with evidence of a strong focus on evaluating and monitoring its economic impacts. In contrast, the purpose of this paper is to explore the generic substitution experience of customers and pharmacists in a pharmacy practice setting.Design/methodology/approach – The study applied a phenomenological method using the narrative inquiry technique combined with critical event analysis, in order to understand the generic medicine experience as perceived by customers and pharmacists as key substitution actors. Interviews were conducted with 15 pharmacists and 30 customers in Australia, Finland and Italy, using a narrative inquiry technique combined with critical events and metaphors.Findings – The findings show that customers, with poor awareness of generic prescription medicine when offered as a substitute, were likely to become confused and suspicious. Pharmacists related how they...

Interaction in community-based aged healthcare: Perceptions of people with dementia

This research sought to understand how people with dementia perceive interaction in the context of their service experience. Using the client data from a qualitative study that was conducted over three years and employed both inductive and deductive techniques, the data from 22 client interviews were consolidated and then analysed. Seven themes related to service experience were identified: Awareness; Communication; Dependency; Expectations; Experience; Position; and Relationship. These themes provide insights that could assist service providers to better understand and facilitate interaction with their clients. The study highlights that clients with dementia wish to be given the opportunity to have input to the creation of their service. Itpoints out that service organizations need to develop tailored mechanisms that will allow this to occur; and the study provides information that could be used to facilitate the achievement of a responsive, client-centred community-based aged healthcare service.

Innovation and Consumer Directed Care: Identifying the challenges.

Our aim was to report clinician and researcher observations about the practical difficulties with achieving the articulated objectives of Consumer Directed Care (CDC). The methods used were as follows: identification of key client community services issues through analysis of qualitative data related to a PhD project; review of the summary of these issues by the supervising academic; presentation of the issues to five clinicians involved with a community service clinical trial; verification of the findings through discussions with a senior community service provider. There is anecdotal evidence that the current overlay of CDC in the existing community‐based home services sector for people who are older will continue to prevent its effective implementation. The existing culture and underlying philosophies related to this sector maybe unable to support the level of innovative change required. Research is needed into how the stated objectives of CDC can be achieved in Australia and how this can best be managed.

Developing Interventions for Frailty

Frailty is a well-recognised, complex syndrome, predominantly affecting older people. Currently, there are two main conceptualizations of frailty: the phenotypic and the accumulated deficit models, with the phenotypic model being more widely applied in clinical research. Based on these models, we contend that a number of the phenotypic frailty components (weakness, slowness, and low energy expenditure) are potentially reversible. This paper outlines the results of a frailty research program. It summarizes the initial frailty treatment model and reports its effectiveness. Briefly, the effect of a twelve-month individually tailored multifactorial, interdisciplinary intervention targeting frailty was compared with usual care. The intervention reduced phenotypically defined frailty and improved mobility. Further, it is contended that there is evidence of substantial unmet need due to treatment fragmentation and the absence of a comprehensive approach for this population. Our paper then outlines the current stage of our research in which the model is now being extended to prefrailty. Interventions aimed at reversing the frailty syndrome or its consequences are only in their early stages. There is significant scope for future research to identify optimal management programs for frail older people.

Consumer Directed Care in Australia: early perceptions and experiences of staff, clients and carers

The study aimed to identify the shared issues and challenges being experienced by staff, their clients and informal carers, with the introduction of Consumer Directed Care (CDC). Secondary analysis was undertaken of data that had been initially collected, via semi-structured in-depth interviews, to inform the development of a discrete choice experiment. The raw staff and client/carer data were re-examined using an iterative inductive process. The analysis focused on locating the shared themes and differences between the participant groups based on their CDC experience. The data were also assessed for difficulties or barriers that impacted on the service. Four broad shared themes were derived: culture, role change, operational systems and resourcing, but with a range of diverse and sometimes conflicting sub-themes between the different participant groups. Differences can be linked to participant role in the service chain, with discordance emerging between what has been traditionally offered and what might be possible. This investigation occurred during the period in which services were transitioning from a traditional aged care service model to a new model of service provision requiring considerable industry change. We conclude that existing industry regulation, culture and practice supports an established service model in Australia that arguably makes translation of the objectives of CDC difficult.

Factors that influence intent to adopt a hearing aid among older people in Italy

Hearing loss is one of the most prevalent health impairments associated with ageing in developed countries, and it can result in social, emotional and communication dysfunction. Hearing loss in Italy is increasing, yet, despite the availability of free hearing aids and access to qualified community-based health professionals specialising in audiology services, their uptake remains low (about 15%-20%). This paper presents an investigation of the possible reasons why older people in Italy resist adopting a hearing aid. We used the literature to identify factors influencing people with hearing losss decision-making, and drew on the theory of reasoned action to create an explanatory model. To test our hypotheses, we applied a cross-sectional design. We developed a questionnaire including 13 items related to adopting a hearing aid. Health professionals identified 400 persons aged 60-90 who were candidates for a free hearing aid. Those willing to participate were sent a copy of the questionnaire and telephoned between August and September 2009; a total of 243 responded (response rate of 60.8%). Linear regression analysis highlighted that a persons intention to adopt a hearing aid was positively related to their attitude towards its adoption, but negatively linked to their perceived subjective norms. It was found that trust in the health professional does not moderate the relationship between a persons attitude and their intention to adopt a hearing aid, but trust mitigates the relationship between a persons perceived subjective norms and their intentions. These findings underline the importance of the potential role that the healthcare professional could play in reducing the uncertainty created by external social pressures. For this purpose, stronger collaboration between the various health professionals involved in hearing aid provision, from diagnosis to fitting, is recommended.

Service-based vs. goods-based positioning of the product concept

Purpose – To counteract increasing competition and satisfy evolving customers’ needs, many firms are changing the positioning of their product concepts, from being product-based into service-based. Despite the increasing relevance of this shift, it is still unclear if this choice has a differential impact on customer perceived value. The purpose of this paper is to analyze customer perceived value for a firm’s product concept being positioned either as service-based or goods-based. Design/methodology/approach – An experiment was conducted using stimuli for two different product categories (hearing aids and bicycles) and measuring customers perceived value through the PERVAL scale’s four dimensions (quality value, emotional value, price value and social value). Findings – The results show that presenting the product concepts as service-based instead of good-based can enhance customer perceived value (in particular: quality, emotional and social value), but only if customers are not familiar with the produc...