Report of a user-satisfaction analysis of a service provider for an oncology clinic

Abstract

Purpose

We used a questionnaire to assess professional user-satisfaction concerning the quality of services provided by a university hospital pharmacy for an oncology clinic.

Methods

All staff members at a major university medical center were given questionnaires pertaining to their satisfaction with various aspects of the services of the center’s pharmacy department. The data analysis was carried out differentiating between the occupational groups and the various service sectors.

Results

Responding subjects (n=460, 15% yield) were generally satisfied with the quality of all sections of the hospital pharmacy. Features appreciated included competence, reliability, flexibility, and rapid service, as well as helpfulness and friendliness. However, assessments differed among occupational groups: those working in the natural sciences tended to be most critical of pharmacy services, including availability of up-to-date information and speed of service.

Conclusions

By surveying user-satisfaction, several shortcomings in the pharmacy ordering and complaint-management system were detected. Study findings should lead to improved service quality and will contribute to developing a manual for a quality management system (QMS).

Introduction

A consumer-focus in quality management implies orienting the design and functioning of services to the needs and expectations of users, with ongoing assessments of whether these aims are being met and actions aimed at improving consumer satisfaction. Objectively demonstrated high service-quality is a precondition for satisfied consumers, but, alone, does not necessarily lead to satisfaction since service-quality is perceived and evaluated subjectively by individuals. Consumer satisfaction improves as the subjective expectations and demands of consumers are balanced against the quality of the service delivered (Homburg et al. 1998, Toepfer et al. 1999a).

We now report on the findings of a user questionnaire carried out to evaluate satisfaction among the professional staff at the Friedrich Schiller University Medical Center in Jena. The aims of the survey were to systematically acquire and analyze the experiences and the opinions of users of the hospital pharmacy, and to identify perceived strengths and weaknesses in the delivery of such services.

Materials and methods

The procedure followed three stages: (1) a tentative list of target definitions was drafted in a workshop attended by hospital physicians, researchers, and management staff as a basis for measuring user satisfaction; (2) a problem analysis, based on the target definitions, was carried out to evaluate business and consumer processes; (3) the preceding steps were used to assess specific business fields, including information and consultation, orders, and supply services (provision of general and chemotherapy drugs, diagnostic laboratory supplies, and chemicals), as well as financial accounting and controlling.

For each field of work in the pharmacy, we needed to define and assess specific performance factors and influences on performance quality. For the “order service,” for example, elements including order books, delivery services, and transportation are of special importance. In addition, certain general factors seem to apply to various business processes involving the pharmacy. In order to limit the complexity and the scope of the questionnaire, we selected potentially particularly significant performance factors (information on medicine, cytotoxic drugs, etc.) on the basis of their estimated impact on a 1–5 scale [”very important” (1), “important” (2), “somewhat important” (3), “unimportant” (4), “not at all important” (5)]. These factors were determined in accordance with the recommendations of Etter et al. (1997). By means of regression analysis procedures (Backhaus et al. 1996), we indirectly estimated the importance of individual factors to the medical center staff, who were the user population targeted by the study. Therefore, it was necessary to measure each individual factor as well as overall satisfaction factors. In addition, a 1–5 rating scale proposed by Tull et al. (Tull et al. 1993) was included in the questionnaire to provide a more direct measurement of the importance of specific questionnaire topics. Ratings were: “completely satisfied (1)”, “very satisfied (2)”, “satisfied (3)”, “somewhat dissatisfied (4)”, and “very dissatisfied (5)”. For analysis, scores were converted to a 100-point value scale as described in Table 1.

Table 1.

Classification and interpretation of the scale values

Scale value	Point value (transformed)a	Equivalent for “satisfaction”	Equivalent for “importance”
1	100	Completely satisfied	Extremely important
2	75	Very satisfied	Very important
3	50	Satisfied	Important
4	25	Less satisfied	Not important
5	0	Dissatisfied	Not at all important

^a( ) Interpretation of the scale values; in the questionnaire only the marginal points are indicated

Since it is virtually impossible to find out which staff members of the center have made use of the pharmacy in specific ways, we developed an overall survey sent to all staff members. As an incentive to complete the questionnaire, the pharmacy selected winners of a free “fitness weekend” by lottery. This process yielded a 15% response rate, as 460/3,066 subjects contacted completed questionnaires providing data for analysis. Since some staff members may have been recently employed or otherwise had little reason to make use of pharmacy services, the relevant yield was probably considerably higher than 15%.

Results

Characteristics of survey-responders

Analysis of responses from specific types of consumers can contribute to planning specific adjustments to services to address specific needs or wants. The target subjects of the present survey included professional and non-professional members of the nursing services (41%, and 31% of the total 460 responders were nurses, and so the largest group); medical staff (26%); scientists, technicians, and research assistants (23%); and professional and non-professional administrative employees (10%).

The types of pharmacy services used varied markedly among occupational groups. Nursing staff typically ordered medicines, bandages, and other clinical supplies (79% of the responding nursing staff) as well as seeking individual prescriptions as patients themselves (9%). Among the medical staff, 38% of respondents sought information and advice from the pharmacy department, and 24% ordered medicines for patients. Scientific and technical employees made use of the pharmacy for supplies of chemicals and diagnostic materials (79% of contacts).

A small minority of all respondents (8%) stated that they had daily contact with the pharmacy, and about 30% reported 2–4 contacts per week. A large majority (87%) had at least one contact with the pharmacy department within the preceding 2 months, and 36% had made use of pharmacy services within the preceding week. Overall, pharmacy contacts were most often made by telephone (48%), in-person visits (21%), postal service (21%), or facsimile (19%), whereas use of electronic mail was rare at the time of sampling (June 2001). It is noteworthy that greater overall satisfaction with pharmacy services was significantly associated with a shorter interval since the last contact (P=0.027).

General satisfaction factors

Assessment of satisfaction with pharmacy services and of the importance of specific services was carried out on the basis of a 100-point value scale with five defined steps, from completely satisfied to highly dissatisfied (Toepfer 1999b) (see Fig. 1).

Fig. 1.

Average satisfaction values for the general performance factors

Among the questionnaire respondents, 17% described their overall opinion of the services of the pharmacy as “completely satisfied;” another 55% were “very satisfied,” and 25% were “satisfied.” Personal factors of pharmacy staff, such as helpfulness, friendliness, and competence were assessed especially positively, and rated, respectively, as completely, very, and satisfied, respectively by 90%, 89%, and 84% of respondents.

Competence of the pharmacy staff was considered very or extremely important by almost all respondents. Regression analysis showed that friendliness had the second-highest influence on overall satisfaction. Other factors evaluated, including providing information and quick-service proved not to be significantly associated with satisfaction. Business processes and services at the pharmacy are assessed as sufficiently timely.

On a 100-point value ranking from highest to lowest importance, another factor significantly associated with overall satisfaction with pharmacy services was accessibility or availability during working hours (64%). On the whole, respondents were satisfied with availability and accessibility of pharmacy services during normal opening hours (84%). However, there were some negative opinions about the on-call services outside of regular business hours, which were required by nearly two-thirds of all respondents. Of this subgroup, 25% were “merely satisfied” and 18% were dissatisfied.

Somewhat lesser importance was ascribed to face-to-face contact (ranked 62/100) and “provision of information” (58/100), although nearly 2/3 of respondents considered these factors very important. To the administrative staff, personal contact was more important (60/100) than to other groups (averaging 44/100).

Concerning the speed of processing medication orders and other requests at the pharmacy, respondents from the medical staff were less satisfied than other occupational groups (4.3 points below the overall average of 76.8). When we compared nursing, medical, scientific, and administrative staff respondents, those in administration assessed the pharmacy’s performance most positively. However, the average values of the overall satisfaction within the four occupational subgroups were quite similar, differing by not more than one point. Furthermore, user-satisfaction increased with duration of employment. For those employed for <3 years, the average overall satisfaction score was 68 points, compared to 78 points for staff members employed >25 years.

Respondents were asked their opinions of specific features of the information and consultation services of the pharmacy. Only 2/460 persons (0.4%) were dissatisfied with these services, whereas three-quarters of those who used pharmacy consultation services were very or completely satisfied. All five principal factors (information content, practical relevance and feasibility, scope, quality, processing time) pertaining to consultation services were assessed positively, and 85%–91% of respondents were very or completely satisfied with various performance features, and mean ratings among specific factors varied little.

Larger differences occurred among members of the four occupational groups in their assessment of “information content” and “processing time”. The quality of information provided was considered important by 49% of respondents, and 26% considered it extremely important, with no difference among occupational groups (P>0.05) (see Fig. 2).

Fig. 2.

Assessment of satisfaction with the counselling services comparing the different occupational groups

About 75% of respondents (346/460) provided assessments of essentially administrative function of the pharmacy: 19% were completely satisfied, 53% very satisfied, 26% satisfied, and only 1.4% dissatisfied. Of respondents who place pharmacy orders with the help of order books provided by the pharmacy, 75% were completely or very satisfied with the clarity and organization of the books, and 85% were completely or very satisfied with the frequency of collecting and processing the books. Assessment of the delivery service was generally positive (see Fig. 3).

Fig. 3.

Comparison of the average importance and satisfaction of the performance factors for the order and delivery services

However, the opinions of specific occupational groups differed significantly for some satisfaction factors. Analysis of variance was used to test differences for the following factors: punctual delivery (P=0.027), delivery time (P<0.0001), flexibility (P=0.413), clarity of order books (P=0.317), completeness of delivery (P=0.467), and transport containers (P<0.0001). The medical and technical-scientific staff were less satisfied with the efficiency of deliveries, particularly regarding cancer chemotherapy agents and laboratory or diagnostic supplies. Punctual and full delivery were considered to be of utmost importance to nearly all of the respondents. Of those who use an order book, 47% found its clear organization to be extremely important, and 36%, very important. Less importance was assigned to the frequency of collecting the books (18% of users chose “extremely important” and 44% “very important”). The flexibility of the pharmacy in urgent cases was extremely important to 83% of respondents.

The survey indicated that 49 (10%) of all respondents had complained once or twice to the pharmacy, and that nine (2%) had complained more than twice. Rates of registering at least one complaint among the occupational groups were: 20% in scientists and technicians, 10% among physicians, and 12.5% among nursing staff. A majority (91%) of those registering complaints reported that they were appropriately dealt with and were satisfied; only 9% were not satisfied.

Various performance factors were assessed differently. Differences between occupational groups have been tested using the analysis of variance method. Based on ANOVA, differences among groups were as follows for specific factors: overall satisfaction with handling of complaints (P=0.065), problem solving (P=0.076), prompt responses (P=0.058), interest (P=0.051), and correction of errors (P=0.133) (see Fig. 4).

Fig. 4.

Distribution of the satisfaction values for the factors of the handling of complaints

On average, rapid response to complaints and indication of interest by the pharmacy staff were greatly appreciated and were associated with maximum satisfaction. Although the frequency of complaints made by scientists and technicians was above average, this group was relatively well satisfied with the handling of complaints (mean satisfaction of this group: 85 vs 75 points, overall). However, the medical staff was somewhat less satisfied (76 points), especially about problem-solving and correction of errors.

Discussion and conclusions

The present analysis of survey data pertaining to a major hospital pharmacy department yielded a number of interesting findings despite potential non-response bias due to the low rate of analyzable responses (15%). However, such low response rates are common for questionnaires sent by mail (Schumann 1999). A summary of results is presented graphically as satisfaction or action portfolios that rank the relative importance of specific performance factors relative to the level of satisfaction of those using the services (Zacharias 1998, Werner 1998) (see Fig. 5).

Fig. 5.

Action portfolio to derive strategies for improvement

Strategies aimed at improving user satisfaction can be derived from such summary analyses, with particular attention to items rated high in importance and low in satisfaction. The pharmacy department studied showed relatively high ratings on factors of greatest importance to users, whereas less important factors tended to be rated less favorably. The results also indicate that the role of the pharmacy department went far beyond distribution of drugs and medical supplies, and great importance was attached to its consulting and teaching services, and to the closely related perception of competence and expertise of the pharmacy staff. Specific areas needing improvement included greater availability of pharmacy staff outside normal opening hours, and the need for more extensive up-to-date information about drugs.

In response to the relatively low satisfaction within the customer group of scientists and technicians, the pharmacy department management investigated the problems identified by this group of clients particularly closely. As a first step, an on-line, electronic ordering system was introduced to increase efficiency and to simplify the processing of orders. In addition, the pharmacy established a complaint management system. The results of the survey not only served the purpose of increasing the quality of processing requests, but also the quality of results.

It is important to emphasize that this study measured the quality of services perceived by users of pharmacy services. It is possible that groups who tended to be less satisfied are more critical in general, have higher expectations, or require greater effort to be convinced that services provided are objectively quite good. It will be important to compare the results of this study with findings from other comparable medical-center pharmacy departments to assess generalizability. Finally, long-term success in quality management is most likely when customer satisfaction measurements are carried out regularly (Meister et al. 1996).