Patients' Perspective: An Important Factor in Assessing Patient Satisfaction

Conventionally, the preparation of a patient satisfaction questionnaire is based on textbooks, one's own perception and similar forms used at other hospitals. This process often reflects the providers' perception of factors influencing satisfaction, perpetuating their shortcomings and not adequately dealing with necessary cultural and social variations.

Methods

Aravind Eye Care System in India, one of the highest volume eye care centres in the world, developed an innovative way of developing an in-patient satisfaction assessment tool. All the ‘suggestions and complaints’ of inpatients registered in a separate suggestion register during the year 1997 were scrutinised and grouped. To confirm that the groupings indeed reflected the patient's expectations and concerns, another survey through interviews was conducted on 50 patients and 50 staff (ophthalmologists, nurses, administrative staff) with the objective of finding out the patients' expectations, concerns and worries.

Findings

The 123 different complaints in the initial study and the results of the supplementary study were used to develop 12 different categories to assess patient satisfaction. These are:

1. Medical care

2. Nursing care

3. Behaviour of staff

4. Clear information

5. Personal attention

6. Responsiveness to complaints & care^∗

7. Integrity^∗

8. Physical facilities

9. Supportive services

10. Cleanliness & maintenance

11. Waiting time

12. Charges

Action(s) Taken

In order to monitor patient satisfaction objectively, questions were developed in the broad categories, piloted and developed as a standard questionnaire to grade responses on different point scales. Some additional information, such as age, gender and treatment, was also included for better analysis. The questionnaire also used very clear and simple language and was worded to elicit thoughtful responses.

Consequence of Action(s)

This process has helped to develop a standard questionnaire to measure patient satisfaction regularly in our hospital. The expectations are also understood as these change and are incorporated into the questionnaire from time to time. The results are presented to the hospital's Quality Council and during meetings of heads of departments with a view to taking corrective actions. Individual audits are also undertaken on high patient dissatisfaction areas. The impact is that our patients are more satisfied (our regular survey results confirms this) and we experience an average workload increase of 15% every year. The success of our assessment and improvement of patient satisfaction is because we take into account the patients' own views and perspectives.

Aravind Eye Hospital Quality Council

• Dr P Namperumalsamy, Director Chair of the Council

• Mr A K Sivakumar, Faculty-LAICO, Secretary

• Dr G Venkataswamy, Chairman

• Mr G Srinivasan, Secretary to Trust

• Dr G Natchiar, Joint Director

• Mr R D Thulasiraj, Executive Director

• Dr M Srinivasan, Chief Medical Officer

• Dr S Aravind, Administrator

• Mr R Meenakshi Sundaram, Community Outreach Manager

• Mr Ganesh Babu, EDP In-charge

• Mrs R Alees Mary, Nursing Training Coordinator

Terms Of Reference

1. Aravind Quality Council is a Management Committee, which will meet once a month, to direct, monitor, and support the Quality Management Programmes in Aravind Eye Hospital, Madurai.

2. The Council will approve Department level Quality Objectives and Performance Standards as they are developed or amended.

3. The Council will review and approve any major changes or re-organisation that is perceived as necessary for the quality improvement process.

4. The Council will review and approve requests for additional support relating to quality improvement. Such requests may include the following:

   • Staffing
   • Staff developments
   • Equipment/instruments
   • Space
   • Re-organisation or re-structuring

5. The Council will review the impact of the various quality improvement measures.

6. The Council will approve the Quality Manual, which comprises Quality Principles and Quality Improvement Practice in Aravind Eye Hospital, Madurai.

The ultimate aim of the whole process is to ensure zero defects in the services and a high level of patient satisfaction.

Aravind Eye Hospital In-patient Feedback Form

Patients' Feedback: Follow-up Actions

Suggestions and Grievances	Actions taken
Behaviour of Staff Rude behaviour of certain doctors and nurses	Concerned staff writes apology letter to the patient (decision by Joint Director and the Nursing Superintendent)
Clear Information Appoint a person in the ward who can speak different languages Nurses do not provide sufficient information to patients about the various procedures Place information boards indicating the length of stay, operation charge, etc Health education can be provided using television sets in the wards	Appointed an in-patient counsellor fluent in 5 languages (Tamil, English, Malayalam, Hindi and Telugu) This was addressed in the Quality Service Workshop for Nurses Information boards are now placed in front of the counselling department Information cassette on cataract and eye care has been developed and is being played frequently in the wards
Personal Attention and Care Receptionists guiding the patients to the clinics walk very fast leaving the patient behind	This was addressed in the Quality Service Workshop
Physical Facilities Provide hot water for the patients	Hot water is now provided to the rooms, but needs improvement
Supportive Services Complaints about quality and quantity of food Open a separate telephone booth for local calls	Did a quality audit on catering; a member of the management team checks the quality and quantity randomly every day before serving A separate local call booth established near the cycle stand
Cleanliness and Maintenance Toilets near Room no. 10 smell badly	Frequency of cleaning the toilets has been increased
Waiting Time Explanation should be given to the patients about the long waiting time in the Laser room.	Sisters are asked to provide an explanation when a patient is made to wait in the Laser room
Charges Provide instruction about the fees to be paid at ‘old card’ registration	Boards displayed in the ‘new card’ & ‘old card’ registration counters provide information about the consulting fees
Miscellaneous Take some action against the monkey menace	The monkeys have been caught and taken away