Poor Patient Satisfaction

Janna Enikeeva
Student ID: N01026810
Date submitted: March 8, 2016
Humber College

Cleary & Mcneil (1988) state that, Patient satisfaction with medical care is perhaps one
of the most commonly measured patient attitudes (p. 25), and it makes sense. What better way
to understand the quality of care thats being provided than to ask the patients how they feel
about it? If a specific nursing unit has poor patient satisfaction, its important to find out the
causes of it and implement fixes. However, doing so is much easier than it sounds and this will
be demonstrated in the alternative actions below.
Poor patient satisfaction can be derived from a number of things including staff shortage,
poor staff satisfaction, and inexperienced/ignorant nurses. One of those concepts has been
echoed before in my previous essay when Buchan (2008) stated, Failure to deal with a nursing
shortage be it local, regional, national or global will lead to failure to maintain or improve
health care (Nursing Shortages and Their Impact section, para. 1). A study done by Vahey,
Aiken, Sloane, Clarke and Vargas (2004) attempted to find a correlation between staff
satisfaction and patient satisfaction. Vahey et al. (2004) results are as follows:
Patients cared for on units that nurses characterized as having adequate staff, good
administrative support for nursing care, and good relations between doctors and nurses
were more than twice likely as other patients to report high satisfaction with their care,
and their nurses reported significantly lower burnout. The overall level of nurse burnout
on hospital units also affected patient satisfaction. (Results section, para. 1)
This excerpt demonstrates how poor patient satisfaction isnt a problem in and of itself,
but rather the effect of greater problems. That is to say until bigger problems like poor staff
satisfaction, nursing shortages and negative work environments are addressed properly, it will be
near impossible to solve the problem of poor patient satisfaction.

There is currently a standard in patient satisfaction data gathering called the Patient
Satisfaction with Nursing Care Quality Questionnaire. It involves 22 questions with a 5 point
scale going from poor to excellent. However, Sitzia (1999) comments that perhaps this isnt the
best way to go about interpreting patient satisfaction. Sitzia (1999) makes a note to say that,
ratings may be influenced by respondent characteristics, such as age or educational attainment,
by the patients expectations and by socio- psychological phenomena, such as self-interest, the
Hawthorne effect, or gratitude (p 319). I want to focus on self-interest and the Hawthorne effect
for the purposes of my alternative. In order to alleviate bias in these questionnaires, I believe the
concept of anonymity needs to be introduced. This can be done through a third party who gathers
feedback from patients through a private, anonymous forum, such as an online questionnaire in
an undisclosed location (undisclosed to the nursing staff). This third party then compiles the data
and relays it back to nursing units who in turn implement the findings into their daily routines.
This will help reduce the bias from self-interest because there would be nothing to gain from a
patient giving an inflated rating. This will also help reduce the Hawthorne effect because there
will be no one watching to influence the patients decisions.
The other alternative that I think could be implemented is a reformatting of the structure
of the questionnaire itself. The current model is too linear and unspecific enough to give a
concrete indication of where the problems lie. A 5 point scale is not in-depth enough. Instead, I
propose a more paragraph-to-essay type of format where patients can really write about how they
feel theyre being treated. I believe by combining both of my concepts into one would make a
really effective tool for understanding poor patient satisfaction.
In order to implement my action, a third party would need to be selected and Statistics
Canada makes the perfect candidate. At whatever point in time that the patient satisfaction

questionnaire is supposed to be done, the patient contacts a representative of Statistics Canada.

The representative indicates to the patient where they should fill out this online questionnaire
(that has a paragraph-to-essay type of format) and the patient does so in anonymity. Once data
has been gathered over a period of time, its relayed to the nursing staff.
To evaluate my action, I would simply document the differences in patient satisfaction
over time. If patient satisfaction steadily goes up due to the accuracy my new questionnaire in
finding problems, partnered with better implementation of the feedback, then Ill know my
action was a success. However, as stated before, I think its more important to solve the greater
problems first such as staff satisfaction, because that directly influences patient satisfaction.

References
Buchan, J. (2008). Solving nursing shortages: a common priority. Journal of
Clinical Nursing, 17(14), 3262-3268. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858425/
Cleary, P. D., & McNeil, B. J. (1988), Patient Satisfaction as an Indicator of
Quality Care. Inquiry, 25(1), 25-36. Retrieved from
http://www.jstor.org/stable/29771928?seq=1#page_scan_tab_contents

Kutney-Lee, A., McHugh, M. D., Sloane, D. M., Cimiotti, J. P., Flynn, L., Neff, D.
F., & Aiken, L. H. (2009), Nursing: A Key to Patient Satisfaction. Health
Affinity, 28(4), 669-677. Retrieved from
http://content.healthaffairs.org/content/28/4/w669.full

Otani, K., Waterman, B., Faulkner, K. M., Boslaugh, S., Burroughs, T. E.,
Dunagan, W. C. (2009), Patient satisfaction: focusing on "excellent". Journal
of Healthcare Management, 54(2). Retrieved from
http://www.biomedsearch.com/article/Patient-satisfaction-focusingexcellent/197664736.html

Sitzia, J. (1999). How valid and reliable are patient satisfaction data? An analysis of 195 studies.
International Journal for Quality in Health Care, 11(4), 319328. Retrieved from
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.530.3917&rep=rep1&type=pdf
Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2004).
Nurse Burnout and Patient Satisfaction. MedCare, 42(2), 1157-1166.
Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904602/#APP6

Community Resources
PSNCQQ - Patient Satisfaction with Nursing Care Quality Questionnaire
http://publish.uwo.ca/~hkl/tools/psncqq/index.html

Statistics Canada
http://www.statcan.gc.ca/start-debut-eng.html