Patient-centered health care is the dominant model in health service delivery. Within this framework, patient satisfaction has emerged as an important indicator of the quality of patient care (Brown, Stewart, McCracken, et al, 1986). The significance of patient satisfaction is further emphasized by evidence that satisfied patients are more likely to adhere to treatment, benefit from their health care, and have a higher quality of life.
Additionally, patient satisfaction data have been used for quality assurance and accreditation of hospitals and rehabilitation centers (Draper & Hill, 1995). Beyond these quality assurance imperatives, patients’ views and concerns should be essentially important to clinicians because they can inform improvements in the quality and outcomes of care (Wagner & Bear, 2009, p. 693).
With the growing number of physical therapy clinics in today’s market, and where patients are becoming more involved with their healthcare secondary to having greater access to information and higher expectation for the quality of care they receive, satisfying the patients is very important. Consequently, physical therapy clinics are being challenged to provide the best ustomer satisfaction as possible, secondary to the saturation in the marketplace of physical therapy. The increasing of physical therapy clinics has allowed patients more choices in providers.
Additionally, physicians have been under pressure to decrease referrals for physical therapy, by insurance companies. Therefore, as the marketplace grows with competition, patient satisfaction is becoming very important in order to keep customers. Literature Review Patient Satisfaction Goldstein and Elliot (2000) state “Patient satisfaction is often considered to be an abstract, multidimensional phenomenon. Because it usually is not observable directly, patient satisfaction must often be measured in what we would consider an indirect manner” (p. 0).
Additionally, Roush and Sonstroem (1999) state “Numerous aspects of patient satisfaction have been described, and the most common factors are: the patient-practitioner relationship (competence, personality of the practitioner, communication), location and accessibility of services, continuity of care, cost and payment issues, and the facility (e. g. , cleanliness, noise, equipment)” (p. 79). Maximizing patient satisfaction is a sound way of thinking from both a clinical erspective and a business perspective.
Satisfied patients are more likely to adhere to treatment and to continue to seek health care at a given clinic (Simon & Patrick, 1997). There have been findings to show that adequate time spent in therapy, along with patient care and the professionalism of the therapist and clinic staff are more important for patient satisfaction than are the location of the facility, the quality of equipment, and the availability of parking (Bettie et al, 2002). Scheduling Patient wait times and waiting-room congestion are two of the few tangible quality elements.
A well-designed scheduling system has the potential to increase utilization of personnel and resources as well as reduction in waiting times for patients. Surveys indicate that excessive waiting times are often the major reason for patients’ dissatisfaction in outpatient services (Huang, 1994, p. 7). Additionally, reasonable waiting times are expected in addition to clinical competence (Jackson, 1991, p. 20). Early intervention is important for realizing good medical outcomes. It is also an important determinant of patient satisfaction.
The ability to provide timely access is determined y many factors that include fundamental questions about how should it allocate resources among multiple sites, how should it staff each clinic or hospital site, what rules best determine which providers and patients receive higher priority access to resources, and how appointments are scheduled (Gupta & Denton, 2008, p. 801). DiGiacomo (2005) state “Effective and creative scheduling can help patients meet their goals, decrease stress on staff and boost productivity” (p. ).
The Medical Group Management Association (MGMA) advises practices to schedule accurately and to avoid long wait times for patients. Appointment scheduling can be classified into two categories: static and dynamic. During the static case, all decisions must be made prior to the beginning of a clinic session, which is the most common appointment system in health care. Thus, it is not surprising to see that most of the literature concentrates on the static problem.
However, also consider the dynamic case, where the schedule of future arrivals is revised continuously over the course of the day based on the current state of the system (Liu & Liu 1998). Additionally, recent studies have shown early physical therapy an be associated with lower cost and reduced risk of invasive procedures, such as surgeries, for the patient, when compared with delayed referral, which suggests that patients may benefit from early physical therapy (Fritz, Magel, McFadden, Asche, Thackeray, Meier & Brennan, 2015, p. 1).
In addition to scheduling several multiple advance appointments, recent studies have shown getting patients into physical therapy within a week can be associated with lower cost and reduced risk of invasive procedures, such as surgeries, for the patient, when compared with delayed referral, which suggests that patients ay benefit from early physical therapy (Fritz, Magel, McFadden, Asche, Thackeray, Meier & Brennan, 2015, p. 1). Along with the early intervention of the start of therapy, studies have shown the benefits of following the physician’s order of having therapy 2-3 times to help the patient meet their goals.
According to a study performed, on the benefits of getting patients into therapy 2-3 times a week, the experimental group received joint mobilization and active exercises two to three times per week for 4weeks, for patients with a restricted shoulder. The controls received only active exercises. With the xception of internal rotation in the control group, all motions increased significantly from baseline in both groups. Passive abduction improved significantly more in the mobilization group than in the control group.
Pain scores decreased more in the mobilization group; however, the difference between the groups was not significant. The results suggest that joint mobilization and exercises are clinically effective in the treatment of painfully stiff shoulders, but needs to be performed 2-3 times a week (Nicholson, 1995, p. 1). Quality of Care A patient’s experience often goes beyond making the patient happy. A patient can have a negative outcome, but still have a positive patient experience. Moreover, a patient can have a positive outcome, but also have a negative patient experience.
Most of the time, a patient’s experience is linked to how the healthcare providers engage them. For these reasons, patients often judge healthcare providers not only on clinical outcomes, but also compassionate and excellent, patient-centered care (Devkaran, 2014, p. 18). Additionally, developing standards for evaluating the quality of healthcare should take into account two frames of reference which are: focusing on standards and irection of action to be taken to assure high quality of care (Andamo 1984, p. 19). Quality of care from the patient’s perspective is increasingly in the spotlight, but what exactly does it mean?
From the mid-80s to the present, there has been a general shift in healthcare to view patients as consumers of care (Bury, 1997). A shift was made from measuring the opinion of the patient to measuring facts to assess the quality of care. Additionally, a positive outcome in physical therapy does not always link to a satisfied patient (Sitzia & Wood, 1994). For this reason, there should be a tendency to see the patient as a hole, autonomous person (patient-centeredness) who needed to be empowered to act as a full partner in the treatment process (patient empowerment) (Holmstrom & Roing, 2010).
Therefore, an organization should implement a quality of care improvement program which must include respect for people, a transparent and open culture, employee empowerment and actively engaged leaders (Mannon & Collins, 2015, p. 192). Evidence-Based Practice The use of evidence-based practice (EBP) is central to providing high-quality care and decreasing unwarranted variation in practice. Additionally, physical therapists (PTs) and physical herapist assistants’ (PTAS) knowledge and skills can be a key part of the evidence based process.
EBP consists of activities undertaken by an individual physical therapist that are situated within a physical therapist’s unique body of knowledge where the individual is educated, trained, and competent to perform that activity. Using clinical decision-making and judgement is key. Furthermore, a patient’s wants and needs are the key parts of the evidence based process. The Patients’ values and goals will be central to all efforts in which the physical therapy profession will engage. By doing so, it will incorporate a patient’s ultural considerations, needs, and values is a necessary skill to provide best practice services (Bellamy, 2011).
EBP can be a tool to assist a therapist in selecting the best techniques to correctly identify, quantify, and classify the patient’s problem, a result that will enhance the efficiency and effectiveness of service delivery (Humphries et. al, 2000, p. 10). Training In order for a medical practitioner to manage a patient diagnosis requires a synthesis of information, including the disease process, the patient, the signs and symptoms, interventions, values, and outcomes and are done with a great eal of uncertainty.
All of this must be done (decision making) without knowing precisely what the patient has, with uncertainty of signs and symptoms, with imperfect knowledge of sensitivity and specificity of tests. . . incomplete and biased information about outcomes, and with no language for communicating or assessing values. The same is true in the practice of physical therapy. Therapist need to understand their role in health care, how they gather, sort, and apply information and knowing what beliefs guide their patient interactions will help satisfy the patients (Jensen et al. 00).
There has been research studying clinicians’ level of knowledge in other health care professions, including nursing, medicine, and occupational therapy have argued that research must also be done in the actual practice setting, the clinic, using qualitative research methods. This emphasis on understanding everyday practice is consistent with the argument that a professional’s skillful action is adapted to the context of practice and that learning from one’s practice is a legitimate source of knowledge (Robertson, 2000).
Conceptual Framework The host organization (HO) is having issues with satisfying patients secondary to not being able to schedule the patients for therapy within a reasonable timeframe. This is effecting the HO due to patients are going to the competitors which is able to schedule them for therapy within a reasonable timeframe. Pascoe (1983), defines patient satisfaction as “a health care recipient’s reaction to salient aspects of his or her service experience” (p. 183). Additionally, Goldstein and Elliot (2000) “Patient satisfaction is often considered to be an abstract, multidimensional phenomenon.
Because it usually is not observable directly, patient satisfaction must often be measured in what we would consider an indirect manner” (p. 80). Additionally, Roush and Sonstroem (1999) states “Numerous aspects of patient satisfaction have been described, and the most common factors are: the patient-practitioner relationship (competence, personality of the practitioner, communication), location and accessibility of services, continuity of care, cost and payment issues, and the facility (e. g. , cleanliness, noise, equipment)” (p. 79).
To continue with increasing patient satisfaction within the HO, the scheduling system needs to be investigated to see if there are possible changes that can be made. The Medical Group Management Association (MGMA) advises practices to schedule accurately and to avoid long wait times for patients. DiGiacomo (2015) states “Effective and creative scheduling can help patients meet their goals, decrease stress on staff and boost productivity” (p. 54). According to Dan (2008) about scheduling “If you want the patients to respect your time, then you need to start that process by respecting theirs.
If patients do not feel you value their time, they might not respect yours and thus miss appointments without notice” (para. 12). Therefore, having an effective schedule can illustrate to patients that their care is important to the clinic. With the growing number of physical therapy clinics in today’s market, and where patients are becoming more involved with their healthcare secondary to having greater access to information and higher expectation for the quality of care they receive, satisfying the patients is very important.
Consequently, physical therapy clinics are being challenged to provide the best customer satisfaction as possible, secondary to the saturation in the marketplace of physical therapy. The increasing of physical therapy clinics has allowed patients more choices in providers. Additionally, physicians have been under pressure to decrease referrals for physical therapy, by insurance companies. Therefore, as the marketplace grows with competition, patient satisfaction is becoming very important in order to keep customers.
Scheduling patients in advance, guarantees appointment, for the patients, within a reasonable amount of time (DiGiacomo, 2005, p. 55). In addition to scheduling several multiple advance appointments, recent studies have shown getting patients into physical therapy within a week can be associated with lower cost and reduced risk of invasive procedures, such as surgeries, for the patient, when compared with delayed referral, which suggests that patients may benefit from early physical therapy (Fritz, Magel, McFadden, Asche, Thackeray, Meier & Brennan, 2015, p. 1).
In figure 1, it shows what outcomes can happen if patients do not schedule therapy within a reasonable time, which is ten days. After reviewing the pertinent literature, which are: scheduling, quality of care, evidence-based practice and training, these are areas that can help with improving the host organization’s patient satisfaction issues (see Figure 1). Figure 1. Conceptual Framework for Host Organization on Patient Satisfaction. Ethical Considerations Activities and teachings that can will improve quality to help increase patient satisfaction in health care must be conducted ethically.
Stakeholders of the organization must hold each other accountable for maintaining these ethics. To address ethical requirements for quality improvement and their relationship to patient satisfaction. According to Lynn et al (2007) quality improvement is defined as “systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings” (p. 2). For this reason, the improvement of quality should be a key part of normal health care operations.
Both clinicians and patients have an ethical responsibility to participate in quality improvement to help improve patient satisfaction, as long as that it observes ethical standards. Chapter Summary In chapter two of the research study, the literature was reviewed along with the creation of the conceptual framework. This literature showed the importance of continuing the investigation to better understand the concerns of patient satisfaction within the host organization.
