New dimensions

Still trying to adapt to my “new” life as a PhD student. The hardest part is to prioritize which “task of the day” I’m should lay hold of. There are so many of them… so how do I select them in a good, structured and effective way? I find myself doing list of what I’m about to do… spending time to organize my tasks instead of actually do them. But I’m doing “things” all the time, every day of the week and still… it is not enough. Every so often, I think I’m on the wrong path but then I remember that the path never is straight forward. The path is supposed to be winding and that the path is the journey and that the process have to take time… and then I’m back in my loop again, trying to figure out what to do next. Maybe a blog post…?

Earlier I wrote about six dimensions of quality, according to the report “Crossing the quality chasm”. Today I’ve learned about new dimensions but this time it is regarding “Patient satisfaction”. Ware et al. (1978) argued for 8 dimensions of patient satisfaction in a proposed taxonomy:

  • Art of care
  • Technical quality of care
  • Accessibility/convenience
  • Finances
  • Physical environment
  • Availability
  • Continuity of care
  • Efficacy/outcome of care

It amaze me that some truths still remains. The taxonomy is complex and two weeks ago I got the suggestion or may I say an advice not to center my attention towards patient satisfaction and instead focus on patient experiences since it is an “easier” topic to define and thereby study. I’m in an early stage of my research and now, I have the opportunity to choose, so obviously I’ve been thinking a lot of this ever since.

I looked attitude up on the internet and is says “A settled way of thinking or feeling about something“. Our expectations is “A strong belief that something will happen or be the case“. My instant thought is that this must be very individual, I mean which attitude and what expectations we have. And then we experience something “An event or occurrence which leaves an impression on someone” and perceive it “A way in which something is regarded, understood, or interpreted“.  Again, extremely individual how an event is interpreted by my attitude. So were does satisfaction fit into all this? The internet says that satisfaction is “A fulfillment of one’s wishes, expectations, or needs, or the pleasure derived from this“. I don’t know about this pleasure thing according to my research topic, colonoscopy, but definitively needs. This is align with Cleary & McNeil (1988) who states that patient satisfaction builds upon the individuals needs. So, is a patient satisfied if their individual needs are fulfilled? Then I have to identify which needs are the most common to patients undergoing a colonoscopy in order to know if the patients is satisfied with the experiences from the procedure, right? Easy Peasy!

Or… Why not choose satisfaction, why is experiences (and for that matter needs) “easier”? Is experiences more single dimensional? Maybe, I don’t have to go all the way around…? Some may define patient satisfaction in the gap between the patient expectation and the actual experience (Beattie et al., 2015). There are many definitions of patient satisfaction and one reasonably definition is made by Maciejewski et al. (1997) who suggests that it represents:

“A patient’s cognitive or emotional evaluation of a health care provider’s performance and the evaluation is based on relevant aspects of the patient’s experience.”

I guess I’m back with patient experience. I realize that yet another task for me, is to define patient experience. One way to consider patient experience is in terms of the determinants (factors) of the experience, its components and/or the outcomes of the actual experience (de Silva, 2013). In the report de Silva refers to a study by Lau et al. (2012) who indicates the need of, not only focusing on the experience but also ask patients about their levels of experience and how they want to see it improved. I believe I’m back again with the outcome – patient satisfaction…

*BIG sigh & rolling my eyes*

Beattie M, Murphy DJ, Atherton I, Lauder W, (2015) Instruments to measure patient experience of healthcare quality in hospitals: a systematic review. Syst Rev, 23, 4:97.

Cleary P, McNeil B, (1988) Patient Satisfaction as an indicator of quality for care. Inquiry. 25, 25-36.

de Silva D, (2013) No 18: Measuring patient experience. Evidence scan, The health foundation.

Lau RL, Gandhi R, Mahomed S, Mahomed N, (2012) Patient satisfaction after total knee and hip arthroplasty. Clin Geriatr Med, 28(3), 349-365.

Maciejewski M, Kawiecki J, Rockwood T, (1997) Satisfaction in understanding health care outcomes research. Gaithersburg, Aspen Publishers Inc.

Ware J, et al. (1978) The measurement and meaning of patient satisfaction: a review of the literature. Health Med Care Serv Rev. 1(1), 3-15.

Photos: Pixabay

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