Patient Satisfaction Why Bother?
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Loading ...What was more revealing was some of the comments made regarding the ability or even the right of patients to make informed choices about their care. Here are some examples :
as a measure of effectiveness and safety, patient satisfaction ratings are worse than useless.
You see patients are stupid. I should know, I’ve been one often enough
The research is shit. It looks at ‘patient satisfaction’. Exactly what relevence does ‘patient satisfaction’ with their care have
Not only can patients be stupid, but they are increasdingly coming in armed with information from the internet
Finally, only a total spaktard would think that ‘patient satisfaction’ scores are a reasonable assessment of clinical competence. Patients have fuck all idea what is good medicine and what is dangerous medicine. (Presumably if they received lethal medicine they would not be around to answer the questionnaire, which is a bias right there).
The fact that the punters thought the nurse was nice is of absolutely no fucking use whatsoever. I’d rather be DIAGNOSED by an obnoxious bastard who knew what they were doing than by the nicest nurse in the world that did not.
And in a more reasonable tone
I’m sure patient satisfaction surveys paint a pretty picture because that is what patient satisfaction surveys tend to do. They ask questions which elicit satisfied responses. We all know the problems with these sorts of surveys - poor response rates, the more ‘conformist’ people tend to respond, their responses are influenced by what they think those conducting the survey want to hear. It is far more honest and informative to look at complaints.
Apparently a spaktard is a spastically retarded individual, who can’t tell their arse from their elbow. Dr Rant stops short of saying (just) that patients don’t know what is good for them but what the above comments do show is how deeply ingrained the one size fits all system of socialised medicine is that we have in this country, with it’s Mother, (or in the NHS’s case), Doctor knows best attitude.
Can you imagine Stuart Rose or the managing director of Tesco’s adopting a similar attitude towards their customers? The Ford motor company I am sure have no difficulty in marrying safety and fuel efficiency with comfort and driving pleasure and they do this in any colour you want including black. The Private and Voluntary sector achieves better performance in what they do at least in part through satisfaction surveys or as it is called in private industry, sales. There are of course important differences between private industry and the NHS, between patients who use a service and customers who purchase a product. But even Dr C agrees that a nationalized healthcare system will never match the efficiency of a system based on choice and competition. The longer we ignore this fact the more the productivity of the NHS will continue to slump until the wheels finally and irrevocably come off all together.
But are patient satisfaction surveys a good idea or not? Do they help to inject some of the consumer driven ethos that makes private industry efficient and helps it deliver a quality service or are they a complete waste of time? Those that say that they are argue that the data is unreliable, or that the costs of carrying out the survey are not justified by the results, or may be they don’t want to be held to account for the service they provide by a consumer who has no choice over where to shop.
Responding to the first of these objections, a report in the BMJ in 1996;313:841-844 (5 October) , Can different patient satisfaction survey methods yield consistent results? Compared three surveys and concluded that when it came to respect for privacy, treatment with dignity, sensitivity to feelings, treatment as an individual, and a clear explanation of care there was good agreement among the surveys despite differences in wording. But for items to do with being encouraged and given time to ask questions and being listened to by doctors there was substantial disagreement.
The truth about patient satisfaction surveys is that if they are properly constructed and well carried out they can identify ways of improving practice which ultimately translates into improved outcomes and happier patients which is I think something we can all agree on without calling anyone a spaktard.
Tags: patients, service users
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11 comments
April 6, 2008 at 8:43 pm
zarathustra
I think I can see both sides of the argument in this case.
I’ve certainly worked with patients who had utterly unrealistic expectations, or had a poor appreciation of what we were doing for them, or just weren’t going to be pleased no matter what. (Conversely, I’ve also had some patients who, despite considerable evidence to the contrary, thought we were doing a great job.)
So I certainly would agree that patient satisfaction should not be taken as a sole barometer of quality of care. That said, I also wouldn’t dismiss it as irrelevant either.
April 6, 2008 at 10:52 pm
TheShrink
What Zarathustra said
I’d see patient satisfaction and comments as valuable. I seek them out myself. Personally, they’re used in 360 degree apraisal (where I give a list of 30 consecutive patients I see that’s used to send surveys out that’s then collated independently by the Royal College). Patients anonymously get to say how satisfied they are with me, how I work, what I do. I find this useful.
Also, I rely on patient satisfaction and information in service development. Last week I met with 2 patient representative groups and one carer group. There’s no sense having an ace service if it’s not accessible and usable so I’m always keen to hear what works well and what can be changed.
But we know that when a PCT tried to prioritise funding and struggled, generating research whereby the public was asked to rank importance of different health priorities, plastic surgery was ranked far far higher than hip replacements. Getting breasts sculpted is something the vocal public wanted, but getting a broken hip fixed is something that’s needed.
And that’s where I see the middle ground. As providers of health care, we are in a position to have awareness about what’s needed as well as what’s wanted.
Thus, I can’t see patient satisfaction and comments wholly directing service reconfiguration any more than I can see managers generating a service without discussion with patients and carers.
Another topic where middle ground, common sense and a sense of perspective is the answer, methinks.
April 7, 2008 at 4:25 pm
Disillusioned
Patient / service user views matter hugely. To suggest otherwise is to demean us. But what matters most about surveys is not whether they take place but whether anything happens as a result of them.
April 7, 2008 at 6:55 pm
E
Ah yes exactly surveys like enquiries can be used to dig the truth in rather than dig it up. They are also great for ignoring the views of “service users” while patronising them at the same time.
April 7, 2008 at 9:00 pm
Mandy Lifeboats Adrift
I agree with D.
My experience as a struggling user rep was that the service user surveys wasted service users time because all that happened was the Trust would say alot of things….but the next year the same problems would be highlighted in the survey as the year before and so it goes.
What point surveys if no useful action is taken?
Just becomes another paper trail with nothing to show for it.
April 7, 2008 at 9:54 pm
apple
It is already the case that some patients get more than other patients. I have seen interviews with cancer patients in the newspaper because they didn’t get a very expensive experiemental drug. Ever seen a schizophrenic patient in the newspaper because he didn’t get CBT? Or a patient with PTSD because he didn’t get EMDR? Or apatient with a personality disorder because he didn’t get evidence based psychotherapy? Service user information is useful, but to give people a choice, the NHS needs first to sort out that evidenced based treatments are available everywhere. Lets make that our first priority.
April 7, 2008 at 10:03 pm
cAsAcambs
As the co-ordinator of a service users group, I can say we are all deeply cynical about the consultation process we’re involved in, and most of us feel it’s a box ticking exercise for the MHP Trust to pick-up brownie points from the DoH. Talking about naming the new acute ward - OK; Talking about the Joint Strategic Needs Assessment - It’s an instant 136 and a RT.
April 9, 2008 at 3:03 pm
Mandy Lifeboats Adrift
Hi CAsAcambs
Can I ask you a question? Is your service user group involved in the Trust Self Assessment process?
I ask this because the group I used to be in was. For what it is worth. We were sent off with reams of paper that we then had to make judgements on. We duly did this and then at the formal Self Assessment Meeting the Mental Health Commissioner (one of them) basically overuled what was siad. I didn’t attend the meeting, which is a shame, because I never used to take any crap.
Now, I am all crapped out from being involved in these forums. Not sure how effective yours is. Hope it is effective but ours ended up becoming a Trust and Mind (the charity that ran it) mouthpiece. I had bailed out by then.
April 10, 2008 at 11:10 pm
cAsAcambs
Mandy, Self Assessment?! Our Trust?! Our consultation process is typically an email invitation to participate in a meeting where the agenda is set by the Trust - and is usually along the lines of A.M. Workshop “Are you getting enough leaftets”, P.M. Workshop “Where should we distribute the leaflets”. Any attempts to lobby staff directly are frowned on as “inappropriate”, letters and emails unanswered and questions like “Can you tell us about your differential diagnostic process in say, ASD’s and schizophrenia when a patient presents with a first psychotic episode? It’s just there’s a lot less autism round here than one would expect…” are met with stony silence.
April 12, 2008 at 2:32 pm
apple
I’m also cynical about service-user-involvement. When managment in the NHS doesn’t listen to her empoyees, why would we expect them to listen to service users? But still, it might be a way to change things. I think that if desillusioned workers in the NHS would join with the service users, we might get the change we want. Better care for more patients.
April 12, 2008 at 6:36 pm
Mr Ian
Just in case it gets wiped from Drs Rant et al…
How does this:
“But as a measure of effectiveness and safety, patient satisfaction ratings are worse than useless.”
http://www.drrant.net/2008/04/.....-just.html
Support the legendary bleatings of “but 84% of patients said they were satisfied with GP opening hours”.
Obviously, as one Rantette puts it:
“The research is shit. It looks at ‘patient satisfaction’. Exactly what relevence does ‘patient satisfaction’ with their care have?”
Or:
“You see patients are stupid. I should know, I’ve been one often enough. I’ve also seen enough incompetent doctors get away with terrible care because their patients liked them, and I’ve seen plenty of apparently excellent doctors who were in trouble because they were grumpy bastards”
So I guess if you want your patients satisfied with the opening hours - you don’t actually care about the hours - you just have to be nice to them when they’re there?
That’s probably why they dole out Prozac so much.