Patient satisfaction & quality in health care (13.3.2017) dr.nyunt nyunt wai

1. PATIENT SATISFACTIONPATIENT SATISFACTION
Dr. Nyunt Nyunt WaiDr. Nyunt Nyunt Wai
Senior Medical Superintendent (N.Y.G.H)Senior Medical Superintendent (N.Y.G.H)
(13.3.2017)(13.3.2017)
QUALITY IN HEALTH CAREQUALITY IN HEALTH CARE
ANDAND

2. Patient satisfactionPatient satisfaction
• The degree to which the individual regards the health carehealth care
serviceservice or product or the manner in which it is delivered by
the provider as useful, effective, or beneficial.useful, effective, or beneficial.
What is patient satisfactionWhat is patient satisfaction
-- and what can we do about it?and what can we do about it?

3. Evolution of patient-centrednessEvolution of patient-centredness
• Increased lay knowledge and self-help
• Increased awareness of professional falliability and
diagnostic uncertainty
• Rise in scepticism about medicine/science
• Awareness of wider influences on health
• Shift in focus from acute to chronic conditions
• Wide variation in clinical practice
• Pressure to increase accountability
• Pressure to democratise public health systems
• Shift from objective to subjective medicine

4. TOTAL QUALITY MANAGEMENT

5. Why is patient satisfactionWhy is patient satisfaction
important?important?
• Public accountability
• Quality improvement
– Macro-level:
• system performance management
• benchmarking
• competition/contestability through markets
– Micro-level:
• feedback to professionals and managers
• acceptability of processes / social model of health

6. Client Centered Health CareClient Centered Health Care
Client centered approach often require
a shift in attitude
In client centered care, client (patient)
customers are first and foremost (total quality
management)
To ensure client safety and maintain quality of
care
Explain range of methods available
Discuss the efficacy & adverse effect of
treatments method

7. CUSTOMER (PATIENT)
NURSE & TECHNICIAN
DOCTORDOCTOR
CUSTOMER (PATIENT)
NURSE & TECHNICIAN
DOCTORDOCTOR
IMPORTANCEIMPORTANCE
IMPORTANCEIMPORTANCE
TRADITIONAL MANAGEMENTTRADITIONAL MANAGEMENT TOTAL QUALITY MANAGEMENTTOTAL QUALITY MANAGEMENT
THE INVERTED PYRAMID OF CONTROLTHE INVERTED PYRAMID OF CONTROL

8. What Do Patients Want?
 Respect and recognitionRespect and recognition
Patients to be treated with respect and friendlinessPatients to be treated with respect and friendliness
 UnderstandingUnderstanding
Patients value individualized service and prefer providerPatients value individualized service and prefer provider
who try to understand the real situationwho try to understand the real situation
 Emphatic ListeningEmphatic Listening
Five levels of ListeningFive levels of Listening
1. Ignoring1. Ignoring
2. Pretending2. Pretending
3. Selective listening3. Selective listening
4. Attentive listening4. Attentive listening
5. Emphathic listening: the highest form of listening.5. Emphathic listening: the highest form of listening.
 Complete and accurate informationComplete and accurate information
Patients want complete & accurate information about theirPatients want complete & accurate information about their
disease, treatment and outcomedisease, treatment and outcome

9. Technical competenceTechnical competence
• Patients want to know technicalPatients want to know technical
competence of providerscompetence of providers
AccessAccess
• A convenient action and prompt serviceA convenient action and prompt service
are neededare needed
FairnessFairness
• Patients want provider to offer thoroughPatients want provider to offer thorough
explanations and examination to everyone alikeexplanations and examination to everyone alike
ResultsResults
• A quality product or service at a fair priceA quality product or service at a fair price
• SatisfactionSatisfaction

10.  Patients’ rights and providers' needsPatients’ rights and providers' needs
Patients’ rightsPatients’ rights
 InformationInformation about the diseaseabout the disease
 AccessAccess to all service delivery systems and health careto all service delivery systems and health care
providersproviders
 ChoiceChoice of adopting, switching or discontinuing methodsof adopting, switching or discontinuing methods
 SafelySafely in practice of treatmentsin practice of treatments
 PrivacyPrivacy during discussion & physical examinationduring discussion & physical examination
 ConfidentialityConfidentiality of all personal informationof all personal information
 To be treated withTo be treated with dignitydignity courtesy , consideration andcourtesy , consideration and
attentivenessattentiveness
 ComfortComfort while receiving treatmentwhile receiving treatment
 ContinuityContinuity of care for as long as the client desireof care for as long as the client desire
 ToTo expressexpress their opinion about the quality of services receivetheir opinion about the quality of services receive

11.  TrainingTraining on technical and communication skillon technical and communication skill
 InformationInformation on technical issue ,updated regularlyon technical issue ,updated regularly
 InfrastructureInfrastructure, including appropriate physical facilities and, including appropriate physical facilities and
efficient organizationefficient organization
 SupplySupply of proper medicineof proper medicine
 GuidanceGuidance from service guidelines ,checklist and supervisionfrom service guidelines ,checklist and supervision
 Back upBack up from other providers and level of carefrom other providers and level of care
 Respect and recognitionRespect and recognition from co-workers, managers, clientsfrom co-workers, managers, clients
and communityand community
 EncouragementEncouragement to provide good quality of careto provide good quality of care
 FeedbackFeedback from managers to supervisors, other servicefrom managers to supervisors, other service
provider and patientprovider and patient
 Self-expressionSelf-expression so that managers consider their views whenso that managers consider their views when
making discussion.making discussion.
Providers’ needsProviders’ needs

12. A theoretical model of patient
satisfaction
Expectations
Disconfirmation
Satisfaction
Emotions
Attribution
of cause
Equity
Perceived attribute
performance
COGNITIVE
AFFECTIVE

13. CONCEPTUAL MODELCONCEPTUAL MODEL
Socio-Economic
Factors of Patients
Education
Occupation
Income
Utilization of
Hospital
SATISFACTION
OF PATIENTS
Good
Interpersonal
Relationship
Prompt and
Efficient
Treatment
Amenities of
Adequate Quality
Patient's Choice
Revenue

14. FACTORS INFLUENCING PATIENT SATISFACTIONFACTORS INFLUENCING PATIENT SATISFACTION
PATIENT
SATISFACTION
Quality
& Competency of
providers
Availability & Skill
of Health Care
Providers
Effectiveness of Care
Appropriateness of Care
Continuity of Care
Information
&
Explanation
Interpersonal
Relation
Waiting
Time
Financial Expense
(Out of Pocket)
Fairness
Safety
Security
Convenient
of Service
Pleasant
Surroundings
Amenities
Supporting
Machine &
Equipments
Material
&
Drug Supplies
Efficiency
of Outcome

15. Quality Health CareQuality Health Care
Quality health care consists of proper performance accordingQuality health care consists of proper performance according
to the standard of intervention of that are known to be safe, that areto the standard of intervention of that are known to be safe, that are
affordable to society and in question and that have the ability toaffordable to society and in question and that have the ability to
produce an impact on mortality ,morbidity and malnutrition.produce an impact on mortality ,morbidity and malnutrition.
Quality means offering the greatest health benefits, with theQuality means offering the greatest health benefits, with the
least health risk, to the greatest number of people, given to theleast health risk, to the greatest number of people, given to the
available resourcesavailable resources
Benefit of good qualityBenefit of good quality
• Safety & effectivenessSafety & effectiveness
• Client satisfactionClient satisfaction
• Job satisfaction for providersJob satisfaction for providers
• Better program reputation and competitivenessBetter program reputation and competitiveness
• Expanded access to servicesExpanded access to services

16. Quality definitions - generalQuality definitions - general
1. Doing the right thing
On the right time
In the right way
At the right place
On the first time
2. Aiming to Excellency toward the customer
3. The ability of “surprise” the customer

17. Definitions 1Definitions 1
QC – Quality ControlQC – Quality Control –
assessment (evaluation) of the level
of existing performance – measuring.
QA – Quality AssuranceQA – Quality Assurance –
activity of bridge – the gap between
observed quality & expected quality.

18. Definitions 2Definitions 2
TQM – Total QualityTQM – Total Quality Management.Management.
CQI – Continuous Quality ImprovementCQI – Continuous Quality Improvement
- prospective continuous process
involving all staff, that leads to higher
performance, outputs & outcomes.

19.  Provider Perspective ( Service Oriented )Provider Perspective ( Service Oriented )
- Safety
- Effectives
- Technical Competence
 Administrator Perspective ( Target Oriented )Administrator Perspective ( Target Oriented )
- Technical Competence
- Effectives
- Efficiency
- Accessibility
 Patients Perspective ( Satisfaction OrientedPatients Perspective ( Satisfaction Oriented )
- Safety
- Effectives
- Efficiency
- Accessibility
- Inter Personal Relation
- Continuity
- Amenities
Quality means different things to different peopleQuality means different things to different people
PatientPatient
ProviderProvider AdministratorAdministrator

20. Customer SatisfactionCustomer Satisfaction
Complaints
Management
Monthly
Feedback
Customer Service
Level Trending Surveys
Complaints Trending
& Analysis Report by
DQM on Quarterly
basis
Compilation of Feedback
By Communications
Department
Customer Service level
Trending survey Conducted
on
Quarterly Basis by
Corporate Affairs
Discussion at Monthly
Feedback Meeting with
CEO
Implementation Of action
plans by Departments
Implementation Of action
plans by Departments
Process owners present action plans / results at Management Meeting
Process owners present action plans / results at Management Meeting
Process owners present action plans / results at Management Meeting
review

21. Methodology for survey
a. The structured questionnaires (feed back
forms)
b. Discharge interviews
c. Suggestion/Complaint boxes
d. Periodic meetings with the public
Evaluation Through Patient Satisfaction SurveyEvaluation Through Patient Satisfaction Survey

22. - Simple to understand, with yes or no type
answers (or)
- Multiple answers (very good/ good/ fair/
satisfactory/poor)
- For ticking the appropriate one
- Survey should cover outpatients /inpatients
- Details of patient name, R/N, ward, D.O.A,
D.O.D
- Signed by the patient
a.The structured Questionnairesa.The structured Questionnaires

23. - Face to face interviews
- Important feedback is known immediately
- At the right level for initiating timely action
eg.Discharge Parade in N.Y.G.H by medico.
social worker,Matron,AMS,DMS
b. Discharge Interviewsb. Discharge Interviews

24. - Very useful feedback from the
patients/relatives/visitors.
- Boxes placed at reception,OPD,waiting areas,
wards, X-ray Dept, Lab, Blood Bank,…..ect..
- Opened every day/once a week/month at
fixed timing
- Put up to the management for further action
c. Complaint/Suggestion Boxesc. Complaint/Suggestion Boxes

25. - Scheduled after due announcements
- The community gets the message the hospital
is sincere about improving the services
- Suggestions/Points from the public
discussed to understand noted down
for action
- Record of meetings,important points
discussed and follow up action,should be
maintained
d. Periodic Meetings With The Publicd. Periodic Meetings With The Public

26. - Processed at the earliest
- Involve the collection,compiling,analysis,Investigations
- To find out likes/dislikes (or) expectations of the
patients
- to improve the services to meet the patients’
requirements
- Positive feedback/Negative feedback
- Speed of processing the feedback is important for
prompt action and right impact
- To understand the true value of the feedback and
derive the right conclusions
Processing of the survey feedbackProcessing of the survey feedback

27. - Communication to the respondent in
writing/telephone/personal interview
- Ensuring that a corrective action has been
implemented
Feedback to the respondents about the action takenFeedback to the respondents about the action taken
Dissemination of Information to the staffDissemination of Information to the staff
- The purpose of survey would be defeated if
the staff are not given the feedback at the
earliest possible
- Not given the feedback at the earliest possible
- Detailed action plan for eliminating the
deficiencies
- In the periodic staff meetings communicated
publically

28. - Discussed in detail in the presence of all the heads of
department (SMO meeting)
- Policy decisions , Resource allocation
- Reviewed and targets reset for the next period.
Periodic (Quarterly) Review of the Satisfaction LevelPeriodic (Quarterly) Review of the Satisfaction Level

29. - Feedback from the patients/public, through an on
going program of patient satisfaction survey
- Very effective tool for improvement of quality of
services and level of satisfaction of patients
SummarySummary

30. Sanpya Hospital ThingangyunSanpya Hospital Thingangyun

31. New Yangon General HospitalNew Yangon General Hospital

32. Reception Counter(NYGH)Reception Counter(NYGH)

33. Suggestion Boxes (NYGH)Suggestion Boxes (NYGH)

34. Suggestion Boxes (S.P.H )Suggestion Boxes (S.P.H )

35. Discharge Parade(S.P.H )Discharge Parade(S.P.H )

36. Discharge Interviews(S.P.H )Discharge Interviews(S.P.H )

37. Discharge Parade (N.Y.G.H)Discharge Parade (N.Y.G.H)

38. Discharge Parade
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40. 8 Ways to Improve Patient Satisfaction,8 Ways to Improve Patient Satisfaction,
Patient Experience And (By The Way)Patient Experience And (By The Way)
HCAHPS ScoresHCAHPS Scores
(Hospital Consumer Assessment of(Hospital Consumer Assessment of
Healthcare Providers and Systems)Healthcare Providers and Systems)

41. 1.1. If you want to stem patient dissatisfaction,If you want to stem patient dissatisfaction,
stop giving off cues of indifference andstop giving off cues of indifference and
uncaring.uncaring.
2.2. Strive actively to experience your care theStrive actively to experience your care the
way that your patients do.way that your patients do.
3.3. Get every employee thinking about purpose,Get every employee thinking about purpose,
not just functions.not just functions.
4. “Sorry” may be the hardest word, but it’s a4. “Sorry” may be the hardest word, but it’s a
word that everyone on your team needs toword that everyone on your team needs to
learn.learn.

42. 5. Teach your employees-every single one-5. Teach your employees-every single one-
how to handle a patient or family member’show to handle a patient or family member’s
complaint or concern.complaint or concern.
6. If you want to improve,strive to create a6. If you want to improve,strive to create a
blame-free environment.blame-free environment.
7. Understand that improving patient7. Understand that improving patient
satisfaction is about systems just as muchsatisfaction is about systems just as much
as it is about smiles.as it is about smiles.
8. Benchmark outside healthcare.8. Benchmark outside healthcare.

43. Horses for courses
• Micro-level: service quality improvement
– professionals and managers need to know where
to focus (ratings) and how to improve services
(reports)
– need information on what is important, as well as
the most satisfying/dissatisfying
• Macro-level: public accountability
– need for a parsimonious set of indicators
– evidence (limited) of superiority of ratings

44. KEY POINTS•
• Physicians can find ways to improve the
doctor-patient relationship by examining
what works in other fields, such as sales.
• When patients trust their physician, they
are more likely to adhere to treatment plans
and follow advice.
• Effective listening and inquiry will help you
uncover patients' real needs and goals.

45. Concluding commentsConcluding comments
• To decide on the value of patient judgements, there
is a need to know:
– causes of satisfaction and dissatisfactioncauses of satisfaction and dissatisfaction
– meanings and importance of quality in health caremeanings and importance of quality in health care
• In attempting to solve apparent methodological
problems, a focus on reports alone raises problems
of an ethical and political nature
• Need to embrace subjectivity and work to
understand it to create patient-centred servicesto create patient-centred services andand
a coherent theory of patient satisfactiona coherent theory of patient satisfaction

46. Dr. Nyunt Nyunt WaiDr. Nyunt Nyunt Wai
Senior Medical Superintedent (N.Y.G.H)Senior Medical Superintedent (N.Y.G.H)