The characteristics of patient satisfaction measures

The words "patient" and "customer satisfaction" are widely used in health c are contexts. Because this concept is so much a part of current rhetoric in health care, it is easy to accept unquestioningly its inclusion as an inte gral part of the evaluation of health care quality(11) and to assume that i ts measurement and interpretation are evident. Many clinicians, however, ap pear skeptical of the usefulness of satisfaction measures. This may, in par t, reflect a belief that as an indicator of health care quality, satisfacti on is an administrative issue and not something that is of interest or use to clinicians who are often more immediately concerned with the effectivene ss of their treatment interventions than with how patients feel about the c ost or accessibility of services, the parking and food at the hospital, or their interpersonal relationships with health care professionals. There als o seems to be a sense that these measures are concerned with aspects of pat ients' health care experience over which clinicians have no control. It is known that "satisfied and dissatisfied patients behave differently."( 20) Satisfied patients seem more likely to cooperate with their treatments, continue using medical care services, maintain a relationship with a speci fic provider, participate in their own treatment,(3,7) and cooperate with t heir health care providers by disclosing important medical information.(3) Conversely, if dissatisfied, "patients may make services less effective, ei ther by neglecting to seek care when needed or refusing to comply with the prescribed course of treatment."(48) It is assumed that outcomes such as pa tient's health status, frequency and length of hospital stay, and continuit y of care are influenced by patient compliance and satisfaction.(3,38) Beca use patient satisfaction can influence the quality of care provided and the outcomes of treatment, this information can be of direct relevance and val ue to clinicians. Having given the "right" treatment, it is reasonable to b elieve that clinicians should strive to satisfy their patients as well. The heterogeneity of patient satisfaction measures makes choosing a measure confusing. It is noteworthy that the word "satisfaction" does not even app ear in many measures considered reflective of this concept. Lack of clarity concerning the meaning of satisfaction and its relation to other measures has been highlighted as a major weakness in this field of inquiry.(1,22,39, 55,73,74,76) For example, how does health care quality relate to satisfacti on, and can it be assumed that high ratings of health care quality imply hi gh levels of satisfaction? The correlation among various measures or concep ts is beyond the scope of this article. In this article, a satisfaction mea sure is considered any measure that seeks patients' evaluations or affectiv e responses to distinct dimensions of the health care experience.(35,66) Clarity about how satisfaction measures differ is necessary, because conclu sions about satisfaction vary depending on the characteristics of the measu res used.(13,49,65,68) This article is intended to orient clinicians to the characteristics of patient satisfaction measures and should assist them in selecting and administering a measure appropriate for their needs. Three m easures will be discussed in detail: the Patient Satisfaction Questionnaire (pSQ),(71) the Patient Satisfaction Scale (pSS),(8) and the Client Satisfa ction Questionnaire (CSQ).(32) These particular measures were selected beca use they vary across many of the characteristics of satisfaction measures. Although the DSS is intended specifically for patients with low back pain, the PSQ and CSQ are commonly used for any patient group. These are by no me ans the only satisfaction measures available, nor are they always the best choice depending on the users' purpose. Comprehensive reviews of satisfacti on measures are available.(20,47,66).