Short piece, just over 400 words, without an Abstrac

van Teijlingen, Edwin

English

Bournemouth University Research Online

Measuring patient satisfaction to allocate NHS funding: Opening a can of worms?Edwin R. van Teijlingen   (22 December 2009) It is interesting that the NHS in England in its attempts to improve ‘patient choice’ is nowintroducing patient satisfaction into the equation.[1] You quoted the NHS representativeas recognising the inter- relationship between patient demographics and socioeconomicfactors on the one hand, and patient satisfaction on the other: "Variations in people’sexpectations of what kind of service they should receive can be considerable, and factorslike geographical location, age, gender, and ethnicity can all impact on the kinds ofresponses received.” [1]There is a growing literature on the strengths and limitations of theconcept of patient satisfaction. The problem of defining satisfaction wasraised three decades ago. [2] However, despite considerable work in thisarea there appears to be little consensus regarding the definition of theconcept, [3] and it is generally agreed that satisfaction is amultidimensional concept determined by a variety of factors. [4]It is debatable how closely patient satisfaction is related to the quality ofthe services provided. Using the example of satisfaction with hospitalcatering remind us that low levels of patient satisfaction with hospitalmeals “does not reveal how important this issue is in relation to otheraspects of care. This characteristic of care with which patients are leastsatisfied may also be the one with which they are least concerned.” [5]More generally, many satisfaction studies lack a conceptual or theoreticalbasis [6,7,8,9] and the limitations of satisfaction as an outcome measurehave been well documented. Hence various authors have arguedconvincingly that satisfaction studies should not be used to allocatehealth care resources. [5,10,11,12] As Bennett also pointed out, healthservice users’ views will inevitably be limited by their expectation, [13]and there are complex linkages between expectations, preferences andsatisfaction. On top of this it has also been argued that patients rarelyevaluate care in terms of satisfaction. [14] Ryan and colleagues pointedout that satisfaction studies are not the same as public preference studiesand one can question whether satisfaction studies should be used inmaking decisions about allocating resources. [15] Whilst Carr-Hillreminded us, “many ... researchers launch into patient satisfactionsurveys without realising the complexity of the task.” [8] All in all, thissuggest that there is a lot of debate about the ‘how’ and ‘whys’ of usingthe concept of patient satisfaction in health services research, whichneeds to taken into consideration before NHS officials embarked onanother scheme that has little chance of improving UK health care in thedesired way.Prof. Edwin van TeijlingenEmail: vanteijlingen@bournemouth.ac.ukReferences1. Wise J. Part of hospitals’ funding will depend on patient satisfactionratings from 2010-11. BMJ 2009; 339:b5451.2. Locker D, Dunt D. Theoretical and methodological issues insociological studies of consumer satisfaction with medical care. Soc SciMed 1978; 12, 283-292.3. Avis M, Bond M, Arthur A. Satisfying solutions? A review of someunresolved issues in the measurement of patient satisfaction. J Adv Nurs1995; 22, 316-322.4. Williams B. Patient satisfaction: A valid concept? Soc Sci Med 1994;38, 509-516.5. Teijlingen van E, Hundley V, Rennie A-M, Graham W, Fitzmaurice A.Maternity satisfaction studies and their limitations: "What is, must still bebest". Birth 2003; 30, 75-82.6. Avis M. Incorporating patients’ voices in the audit process. Qual HealthCare 1997; 6, 86-91.7. Bisset A, Chesson R. Is this satisfaction survey satisfactory? Somepoints to consider in their planning and assessment. Health Bull 2000; 58,45-51.8. Carr-Hill RA. 1992. The measurement of patient satisfaction. J PublicHealth Med 1992; 14, 236-249.9. Cleary PD. The importance of patient surveys. BMJ 1999; 319, 720-721.10. Brown S, Lumley J. The 1993 Survey of Recent Mothers: Issues insurvey design, analysis and influencing policy. Int J Qual Health Care1997; 9. 265–275.11. Bramadat IJ, Driedger M. Satisfaction with childbirth: Theories andmethods of measurement. Birth 1993; 20, 22–29.12. Scott A, Smith RD. Keeping the customer satisfied: A technique foradding value to patient satisfaction surveys. Int J Qual Health Care 1994;6, 353–359.13. Porter M, Macintyre S. What is, must be best: a research note onconservative or deferential responses to antenatal care provision. Soc SciMed 1984; 19, 1197-1200.14. Staniszewska S, Ahmed L. The concepts of expectation andsatisfaction: do they capture the way patients evaluate their care? J AdvNurs 1999; 29, 364-372.15. Ryan M, Scott DA, Reeves C, Bate A, van Teijlingen ER, Russell EM,Napper M, Robb CM Eliciting public preferences for healthcare: asystematic review of techniques. Health Technol Assess 2001; 5(5).http://www.hta.nhs.uk/fullmono/mon505.pdfCompeting interests: None declared

Incorporating patients’ voices in the audit process. Qual Health Care

Is this satisfaction survey satisfactory? Some points to consider in their planning and assessment. Health Bull

Keeping the customer satisfied: A technique for adding value to patient satisfaction surveys.

Maternity satisfaction studies and their limitations: &quot;What is, must still be best&quot;.

Part of hospitals’ funding will depend on patient satisfaction ratings from 2010-11. BMJ

Patient satisfaction: A valid concept? Soc Sci Med

Robb CM Eliciting public preferences for healthcare: a systematic review of techniques. Health Technol Assess 2001; 5(5). http://www.hta.nhs.uk/fullmono/mon505.pdf Competing interests: None declared

Satisfaction with childbirth: Theories and methods of measurement. Birth

Satisfying solutions? A review of some unresolved issues in the measurement of patient satisfaction.

The concepts of expectation and satisfaction: do they capture the way patients evaluate their care?

The importance of patient surveys.

The measurement of patient satisfaction.

Theoretical and methodological issues in sociological studies of consumer satisfaction with medical care. Soc Sci Med

What is, must be best: a research note on conservative or deferential responses to antenatal care provision. Soc Sci Med

Measuring patient satisfaction to allocate NHS funding: Opening a can of worms? Rapid Responses to: NEWS: Jacqui Wise: Part of hospitals’ funding will depend on patient satisfaction ratings from 2010-11 BMJ 2009; 339: b5451

Measuring patient satisfaction to allocate NHS funding: Opening a can of worms? Rapid Responses to: NEWS: Jacqui Wise: Part of hospitals’ funding will depend on patient satisfaction ratings from 2010-11 BMJ 2009; 339: b5451

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