Authors' objectives:

The review sought to: - summarise the results of studies that investigated methodological issues - identify determinants of satisfaction with healthcare in different setting - explore gaps in existing knowledge so that they can be addressed by future research - consider the implications of the findings for the NHS.

Better information on the factors affecting satisfaction will assist healthcare providers and planners in the NHS to improve the quality of the service they deliver to users. Guidance on methods of collecting feedback from consumers will ensure that reliable information for the decision-making process may be collected.

Authors' recommendations: Areas identified where further research may be warranted: A review of the effects of satisfaction on health behaviours and health outcomes is needed in order to establish the importance to health services, and to individuals, of fostering satisfaction. With respect to methodological issues, research is needed on: - the effect of timing of surveys on reported satisfaction - the extent of bias introduced by interviewers - cross-cultural issues and adaptations - how consumer feedback can be incorporated into healthcare decision-making, including the development of measures of relative preference. With respect to the role of expectations, research is needed to: - classify different types of expectations and explore how consumers operationalise these in evaluations - identify influences on expectations - examine the relationship between sociodemographic factors and expectations. There is a need to explore how different types of illnesses and health outcomes affect evaluations. Research is needed to explore the effect of different incentive structures on physician behaviour and patient satisfaction. Methodological recommendations: Researchers seeking to collect high-quality information about consumers views should pay particular attention to: - how different ways of conducting surveys affect response rates and consumers evaluations - sampling methods, particularly to include disadvantaged groups - promoting high response rates, to protect against low response bias - the effect of respondents expectations, prior experiences and desires - establishing the strength of relative preferences between attributes because this has advantages in a policy-making context, particularly with cost-effectiveness considerations in mind. Resource considerations are likely to be an important influence on the choice of survey method. Investigators must determine, in the context of their own requirements, whether the extra benefits derived from more costly approaches are worth the extra expenditure. Qualitative approaches provide in-depth information, in contrast to the reductionism implied by quantitative approaches. Open-ended questioning in structured questionnaires may be a compromise. If resources permit, a mix of approaches may be optimal. Recommendations from the review of the determinants literature: If consumer satisfaction is a priority, there is a need systematically to address interpersonal issues in the training of all staff, and to ensure that the financial and regulatory arrangements encourage practitioners to foster supportive and interactive relationships with their patients. There is evidence that age and health status can affect consumers ratings; these non-policy factors should be borne in mind when interpreting the results of satisfaction surveys. Implications of the review for the NHS: Information gathering from NHS consumers about their satisfaction, or causes of dissatisfaction, is essential to the quality assurance process because limited choice means that preferences cannot be expressed by changing providers. The review addressed methodological issues to help managers and practitioners to collect reliable information from users about their views. The evidence on the determinants of satisfaction has been synthesised. User interests will be served only if their feedback affects decision makers. Complaints data are not comprehensive. The National Plan for the NHS requires local managers and practitioners to conduct surveys of consumers views. The results of these surveys could be used in national level performance indicators. Evaluation of the costs and consequences of alternative means of collecting feedback would be beneficial, in particular the balance between local and national needs, and between qualitative and quantitative approaches. Instrument design is costly and complex, but some validated instruments are available.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1035

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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