Patient Satisfaction - Assessing and Achieving?

The best way to improve patient satisfaction is to use methods of assessing patients' views over a wide range of specific issues. Then the conclusions can be used to work with patients to develop a service that is of the greatest benefit to those who use the service, as well as a pleasure to those who provide the service.

Patient satisfaction is affected by every stage of the pathway; from the phone call to make an appointment, to the outcome of the consultation. Therefore satisfaction will be influenced by many specific issues including:

• How easy it is to get through to the practice on the phone.
• How polite and helpful the receptionist is.
• How effectively the practice appears to be organised.
• How nice the practice premises are.
• How long after the designated appointment time the patient waits to be seen.¹(Although research has shown this is of less importance than the amount of time spent in consultation.)²
• How receptive, sympathetic and effective the doctor or nurse appear.
• Whether the effectiveness of the consultation is improved with written information or leaflets.
• Whether the outcome of the consultation leads to the patient feeling better.

Patient satisfaction can be assessed:

• Anecdotally; general perception of patients' attitudes, gifts, complaints
• Systematically; by questionnaires

Audit of specific patient satisfaction issues, e.g. how many patients see the doctor of choice, on the day of choice, is also a useful tool.

Assessment of patient satisfaction by questionnaires is being given increasing importance within the NHS and is part of the new GMS Contract (although there are no longer any payments specifically for doing an annual survey).³
Although the validity of questionnaires can be questioned, i.e. whether they are truly representative or if they are affected by the well-being of the patient who completes it, they can be used to identify key areas of the practice that are working well, and those that are working not so well. They can therefore be a useful tool in evaluating the services provided for patients, and provide a direction for future change and development.
Patient surveys require a lot of effort from the whole practice team. Therefore involvement and getting the enthusiastic support of the team is very important.

The practice should have a robust system for complaint management and have regular significant event analyses. Discussing these can help to change practice for the better. Widespread discussion enhances effective communication within the primary care team, and will often lead to the expression of useful opinions and ideas.

Patient groups also provide an excellent opportunity to incorporate the views of patient for the development of the practice.⁴
However, patient groups may not be truly representative of the whole practice population and may not provide a broad range of specific conclusions for practice priorities and development.
Therefore patient groups and satisfaction surveys should be seen as having additional benefits rather than being alternatives.
The group could either be a cross-section of all patients or be a focus group with particular service needs, e.g. mothers with young children, or the elderly.
If there is not a patient group already, a meeting with patients could be organised by:

• Advertisement in the waiting room at least two weeks before the meeting.
• Write to a random sample of patients at least three weeks before a proposed meeting.
• Advertisement in the practice newsletter.
• Leaflet handed out by reception staff or a notice on the side of prescriptions.

The PCT bases payments on the results of an annual postal survey of the practice's patients. The practice may also use patient satisfaction questionnaires which can be given to patients attending the surgery or receiving home visits, to be filled in after consultation with the GP or nurse.
The two currently recommended surveys are:

• The General Practice Assessment Questionnaire (GPAQ)⁵
• The Improving Practice Questionnaire (IPQ)⁶

The practice needs to take time to decide which of the questionnaires is right for them. They differ in terms of cost, time and effort, style and feedback.

• GPAQ is also available in a version designed to be sent out by post.
• An advantage of giving out the questionnaires in the surgery is that they can relate to an individual GP; postal surveys do not generally relate to a named doctor.

Quality and Outcomes Framework - summary of patient indicators (2009-10), patient experience domain

There are 91.5 points available in total.^7,8

• Patient experience of length of consultations - PE1: the length of routine booked appointments with the doctors in the practice is not less than 10 minutes - 33 points are available.
• Patient experience of access (1) - PE7: the percentage of patients who, in the appropriate national survey, indicate that they were able to obtain a consultation with a GP (in England) or appropriate healthcare professional (in Scotland, Wales and Northern Ireland) within two working days (in Wales this will be within 24 hours). 23.5 points available - payment stages 70-90%
• Patient experience of access (2) - PE8: the percentage of patients who, in the appropriate national survey, indicate that they were able to book an appointment with a GP more than 2 days ahead. 35 points available - payment stages 60-90%