Structure, process or outcome: which contributes most to patients’ overall assessment of healthcare quality? BMJ Qual Saf

Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
BMJ quality & safety (Impact Factor: 3.99). 02/2011; 20(4):326-31. DOI: 10.1136/bmjqs.2010.042358
Source: PubMed


The paper explores which type of quality aspects (structure, process, outcome) most strongly determines patients' overall assessment of healthcare, and whether there is a variation between different types of patient groups in this respect.
Secondary analyses were undertaken on survey data from patients who underwent hip or knee surgery, cataract surgery, patients suffering from varicose veins, spinal disc herniation or rheumatoid arthritis. In these analyses, the patient-given global rating served as the dependent variable, and experiences regarding structure (waiting times, continuity of care), process (doctor-patient communication and information) and outcome aspects (improvement or worsening of symptoms) served as independent variables.
Experiences regarding process aspects explained most of the variance in the global rating (16.4-23.3%), followed by structure aspects (8.1-21.0%). Experiences regarding outcome did not explain much variance in the global rating in any of the patient groups (5.3-13.5%). The patient groups did not differ with respect to the type of quality aspects that most predicted the overall assessment.
Improving process and structure aspects of healthcare is most likely to increase patients' overall evaluation of the quality of care as expressed in a global rating. A more sophisticated method of patient reported outcome measurement, with pre- and post-treatment questionnaires and the inclusion of quality-of-life criteria, might lead to higher associations between outcome and the overall evaluation of the received care.

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    • "Different factors are important to achieve good quality of care. Doctor–patient communication has been found to be the most important aspect in patients' assessment of quality of care [2]. Using a patient-centered communication style improves patient satisfaction [3]. "
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    ABSTRACT: Objectives: Studies demonstrate that there are important gender differences in perceptions of medicinal care. Our aim is to investigate whether there are also gender differences in patients'quality of care experiences during their hospital stay. Methods: In a cross-sectional survey, patients who were admitted to a university hospital were invited to complete a questionnaire. Answers were compared between men and women of different ages, education levels, and health assessments, using the independent t-test. A linear regression model was performed to investigate the relationship between patient characteristics and hospital assessments RESULTS: 4169 questionnaires were sent (41.8% returned). Women rated the hospital significantly (P=0.007) lower than men, especially higher educated women and women between the ages of 18 and 44 years. Behaviors of nurses were perceived to be unsatisfactory by significantly more female patients than male patients (P=0.016). One in six women wanted more privacy compared with one in ten men (P<0.001), and ten percent more women suffered from pain (P<0.001). Conclusion: Women, particularly those higher educated and between 45 and 64 years of age, assess hospital care significantly lower than men. Implications for practice: To optimize patients' assessments of hospital care, women require more gender-sensitive nursing care, more privacy, and better pain management than they receive at present.
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    • "Assessing patient experiences of the quality of care not only provides information about the actual experiences, but also reveals which quality aspects patients regard as most important [7]. Many studies have been performed to analyse what patients consider essential within healthcare [8-10]. "
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    ABSTRACT: Background Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences. Methods A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis. Results The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care. Conclusions According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences.
    Full-text · Article · Jun 2014 · BMC Health Services Research
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    • "Research has shown that the global rating largely represents patients’ experiences with the process of care (e.g. communication), even though patients also consider many other aspects of care to be highly relevant [9,14,15]. Thus, there is a substantial risk that a global rating represents only some of the patient experience indicators. "
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    Full-text · Article · Nov 2013 · BMC Health Services Research
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