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A patient satisfaction rating scale for psychiatric service users

  • Lars K. Hansen (a1), Selvaraj Vincent (a2) (a3), Scott Harris (a3), Emily David (a2) (a3), Sheeba Surafudheen (a2) (a3) and David Kingdon (a3)...
Abstract
Aims and method

The patient's experience of the clinician is an increasingly important area in time of ‘consumer choice’ and appraisal of the individual practitioner. Validated, easy-to-use scales are scarce. The aim was to validate a user-friendly, brief scale measuring patient satisfaction (PatSat scale). Over three phases, patients were involved in developing and validating the scale against the Verona satisfaction subscale.

Results

A highly significant correlation was found between the two scales (Spearman's correlation coefficient 0.97, two-tailed P <0.001).

Clinical implications

The PatSat is a new patient satisfaction scale validated in a psychiatric out-patient population. It appeared popular with patients and took less than 1 minute to fill in. The use of validated scales measuring patient satisfaction is a pivotal part of mental health delivery and advancing overall quality of care.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Lars K. Hansen (lh4@soton.ac.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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4 General Medical Council. Good Medical Practice. GMC, 2006.
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6 Horgan, A, Casey, P. What do you think of us? Attitudes to psychiatric treatment. Q J Ment Health 2007; 1, 2: 6774.
7 Haig-Smith, C, Armstrong, D. Comparison of criteria derived by governments and patients for evaluating general practitioner service. BMJ 1989; 299: 494–6.
8 Rosenheck, R, Stroup, S, Keefe, RSE, McEvoy, J, Swartz, M, Perkins, D, et al. Measuring outcome priorities and preferences in people with schizophrenia. Br J Psychiatry 2005; 187: 529–36.
9 Rider, E, Perrin, JM. Performance profiles: the influence of patient satisfaction data on physicians' practice. Pediatrics 2002; 109: 752–7.
10 Ruggeri, M, Lasalvia, A, Dall'agnola, R, Tansella, M, Van Wijngaarden, B, Knudsen, HC, et al. Development, internal consistency and reliability of the Verona Service Satisfaction Scale – European Version: EPSILON Study 7. Br J Psychiatry 2000; 177 (suppl): s418.
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12 Kincaid, JP, Fishburne, RP Jr, Rogers, RL, Chissom, BS. Derivation of New Readability Formulas (Automated Readability Index, Fog Count and Flesch Reading Ease Formula) for Navy Enlisted Personnel. National Technical Information Service, 1975.
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15 Steine, S, Finset, A, Laerum, E. A new, brief questionnaire (PEQ) developed in primary health care for measuring patients' experience of interaction, emotion and consultation outcome. Fam Pract 2001; 18: 410–8.
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A patient satisfaction rating scale for psychiatric service users

  • Lars K. Hansen (a1), Selvaraj Vincent (a2) (a3), Scott Harris (a3), Emily David (a2) (a3), Sheeba Surafudheen (a2) (a3) and David Kingdon (a3)...
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eLetters

Why not patient feedback on psychiatric services?

Asif M Bachlani, StR 6 General Adult Psychiatry
22 December 2010

Dear Editor

We read with interest the article by Hansen et al (1) which brings the important issue of patient satisfaction back on the agenda. We would however encourage our colleagues to go further and collect patient satisfaction data for our services routinely. This is especially important considering the time of austerity that we are living in and given the fact that when the UK when compared to other developed healthcare scores badly on patient centred care (2). How else would we know what our patients want from their service?

Most trusts in the current market driven NHS are using Health of the Nation Outcome Scales (HoNOS) (3) as an outcome measure to measure quality of service provided. Although we don’t dispute the importance of getting validated data on improved patientoutcome this is a clinician rated tool. This has the inherent issues of bias and has been described as a builder or plumber rating their own work.

Now let’s be honest we wouldn’t choose a builder solely on their own recommendations. Most large organisations get feedback from the customersand the success of sites such as Trip Advisor and Amazon work on the fact that customers regularly feedback on their website. Shouldn’t we be asking what our patients think of the service we are providing? How do weeven know we are providing the service that our patients want?

When considering service provision in times of fiscal austerity and we need to consider all our stakeholders and patients are at the most important of our stakeholders. When considering justifying our services to our commissioners shouldn’t we also include the view of our patients? Is it not important for us to know what our patients think of the service we provide? We would go further and suggest that our patients could also inform us of how our services could be cut in these difficult financial times.

References

1.Hansen LK, Vincent S, Harris S, David E, Surafudheen S, and Kingdon D. Apatient satisfaction rating scale for psychiatric service users. The Psychiatrist 2010; 34: 485-488.

2.The Commonwealth Fund Commission on a High Performance Health System National Scorecard (2007)

3.Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. (1998) Healthof the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry, 172: 11-18.
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Conflict of interest: None Declared

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Improving outcome through patient satisfaction

lars k hansen, consultant psychiatrist
29 November 2010

Thank you to Dr Whelan and colleagues for their constructive comments[1] regarding the patient satisfaction scale, PatSat [2], published in this month’s edition of The Psychiatrist. The idea for this scale sprung from years of using home-made scales for the yearly appraisal in a flawed attempt to measure the individual doctors’ performance in the eyes of the patient. PatSat is therefore uniquely focussed on the relationship betweenthe clinician and the individual patient. As Whelan and colleague correctly points out this is only a part of patient satisfaction, but PatSat provides an evidence based fundament for the individual clinician to learn about his or her relative strengths and weaknesses of his or her practice. The idea is that the clinician then through supervision can target areas that need further improvement and build on his or her stronger points. Dr Whelan and colleagues also alludes to the importance of outcome and itspossible relationship with patient satisfaction. In spite of inherent problems with patient satisfaction questionnaires such as “ceiling effect”(patients often scoring their clinician at the very high end of the spectrum) and poor response rates there is little doubt that the majority of the existing literature on this issue points to a strong correlation between outcome and patient satisfaction, especially with the individual clinician, e.g. (3). The next step would be to investigate the correlationbetween commonly used, validated rating scales, e.g. Hamilton’s DepressionScale and PANSS, and patient satisfaction. In the PatSat scale the clinician has a direct way of testing and re-testing his personal impact on patients, and the hope is therefore that this will provide an importantavenue to improving outcomes for our patients without adding any further side-effects.

References[1] Patient satisfaction rating scales vs. Patient-related Outcome and Experience Measures. Paul J. Whelan, Leena Reddy, Tresa Andrews. E-letter, The Psychiatrist 8 November 2010[2] Hansen LK, Vincent S, Harris S, David E, Surafudheen S, and Kingdon D.A patient satisfaction rating scale for psychiatric service users. The Psychiatrist 2010; 34: 485-488. [3] Attitudes Toward Antipsychotic Medication The Impact of Clinical Variables and Relationships With Health Professionals. Jennifer C. Day, PhD; Richard P. Bentall, PhD; Chris Roberts, PhD; Fiona Randall, BSc; AnneRogers, PhD; Dinah Cattell, RMN; David Healy, MD; Pam Rae, BSc; Cheryl Power, MSc Arch Gen Psychiatry. 2005;62:717-724.
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Patient satisfaction rating scales vs. Patient-related Outcome and Experience Measures

Paul J. Whelan, Consultant Old Age Psychiatrist
08 November 2010

Dear Editor,

We were pleased to read the paper by Hansen et al in the current issue of The Psychiatrist detailing their validation of a patient satisfaction rating scale [1]. This sort of work is very much in keeping with the recent Government paper, Equity and Excellence: Liberating the NHS [2]. However, we thought the focus of the questionnaire was too narrow: it essentially only dealt with the interaction between psychiatrist and service user in an outpatient setting. A far broader perspective would need to be taken for this instrument to be used as a service satisfaction questionnaire, as patients interact with a far greater range of people and systems as they move through a given care pathway. Even in a rather circumscribed setting such as outpatients a user deals with appointment letters, receptionists, the physical environment of the waiting room etc. before they even get to meet a psychiatrist. However, we did think that the questionnaire would make an excellent instrument for psychiatrists (and other mental health professionals) to use as part of their annual appraisal or multi-source feedback, as it provides good information about the vital interaction between doctor and patient.

More pertinent to today's clinical practice are Patient-related Outcome Measures (PROMs) and Patient-related Experience Measures (PREMs). They provide richer information than patient satisfaction quesionnaires, which relate to a relatively narrow (but obviously very important) area. Although the two are usually related, it is possible for a user to have a satisfactory experience of a service but a poor clinical outcome, and viceversa. Whereas PROMs and PREMs will not only capture the patient experience/satisfacation but also the outcome from their perspective. These data complement the gathering of routine clinical outcome data, which in the UK pertains primarily to Health of the Nation Outcome Scores [3].

PROMs and PREMs have been established in acute trusts for quite so time now. They suit certain specialties well, e.g. post hip operation PROMs are ubiquitous. Whereas PROMs/PREMs in mental health are much rarer.To attempt to address this gap we (and other colleagues from our Trust) are in the process of validating a PROM/PREM for mental health service users, the details of which can be found in the first week of November's issue of the Health Service Journal [4]. A version of the instrument has already been successfully piloted specifically for use with older patientsand prelimanary results are about to be published [5].

Once again, we would like to congratulate Hansen et al on their work.However, we believe that outcome data supercede patient satisfaction questionnaires in contemporary NHS practice, as the latter can easily be incorporated into the PROMs/PREMs, which additionally provide a wider range of information.

Yours sincerely,

Paul Whelan Leena ReddyTresa Andrews

[1] Hansen LK, Vincent S, Harris S, David E, Surafudheen S, and Kingdon D. A patient satisfaction rating scale for psychiatric service users. The Psychiatrist 2010; 34: 485-488.

[2] Department of Health. (2010) Equity and Excellence: Liberating the NHS. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353

[3] Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. (1998)Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry, 172: 11-18.

[4] Pinning down opinion in mental healthcare. Health Service Journal. 4th November 2010; 20-21.

[5] Whelan P, Lewis A, Patel S, Andrews T. (2010) Taking the Cinderella specialty to the PROM: Developing a Patient-Related Outcome Measure for an Older Adult Mental Health Service. Quality in Ageing and Older Adults. In press.
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