Original ArticleFactors Influencing Patient Experience in Pediatric Neurology
Introduction
Owing to the passage of the 2010 Patient Protection and Affordable Care Act in the United States, hospitals are starting to be reimbursed based on a value-based system and patient-centered care.1 The reimbursement hospitals receive through Medicare, according to the Patient Protection and Affordable Care Act, which is up to 1% in 2013 and increasing to 2% by 2017, and the higher the performance of the hospitals, the more reimbursement they receive.2 To measure patient satisfaction, which is empathic care, that promotes partnership, communication, and respect, the Hospital Consumer Assessment of Healthcare Providers and Systems was developed.3 With the value-based system, there is an increasing shift toward more “patient-centered” care, whereby physicians focus both on the patient's illness while not neglecting their feelings and attitudes about their illness.4 More specifically, in pediatrics, there is a need to deliver both patient-centered and family-centered care, as both have been shown to increase satisfaction for the caregiver, ultimately increasing patient satisfaction.5
Although there is a need to change hospital policies to improve patient satisfaction, hospitals find it challenging to recognize and implement patient experience changes, which would increase patient satisfaction scores.6 At a national level, identifying key factors to improve patient experience has been a slow process.7 Staff members are not perceived as being dependable due to the delayed responses and the vulnerability felt by patients, resulting in dissatisfaction with staff members.8 Evidence has been shown that increasing interpersonal skills with staff members, conveying information that can be explained and understood by the patient, and decreasing wait times for appointments and visits could increase patient satisfaction.9 Patient satisfaction could be due to physician empathy skills, implying that the physician–patient interaction will strongly influence patient satisfaction at hospitals.10
Many studies have demonstrated that increased patient satisfaction results in improved patient adherence to treatment regimens and being more trustful of physicians. Whether there is a correlation between increased patient satisfaction and improvement of health outcomes is debated.11 Patient interactions with physicians, and the ability of physicians to fulfill patient expectations, can influence their health care experience, and some studies have concluded that those interactions have influenced patient satisfaction.12 The benefit of increasing overall patient satisfaction can lead to increases in quality of care the physicians provide to their patients.13
In pediatrics, patient satisfaction is more difficult to measure, because the parents and other caregivers are responsible for returning these patient satisfaction surveys. As a result, there has been an increasing demand for family-centered care, which addresses the need of both the patient and the caregiver. Patient experiences that may influence this domain include communication with staff and health care provider, being kept informed throughout procedures, and measures to ensure patient safety are factors that need to be considered that influence patient satisfaction.14 Caregivers would like to be seen and treated as an extension of the patient. Caregivers expect highly attentive and personalized care for their child. Caregivers feel more satisfied when staff and physicians are engaging and genuine with both the child and the caregiver.15 Because of the vulnerable nature of children, caregivers also like to see emotional support offered during times of distress.16
Although several studies have examined the effects of patient satisfaction, few studies have focused on which specific patient experiences affect patient satisfaction in the field of pediatric neurology. Owing to the age group involved and the complexities and vulnerability of the patients, it is important to determine which patient experience factors lead to higher patient satisfaction. Families who bring their child to a pediatric neurologist may present with a variety of conditions. These may include cerebral palsy, concussions, congenital and vascular anomalies of the brain, brain tumors, neonatal brain neurodevelopmental concerns, seizure, neuropsychiatric concerns, muscular concerns, and many other conditions.
The objective of this study was to determine the key drivers of overall patient experience in the ambulatory pediatric neurology setting. Our hypothesis is that the most important patient experience driver will be the interaction with the physician or provider.
Section snippets
Materials and Methods
Patient satisfaction surveys were sent via mail or e-mail to caregivers of pediatric patients after their ambulatory neurology appointments at an academic Children's Health System from January 1, 2012, to December 31, 2014. Press Ganey Associated Inc, an independent consulting health care company which focuses on improving patient experiences, developed and administered the surveys. The survey itself contained 34 questions with the option of additional comments describing any relevant
Results
Over the three-year time frame, 2890 surveys were collected from pediatric neurology ambulatory visits. The top five survey questions that correlated with LTR were cheerfulness of practice (r = 0.79); staff working together (r = 0.76); cleanliness of practice (r = 0.70); wait time at clinic, from entering to leaving (r = 0.66); and likelihood of recommending care provider (r = 0.65; Table).
Discussion
The most important factors in patient satisfaction in pediatric neurology (Table) were cheerfulness of practice (r = 0.79), staff working together (r = 0.76), cleanliness of practice (r = 0.70), wait time at clinic (r = 0.66), and likelihood of recommending care provider (r = 0.65). The correlations listed in Table indicate that the overall mood and tone of the health care team has the most impact on the overall patient experience. Another implication is that multiple individuals, rather than
Conclusion
This study suggests that the top five factors that drive patient experience in the field of pediatric neurology are cheerfulness of staff members, staff members working together, cleanliness of practice, wait time at clinic, and likelihood of recommending care provider. This study is also the first to systematically characterize the top five factors that drive patient experience in the field of pediatric neurology. Although the physician–patient encounter influences patient satisfaction, other
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