Department of Industrial and Systems EngineeringHuman Systems Engineering LabMississippi State University
On the surface, communication appears to be a simple concept within health care. Patients talk to doctors, nurses, and staff members. Doctors explain treatment options to patients. However, many obstacles often get in the way of understandable, quality communication. A lack of quality communication limits the quality of service that can be provided to the patient. Some of these issues are rooted within healthcare system design, while others are the result of inappropriate services provided to patients. Communication limitations often make the patients’ visits frustrating and unpleasant.
Consider a typical hospital inpatient visit. Upon arrival, a patient typically completes paperwork, talks to various staff about where to go and what to do, talks to physicians about their ailments, and talk to a number of nurses about their treatment during their visit. These various interactions could cause an unwanted complexity for patients in their relation with the healthcare providers. It should be noted that patients have special characteristics which differ them from a regular customer who wants to receive a service. They are not in their best physical or mental condition, making communication with this type of customer unique. Although it is a common belief that physicians talking to patients reduces patient anxiety and increases patient satisfaction, there is no indication that talking to multiple health care providers would also be beneficial (1, 2).
Since the products of healthcare systems are services, measuring healthcare quality must extend beyond clinical measures to also incorporate patient perceptions and experiences. In general, service quality is believed to be measured by five dimensions which are tangibles, reliability, responsiveness, assurance, and empathy (3). Previous studies have suggested adding usability which could be translated as ease of use as the sixth dimension (4). The definition of quality from a patient's point of view is usually seen as the outcome of his/her treatment and communication with the healthcare system. As a result, we recommend adding communication between the healthcare system and patient as the seventh dimension of service quality.
In our research, we investigate the effect of communication complexity level on patients’ perceived quality. The amount of communication was measured by self reports regarding the patient’s visit. Specific items included the number of forms/paperwork completed, as well as the number of staff, nurses, and physicians that they have talked to during their visit. Additionally, a number of questions related to communication quality were also included.
We used a self-administrated survey to capture the patients’ visit information as well as their opinion about the service which they received. SERVUSE, an existing tool for measuring service quality, was used as the base questionnaire (4). Additions included demographic, visit information, and communication questions. The survey questioned patients on both their expectations regarding the hospital visit, as well as their actual perceptions. These two scores are then used to calculate a gap score. A positive gap score shows that the hospital is performing beyond customer (patient) expectations, whereas a negative gap score indicates a failure to meet expectations. The survey also includes questions to measure the patients’ quality perception, satisfaction, and behavioral intention (e.g. likeliness to return to the location).
The study was performed in a 722-bed hospital in Jackson, Miss. Out of 150 patients who were initially chosen to be contacted for the study, 44 of them provided complete and usable answers. The respondents who completed the survey received $20.
The results show that the number of nurses which patients have talked to was inversely correlated with satisfaction and perceived quality. Specifically, patients who had talked to more nurses had significantly lower satisfaction rates. MANOVA analysis also showed the relation between high/low complexity and satisfaction, perceived quality, and behavioral intention. Also, Cronbach’s Alpha coefficient scores showed that the survey was reliable and its reliability was actually improved after adding communication questions. Finally, the communication dimension was found to be correlated with satisfaction, perceived quality, and behavioral intention.
These results suggest that in order to increase patient satisfaction, patients should interact with fewer numbers of nurses during their visit. Nurses’ communication should not be removed, but rather simplified, introducing only a limited number of nursing staff to the patient. Also, this study demonstrates that incorporating communication issues into the measurement of service quality provides a more valid and reliable measure.
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