Abstract
To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. Data for 1176 patients (training sample) and 1101 patients (holdout sample) who rated overall satisfaction as either “very good” or “very poor” (Academic Hospital), and for 856 patients (training sample) and 431 patients (holdout sample) who rated overall satisfaction as either “excellent” or “poor” (Community Hospital), were retained for analysis. For both hospitals, nonlinear tree models efficiently achieved overall classification accuracy exceeding 98% in training analysis and 95% in holdout analysis (all p < .0001). The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.
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References
Bjorvell, H., and Steig, J. (1991). Patients' perceptions of the health care received in an emergency department. Ann. Emerg. Med. 20: 734–738.
Bowers, M. R., Swan, J. E., and Koehler, W. F. (1994). What attributes determine quality and satisfaction with health care delivery? Health Care Mgmt. Rev. 19: 49–55.
Bursch, N., Beezy, J., and Shaw, R. (1993). Emergency department satisfaction: What matters most? Ann. Emerg. Med. 22: 586–591.
Carey, R. G., and Seibert, J. H. (1993). A patient survey system to measure quality improvement: Questionnaire reliability and validity. Med. Care. 31: 834–845.
Colt, H. G., and Solot, J. A. (1989). Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department. Ann. Emerg. Med. 18: 145–151.
Davies, A. R., Ware, J. E., and Kosinski, M. (1995). Standardizing health care evaluations. Med. Outcomes Trust Bull. 3: 2–3.
Froehlich, G. W., and Welch, H. G. (1996). Meeting walk-in patients' expectations for testing: Effects on satisfaction. J. Gen. Intern. Med. 11: 470–474.
Glass, A. P. (1995). Identifying issues important to patients on a hospital satisfaction questionnaire. Psychiat. Services 46: 83–85.
Hall, M. F. (1995). Patient satisfaction or acquiescence? Comparing mail and telephone survey results. J. Health Care Marketing. 15: 54–61.
Harpole, L. H., Orav, E. J., Hickey, M., Posther, K. E., and Brennan, T. A. (1996). Patient satisfaction in the ambulatory setting: Influence of data collection methods and sociodemographic factors. J. Gen. Intern. Med. 11: 431–434.
Krishel, S., and Baraff, L. J. (1993). Effect of emergency department information on patient satisfaction. Ann. Emerg. Med. 22: 568–572.
Kristjanson, L. J. (1993). Validity and reliability testing of the FAMCARE scale: measuring family satisfaction with advanced cancer care. Soc. Sci. Med. 36: 693–701.
McMillan, J. R., Younger, M. S., and DeWine, L. C. (1986). Satisfaction with hospital emergency department as a function of triage. Health Care Med. Rev. 11: 21–27.
Mowen, J. C., Licata, J. W., and McPhail, J. (1993). Waiting in the emergency room: How to improve patient satisfaction. J. Health Care Marketing 13: 26–33.
Ostrander, R., Weinfurt, K. P., Yarnold, P. R., and August, G. (1998). Diagnosing attention deficit disorders using the BASC and the CBCL: Test and construct validity analysis using optimal discriminant classification trees. J. Consult. Clin. Psychol. 66: 660–672.
Priebe, S., and Gruyters, T. (1995). Patients' assessment of treatment predicting outcome. Schiz. Bull. 21: 87–94.
Robbins, J. A., Bertakis, K. D., Helms, L. J., Azari, R., Callahan, E. J., and Creten, D. A. (1993). The influence of physician practice behaviors on patient satisfaction. Family Med. 25: 17–20.
Ross, C. K., Steward, C. A., and Sinacore, J. M. (1995). A comparative study of seven measures of patient satisfaction. Med. Care 35: 392–406.
Rosenzweig, S. (1993). Emergency report. J. Emerg. Med. 11: 775–778.
Soltysik, R. C., and Yarnold, P. R. (1993). ODA 1.0: Optimal Data Analysis for DOS, Optimal Data Analysis, Inc., Chicago, IL.
Soltysik, R. C., and Yarnold, P. R. (1994). Univariable optimal discriminant analysis: One-tailed hypotheses. Educ. Psychol. Measure. 54: 646–653.
Stone, V. E., Weissman, J. S., and Cleary, P. D. (1995). Satisfaction with ambulatory care of persons with AIDS: Predictors of patient ratings of quality. J. Gen. Intern. Med. 10: 239–245.
Stump, T. E., Dexter, P. R., Tierney, W. M., and Wolinsky, F. D. (1995). Measuring patient satisfaction with physicians among older and diseased adults in a primary care municipal outpatient setting: An examination of three instruments. Med Care 33: 958–972.
Taliaferro, E. (1983). A case study in management: The patient complaint. J. Emerg. Med. 1: 151–153.
Thompson, D. A., and Yarnold, P. R. (1995). Relating satisfaction to patients' waiting time perceptions and expectations: Testing the disconfirmation paradigm. Acad. Emerg. Med. 2: 1057–1062.
Thompson, D. A., Yarnold, P. R., Williams, D. R., and Adams, S. L. (1996a). The effects of actual waiting time, perceived waiting time, information delivery and expressive quality on patient satisfaction in the emergency department. Ann. Emerg. Med. 28: 657–665.
Thompson, D. A., Yarnold, P. R., Adams, S. L., and Spacone, A. B. (1996b). How accurate are patient's waiting time perceptions? Ann. Emerg. Med. 28: 652–656.
Yarnold, P. R. (1996a). Discriminating geriatric and non-geriatric patients using functional status information: An example of classification tree analysis via UniODA. Educ. Psychol. Measure. 56: 656–667.
Yarnold, P. R. (1996b). Characterizing and circumventing Simpson's paradox for ordered bivariate data. Educ. Psychol. Measure. 56: 430–442.
Yarnold, P. R., Bryant, F. B., and Grimm, L. G. (1987). Comparing the short and long versions of the student Jenkins Activity Survey. J. Behav. Med. 10: 75–90.
Yarnold, P. R., and Mueser, K. T. (1989). Meta analysis of the reliability of Type A behaviour measures. Brit. J. Med. Psychol. 62: 43–50.
Yarnold, P. R., Nightingale, S. D., Curry, R. H., and Martin, G. J. (1990). Psychological androgyny and preference for intubation in a hypothetical case of end-stage lung disease. Med. Dec. Making 10: 215–222.
Yarnold, P. R., and Soltysik, R. C. (1991). Theoretical distributions of optima for univariate discrimination of random data. Dec. Sci. 22: 739–752.
Yarnold, P. R., Soltysik, R. C., and Bennett, C. L. (1997). Predicting in-hospital mortality of patients with AIDS-related Pneumocystis carinii pneumonia: An example of hierarchically optimal classification tree analysis. Stat. Med. 16: 1451–1463.
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Yarnold, P.R., Michelson, E.A., Thompson, D.A. et al. Predicting Patient Satisfaction: A Study of Two Emergency Departments. J Behav Med 21, 545–563 (1998). https://doi.org/10.1023/A:1018796628917
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DOI: https://doi.org/10.1023/A:1018796628917