Healthcare professionals in search of a simple rubric for establishing high satisfaction rates across multiple care settings in pediatric care may find their goal is highly elusive.
A study by the Nemours Children's Health System and Philadelphia's Thomas Jefferson University published in the American Journal of Medical Quality analyzed the results of 27,000 patient-satisfaction surveys and found the way patients respond to their healthcare experience can vary widely across care settings.
Indeed, no single factor such as "physician care," "nursing care" or "personal concern" by healthcare providers had an equal impact, but in fact had varying effects on inpatients, outpatients in specialty settings and emergency room patients. For example:
- Physician care had the biggest impact on overall pediatric patient satisfaction in outpatient specialty care
- Nursing care was most important in inpatient settings
- Overall personal care had the biggest impact on patient satisfaction with emergency care
"As patients move through an integrated care system, their needs and expectations change," Stephen Lawless, M.D., enterprise vice president of quality and safety at Nemours Children Health System and a co-author of the study, said in a study announcement. "What may be important in an emergency care setting may not matter as much to patients in primary care. These findings can help target resources toward improving the patient experience through influencing factors in each setting."
The research also found that overall patient satisfaction decreased the longer patients had to wait for care. In the emergency setting, for example, each one-hour increase in total time spent in the waiting area decreased satisfaction by nearly three percentage points. But patient satisfaction increased if the patients received a follow-up call from the emergency department after discharge.
The findings are important, Lawless said, because it emphasizes the need for healthcare systems to focus on team-based approaches that coordinates care for individual patients. The results, he said, should help healthcare leaders "design customized experiences to achieve optimal patient engagement in any environment within a health system."
The study of patient satisfaction in adult patients has been a long-established part of assessing the healthcare experience, but studies of pediatric patient satisfaction have been rare.
In July, Boston Children's Hospital released a children's version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) so that healthcare providers could find out about young patients' healthcare experiences from their point of view.
But the Nemours study found that while studies of adults "showed that patient characteristics such as age, race, socioeconomic status, and health status were correlated with patient satisfaction," patient demographics were markedly less of a factor in the satisfaction levels of pediatric patients.
The needs of children who are chronically ill and their families are different from the needs and expectations of a child being treated in the emergency room for a broken arm. Some facilities like Pennsylvania's Penn State Milton S. Hershey Medical Center and Lancaster General Hospital have created special emotional support programs for children who are frequently hospitalized.
As healthcare institutions and providers explore and develop the concept of "experience design" for patients of all ages, Lawless and his team said it is important to understand that pediatric care presents its own complex challenges. Each pediatric care network must work establish the different needs and expectations of patients and their families across multiple healthcare delivery settings.