The evaluation ranking scale: a new methodology for assessing satisfaction.

Most patient satisfaction scales produce high, undifferentiated levels of reported satisfaction that fail to detect program areas that consumers do not like. Methodological problems apparently contribute to these results. An alternative procedure, the Evaluation Ranking Scale (ERS), was formulated and tested. A 2 X 3 design was employed with 246 public health center patients randomly assigned to one of two measurement techniques (ERS vs. a global measure) and one of three informational sets. A secondary group of subjects was a convenience sample of 26 staff members, which allowed comparisons of staff evaluations of the health center to patients' evaluations of the health center. Compared to the global measure, the ERS provided more specific information about particular program components, was more discriminating, and resulted in mean satisfaction scores that were significantly lower. This new approach may be a more effective technique for assessing the psychosocial effectiveness of human service programs.

Comparison of indirect and direct approaches to measuring patient satisfaction.

One indirect (PSQ) and two direct (CSQ-18B and ERS) measures of patient satisfaction were compared across a series of psychometric, acceptability, and concurrent validity criteria. None of the three measures was significantly related to health status or demographic characteristics. Each measure performed as expected from prior research on their psychometric properties. The scales contrasted, however, in regard to acceptability, with the PSQ being much less acceptable to patients than the other two. The PSQ also produced more missing data. The results on the PSQ reflected patient inconsistency on cross-check items and patients tended to be uncertain in their responses to many items. In multivariate analyses the three measures were used as predictors of patient-rated indices of global service satisfaction. The CSQ-18B and the ERS were significant predictors of patient-rated indices of global service satisfaction, whereas the PSQ was unrelated to these indices. It was concluded that the direct and indirect approaches measure different satisfaction domains. The PSQ likely assesses more generalized attitudes about health services while the CSQ-18B and the ERS efficiently reflect opinions about the specific setting in which they are administered.

Relationship of service satisfaction to life satisfaction and perceived well-being.

Two procedures for gaining patients' evaluations of health services were compared: (a) the Client Satisfaction Questionnaire (CSQ-18B), a direct approach assessing the setting and services actually encountered, and (b) the Patient Satisfaction Questionnaire (PSQ), an approach that indirectly assesses satisfaction with service by inquiring about general health care attitudes. Results from 148 public health patients indicated that the PSQ produced the most acceptability problems and was tapping aspects of life satisfaction other than service satisfaction. However, the PSQ produced significantly lower reports of satisfaction. Additional comparison and interpretation of typical responses generated from the two approaches suggested, on the whole, that the CSQ-18B data provided clearer, more efficient, and more useful information for program planning and evaluation. In this study, service satisfaction measured by the CSQ-18B did not have any significant relationship to global or multidimensional (LDQ-30) measures of life satisfaction and well-being. In contrast, over a third of the variance in PSQ scores was accounted for by measures of life satisfaction. It appears that the PSQ elicits attitudes toward the more generalized health care delivery system as well as aspects of life satisfaction rather than reactions to specific services actually received.

The evaluation ranking scale: clarification of methodological and procedural issues.

Compared with CSQ-8, a typical questionnaire approach to assessing global patient satisfaction, the Evaluation Ranking Scale (ERS) had equally good patient acceptability, yielded more normally distributed satisfaction scores, and results allowed comparative information about patients' evaluation of specific service dimensions. The study also addressed key questions that have emerged about the ERS procedure. Patients apparently do not distinguish conceptually between "importance" of dimensions and "satisfaction" with dimensions in the first phase (ranking) of the ERS. Results did confirm that the ERS sequence of ranking and then rating the dimensions is essential to achieving optimal utility of results. The ranking task seems to have an organizing effect on patients' approach to the rating task. This effect does not work to dictate results in the rating phase but rather seems to familiarize patients with the dimensions to be rated thereby yielding greater potential discriminative capacity for the ERS. Finally, results indicate that the ERS can be administered in a flexible fashion that yields additional information about the absolute importance of the six dimensions without loss of desired operating characteristics for the measure.

Patient satisfaction in primary health care: a literature review and analysis.

This paper reviews the literature on patient satisfaction in primary health care settings. Definitions and models of satisfaction are considered first. Attention is given to the conceptualization of satisfaction by investigators concerned about consumers in general as well as by researchers focusing on consumers of medical services. Research findings are discussed and used to develop a model of patient satisfaction. The measurement of patient satisfaction and the findings of empirical studies are then reviewed, including summaries of effect sizes. It is concluded that patient satisfaction information can provide a dependent measure of service quality and serves as a predictor of health-related behavior. Issues deserving further investigation and recommendations regarding research strategies are presented.