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Health Services Research, June, 2006 by Judith K. Barr, Tierney E. Giannotti, Shoshanna Sofaer, Cathy E. Duquette, William J. Waters, Marcia K. Petrillo
Given the central importance of the physician's role in patient care and in recommending hospitalization, our finding of less support for QI and patient satisfaction data among the medical (physician) staff suggests that more work is needed to engage physicians in hospital QI and strengthen their support for QI efforts (Bradley et al. 2001). For hospitals to measure and use quality data to direct QI activities, both administrative staff and clinical staff, especially physicians, must understand and accept the need for change (West 1998; Weber and Joshi 2000). More attention should be focused on the dissemination of comparative results of patient surveys to physicians and on their understanding of the uses of such data for QI in hospitals and the relevance of patient satisfaction data to clinical practice.
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Although public reporting may have unintended consequences, it can enhance and reinforce QI efforts in hospitals (Marshall, Romano, and Davies 2004). In RI, public reporting of comparative hospital patient satisfaction data fulfilled a major goal of legislation mandating public reporting. Not only were survey results used to confirm existing QI directions, the results also pointed some hospitals to new areas for improvement. As part of the process, hospitals augmented their data collection capabilities and adopted more systematic and standardized processes for QI. Ultimately, the value of using a statewide survey will be whether or not, over time, patient satisfaction survey ratings increase along with QI initiatives in hospitals in RI and other states with public reporting.
Currently, the RI Department of Health's public reporting program continues its efforts to expand public reporting of quality performance. A second public report on hospital patient satisfaction was published in 2003; subsequent reports await federal decision making on the Hospital CAHPS Survey. A statewide initiative to report nursing home resident and family satisfaction is underway, and the project to report home health patient satisfaction has begun. In addition, the RI Department of Health has produced public reports based on CMS clinical measures for hospitals, nursing homes, and home health agencies. These reports are intended to make the data more accessible to the public through reformatting and/or developing composite scores where appropriate. Future work will extend these activities to other types of health care facilities.
ACKNOWLEDGMENTS
This research was funded by the state of RI through a contract to Qualidigrn. The authors thank the hospital staff who participated in interviews for this study. We appreciate the assistance of Tracey Dewart, Ph.D., in conducting interviews and the support of Patricia A. Nolan, M.D., formerly Director of Health of RI. We also acknowledge the helpful comments and suggestions of two anonymous reviewers. The views expressed in this article are solely those of the authors and do not necessarily reflect the views of their affiliated institutions.
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