Applicability of the results of a user satisfaction survey by nursing

Abstracts

Objective

To analyze the use of the results of a user satisfaction survey by head nurses in inpatient units.

Methods

A descriptive exploratory study conducted at a university hospital. The research tool was a form administered to 14 nurses using interviews. Transcribed testimonies were submitted to content analysis.

Results

Four categories emerged: communication as a means of transmitting information to the nursing team; the contribution of the user satisfaction survey to health care; changes implemented in the units based on survey results; and the influence of the satisfaction survey on the evaluation of nursing team performance.

Conclusion

The information obtained through satisfaction surveys provided an overview of the performance of the nursing service and can assist managers in making decisions. It also serves as a source of information for the assessment of individual employee performance and quality of care indicators.

Patient satisfaction; Health evaluation; Nursing research; Nursing service, hospital; Nursing assessment

Objetivo

Analisar a utilização de resultados da pesquisa de satisfação dos usuários pelas chefias de Enfermagem das unidades de internação.

Métodos

Pesquisa exploratória, descritiva, realizada em hospital universitário. O instrumento de pesquisa foi um formulário aplicado por entrevista com 14 enfermeiras. Os depoimentos transcritos foram submetidos à análise de conteúdo.

Resultados

Emergiram quatro categorias: a comunicação como forma de transmissão das informações para a equipe de Enfermagem; a contribuição da pesquisa de satisfação do usuário para o atendimento em saúde; mudanças implementadas nas unidades a partir dos resultados da pesquisa; e a influência da pesquisa de satisfação na avaliação de desempenho da equipe de Enfermagem.

Conclusão

As informações obtidas pela pesquisa de satisfação fornecem um panorama da performance do serviço e podem auxiliar gestores na tomada de decisões. Servem ainda como fonte de informação para a avaliação do desempenho individual dos funcionários e indicadores de qualidade da assistência.

Satisfação do paciente; Avaliação em saúde; Pesquisa em enfermagem; Serviço hospitalar de enfermagem; Avaliação em enfermagem

Introduction

With the advance of technology and computerization of the means of communication, health service users have new channels of communication for expressing their ideas and needs to those who provide such assistance. Adding the user as a transformational and evaluative agent is a sensitive indicator of service quality, enabling appropriateness of care for user needs, and simultaneously providing real change in health services.⁽¹⁾

In this context, the satisfaction survey is a tool to evaluate the health service by the user, who analyzes the care received in the institution considering his/her needs when seeking care. The user evaluates each attribute of the survey instrument, exposing his/her opinion regarding the care, thereby providing an important measure of health care quality. The evaluation of care is an essential tool in public policy, as a mechanism both to assess for the possibility of course correction, and to provide continuity of interventions, so that the results are always revised and modified according to the perceived needs and are grounded on the social demands.⁽²⁾ This way, there is the possibility of considering the subject in his/her specificity, respecting his/her history of life.⁽³⁾ Hospitals enable the performance of nurses’ activities regarding quality of care when nurses understand the context of health services. Therefore, they care for the user more broadly, seeking to know him/her and to satisfy him/her in his/her expectations, with regard to the care and services available. Conceptually, the term “client”, “patient” or “user” is characterized as one who receives the care or the benefit of a particular work, i.e., to whom a service has been offered or done, and his/her satisfaction becomes a factor of success.⁽⁴⁾ In this study, we chose the term “user satisfaction”, instead of “ patient/client satisfaction “ because, over the years, the term “user” has become more commonly used in research seeking to know the opinion of people who used health services.

The incorporation of the user in evaluation has been valued because it is possibly related to more appropriate use of services, design of actions that have been developed, and also the possibility of targeting and planning of care. This way, health evaluations have included the measurement of satisfaction as an important measure of quality of care in relation to the care provided or received.⁽⁵⁾ User participation stands out as a significant point of these processes, which aids in the transformation of practices of managers, workers and assessors, in the process of the production of health care.⁽⁶⁾ This topic is highly relevant to nursing, because it enables one to check how the results of the satisfaction survey are being used by nurses occupying the lead positions, and also to check the real contribution that the satisfaction survey brings to care. Similarly, this topic is considered very important because it enables feedback on aspects that can be improved in the care delivery, and also the identification of those that are already underway, according to the users’ expectations.

The focus of the study was the applicability of the results of the satisfaction survey, and this article aims to analyze the use of the results of user satisfaction survey by head nurses in inpatient units of a public hospital.

Methods

A descriptive exploratory study with a qualitative approach, conducted in a university hospital in the state of Rio Grande do Sul, in southern Brazil, a member of the network of hospitals of the Ministry of Education, with 795 beds. The study population was composed of the head nurses in clinical, surgical, pediatric hematology/oncology psychiatric, and maternal-child inpatient units. For the composition of the sample, the inclusion criterion was having been in the lead position for at least six months. Among the possible 18 participants, 14 nurses fulfilled that criterion.

Data were collected through semi-structured interview, guided by a script with eight questions developed in order to meet the objective proposed in this study. The interview script was preliminarily tested for understanding and its ability to generate the information sought. The interviews were audio recorded and later literal transcription was performed by the researcher. The audio recordings totaled approximately eight hours. Data were collected from May to July of 2012.

The data were submitted to thematic content analysis. After transcription, free-floating reading and analysis of the testimonies was performed in search of meaning units.⁽⁷⁾ From this process, categories emerged that helped uncover the use of the user satisfaction survey results by the head nurses of the inpatient units. In order to ensure the anonymity of the information, the subjects’ testimonies were coded using numbers, following the order of the interviews for the presentation of results.

The development of the study met national and international standards of ethics in research involving human subjects.

Results

As for the characteristics of the participants, of the 14 nurses interviewed, two were aged between 30 - 40 years (14%), five were between 40 - 50 years (36%), and seven were between 50 - 60 years (50%). In relation to working time, only six respondents (43%) had worked for less than 15 years; the other eight subjects (57%) had been working for over 15 years. As for the service time as the unit's head nuse, eight subjects had up to three years; the remainder had more than four years. Regarding previous nursing experience, only three subjects had no experience in other institutions.

The content analysis of the interviews, based on the testimonies about using the results of the satisfaction survey, enabled the identification of four thematic axes.

The first category, named “communication as a means of transmitting information to the nursing team”, gathered the testimonials that mentioned how information from the results of the satisfaction survey is transmitted to the work team. Several communication strategies were used by the group, with communication as an essential tool for nursing, because it favors the exchange of information and dialogue within the nursing team.

The category named “the contribution of the user satisfaction survey to health care” addressed aspects related to the perception of nurses regarding the contribution that research brings to the unit for attending the user. The statements in this category indicated that the satisfaction survey was a way to provide the user with a moment of listening, when he/she can express his/her opinion about the care received.

In the third category “changes implemented in the units based on survey results”, excerpts of the interviews were grouped based upon the units in which the team worked within that hospital, such as improvements implemented in the unit considering users’ requests through satisfaction survey; changes in routine work; greater involvement with the satisfaction survey by the nursing team, due to incentives offered by the institution.

“The influence of the satisfaction survey in the evaluation of nursing team performance” was the emerging category, because it is a theoretical contribution related to the satisfaction theme, in which aspects regarding the management of the work team are inserted through indicators from the user satisfaction survey.

Discussion

The discussion about the use of the results of the satisfaction survey by the head nurses reveals weighting placed on the quality of nursing care from the user perspective. However, the qualitative design should be considered as a limitation of this study, because it allows for a deeper understanding of the phenomenon, but does not allow for comparisons and generalizations. Furthermore, although the study was developed in a single university hospital, the discussion can contribute to the understanding of similar situations experienced in other services in academic settings.

The nurses’ testimonies express, in practice, the concern for checking the satisfaction survey results in order to know user perception, and to enable tailoring of activities to staff needs in order to provide quality care. Aspects of the users’ perceptions were also identified on how the nursing staff acts, and the contributions that the results of the satisfaction survey can bring to the job sector.

When mentioning the communication strategies used as means of transmitting information to the nursing staff, nurses report that communication is an essential skill for professionals in this area, who must constantly pay attention to the content of the information and use it during their daily routine work, whether in the direct or indirect care of the patient. Communication is something that can be used by people, that to which they can attribute sense. There are multiple ways to communicate, in the same way that communication can occur for various reasons and at different levels of hierarchy.⁽⁸⁾

Regarding the communication strategies used by the nursing team, nurses report that they use more than one communication strategy, including verbal, on duty at the time of shift change and in meetings with the team, reporting directly to a person or a group, being face to face at that moment. Shift change is an activity inherent to the nurse's daily life, at which the transmission of information occurs between professionals who are ending and those who are beginning their work shift.⁽⁹⁾ Meetings are seen as a way to pass the results of the satisfaction survey in more detail, pointing out peculiarities, and also allowing room for discussion of managerial and bureaucratic issues.

Another means that nurses use is a visual resource, e.g., a message board, to show the unit results and provide visibility for all shifts. They also use also the intranet of the institution as a means of spreading net information to all team members. When sending messages by this means of communication for the health team, information should be provided in an attractive way in the document, in order to increase the chances that the target audience will read such e-mails.⁽¹⁰⁾

Information is essential to the management of nursing activities and to support nurses in decision-making, especially with regard to resolution and to minimizing the problems inherent to the unit.⁽¹¹⁾ Studies show that developing teamwork and maintaining effective communication skills should be considered essential to health service managers.⁽¹²⁾

The interviewees reported the contribution of the user satisfaction survey to the health care team, because the institution can identify the perception of the service user and thus set goals to improve its results, as well as maintaining satisfaction with the care.

In addition to the general quality of the service, the satisfaction survey also evaluates user satisfaction with nursing care. Thus, the quality of a healthcare service is directly related to the quality of the interpersonal relationship between users and professionals responsible for health care. There is a consensus that user satisfaction is an integral part of the health care quality, and that its measure contributes to better use of resources and improvement in the performance of various sectors involved in the survey.⁽¹³⁾ Studies corroborate these findings by highlighting interpersonal relationships as an important indicator of quality, because users consider the way they were treated and informed during their contact with the institution to analyze the care and make an evaluation.⁽¹⁴⁾

In this sense, institutions should encourage practices and behaviors that lead to quality performance through a commitment to care improvement.⁽¹⁵⁾ The measurement of satisfaction is an important tool for management and planning. It also plays a fundamental role between the service provider and the user, because it reflects the judgment of the quality of care provided.⁽¹⁶⁾ Listening to the users’ opinions about the function and organization of health services is an action that provides significant benefits to the quality of services offered, since the incorporation of the client's point of view makes health actions more targeted to the users’ needs.⁽¹⁷⁾

The category referring to the changes implemented in the units based on the survey results brings reports of changes already made to the physical area of the unit, the environment, and others related to the routines of the work team, as well as changes in the involvement with the survey by the nursing team, which was encouraged in order to capture more user surveys.

Satisfaction is not always only linked to the nursing care. It is known that users evaluate care considering the context in which they are inserted in health. The evaluation of care includes the human resources and the structure used for the service.

Studies show that the environment has a strong influence, by stimulating or inhibiting interaction between the individuals involved.⁽¹⁸⁾ Thus, the environment is not just about the physical space used by people, but also the furniture, the accommodations, the ventilation, temperature, noise and space conditions.

The results of these satisfaction surveys provided justifiable arguments to ensure the acquisition of additional resources in the units.⁽¹⁹⁾ Nursing has the peculiar feature of being a profession oriented by many rules and routines. The steady implementation of these standards in order to organize and standardize the work and human resources management has been configured in a negative way in the evaluation of nurses’ satisfaction in their professional practice, a fact pointed out by nurses who manage health services, who explain that they require more time during activities to meet all the rules and routines of the institution.⁽²⁰⁾ The search for quality processes can bring changes in values and behaviors, requiring professionals involved to discontinue mechanized care and promote an organizational environment of excellence.⁽²¹⁾

With regard to the influence of the satisfaction survey on the evaluation of nursing team performance, a theoretical contribution related to the satisfaction theme was found. The nurses used the user satisfaction survey as an indicator of team evaluation, i.e., if the provider was cited with praise or criticism, such situations were registered in a performance evaluation form. After that, the negative points were discussed with professionals to encourage them to improve their posture during care. This measure gives the professional a chance to change, and can improve staff performance within the institution.

Performance evaluation is an ongoing process that is used and perceived differently by members of the same workgroup. Understanding how this is reflected in the group, and within the institution, as well as analyzing its real sense in the context of work, is an important point in the design of and true use of this process.⁽²²⁾ The satisfaction survey provides important indicators regarding the management of the team. This fact was evidenced in the findings of this research. Studies point out that professionals feel more satisfied with their performance evaluation when they have the opportunity to discuss the results with their ca manager.⁽²³⁾ The performance evaluation can be a tool that favors the employee, the manager, and the care provided, by indicating adjustments, training needs and improvements in working conditions.⁽²²⁾ Both in the national and international contexts, the performance evaluation is seen as a management tool that can motivate professionals to improve their performance, especially on issues related to their behavior within the hospital.⁽²³⁾

Conclusion

Head nurses used the satisfaction survey results to change the care provided to users in inpatient units, in order to adapt the care to the patients’ expectations. It was observed that the satisfaction survey results were used as an indicator of quality of care, guiding managerial decision making. In addition, they were used as source of information for the management of people, more specifically, for the assessment of individual performance.

Referências

• ¹
  Otani K, Waterman B, Faulkner KM, Boslaugh S, Dunagan WC. How patient reactions to hospital care attributes affect the evaluation of overall quality of care, willingness to recommend, and willingness to return. J Healthc Manag. 2010; 55(1):25–37; discussion 38.
• ²
  Schoenfelder T, Klewer J, Kugler J. Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany. Int J Qual Health Care. 2011; 23(5):503–9.
• ³
  Greenslade JH, Jimmieson NL. Organizational factors impacting on patient satisfaction: a cross sectional examination of service climate and linkages to nurses’ effort and performance. Int J Nurs Stud. 2011; 48(10):1188–98.
• ⁴
  Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013; 3(1). pii: e001570.
• ⁵
  Al-Abri R, Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman Med J. 2014; 29(1):3–7.
• ⁶
  Chang CS, Chen SY, Lan YT. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. BMC Health Serv Res. 2013; 13:22.
• ⁷
  Bacon CT, Mark B. Organizational effects on patient satisfaction in hospital medical-surgical units. J Nurs Adm. 2009; 39(5):220–7.
• ⁸
  Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med. 2012; 172(5):405–11.
• ⁹
  Khamis K, Njau B. Patients’ level of satisfaction on quality of health care at Mwananyamala hospital in Dar es Salaam, Tanzania. BMC Health Serv Res. 2014; 14(1):400.
• ¹⁰
  Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The relationship between patients’ perception of care and measures of hospital quality and safety. Health Serv Res. 2010; 45(4):1024–40.
• ¹¹
  Bowling A, Rowe G, McKee M. Patients’ experiences of their healthcare in relation to their expectations and satisfaction: a population survey. J R Soc Med. 2013; 106(4):143–9.
• ¹²
  Hassali MA, Alrasheedy AA, Razak BAA, AL-Tamimi SK, Saleem F, Haq NU, et al. Assessment of general public satisfaction with public healthcare services in Kedah, Malaysia. Australas Med J. 2014; 7(1):35–44.
• ¹³
  Yan Z, Wan D, Li L. Patient satisfaction in two Chinese provinces: rural and urban differences. Int J Qual Health Care. 2011; 23(4):384–89.
• ¹⁴
  Top M, Tarcan M, Tekingündüz S, Hikmet N. An analysis of relationships among transformational leadership, job satisfaction, organizational commitment and organizational trust in two Turkish hospitals. Int J Saúde Plann Gerenciar. 2013; 28(3):e217-41.
• ¹⁵
  Bleustein C, Rothschild DB, Valen A, Valatis E, Schweitzer L, Jones R. Wait times, patient satisfaction scores, and the perception of care. Am J Manag Care. 2014; 20(5):393–400.
• ¹⁶
  Szecsenyi J, Goetz K, Campbell S, Broge B, Reuschenbach R, Wensing M. Is the job satisfaction of primary care team members associated with patient satisfaction? BMJ Qual Saf. 2011; 20(5):508–14.
• ¹⁷
  Beattie M, Lauder W, Atherton L, Murphy DJ. Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol. Syst Rev. 2014; 3: 4.
• ¹⁸
  Hafner JM, Williams SC, Koss RG, Tschurtz BA, Schmaltz SP, Loeb JM. The perceived impact of public reporting hospital performance data: interviews with hospital staff. Int J Qual Health Care. 2011; 23(6):697–704.
• ¹⁹
  Kvist T, Mäntynen R, Partanen P, Turunen H, Miettinen M, Vehviläinen-Julkunen K. The Job Satisfaction of Finnish Nursing Staff: The Development of a Job Satisfaction Scale and Survey Results. Nurs Res Pract. 2012; 2012: 210.509.
• ²⁰
  Janicijevic EU, Seke K, Djokovic A, Filipovic T. Healthcare workers satisfaction and patient satisfaction – where is the linkage?. Hippokratia. 2013; 17(2):157–62.
• ²¹
  Koné Péfoyo AJ, Wodchis WP. Organizational performance impacting patient satisfaction in Ontario hospitals: a multilevel analysis. BMC Res Notes. 2013;6:509.
• ²²
  Vasset F, Marnburg E, Furunes T. The effects of performance appraisal in the Norwegian municipal health services: a case study. Hum Resour Health. 2011; 9(22):1478–90.
• ²³
  Péfoyo AJK, Wodchis WP. Organizational performance impacting patient satisfaction in Ontario hospitals: a multilevel analysis. BMC Res Notes. 2013;6:509.

Publication Dates

• Publication in this collection
  Mar-Apr 2015

History

• Received
  05 Oct 2014
• Accepted
  26 Nov 2014