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International Journal for Quality in Health Care Advance Access published online on November 10, 2005
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi087
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© The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved
Accepted September 24, 2005

Article

Patient-reported service quality on a medicine unit

Saul N. Weingart 1*, Odelya Pagovich 2, Daniel Z. Sands 3, Joseph M. Li 4, Mark D. Aronson 4, Roger B. Davis 4, Russell S. Phillips 4, and David W. Bates 5

1 Center for Patient Safety, Dana-Farber Cancer Institute; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
3 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA; Zix Corporation, Dallas, TX; Harvard Medical School, Boston, MA, USA
4 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
5 Division of General Internal Medicine, Brigham and Women’s Hospital; Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed.
Saul N. Weingart, E-mail: saul_weingart{at}dfci.harvard.edu


  Abstract

Purpose. Service quality, defined as patients’ self-reported experience of care, is used as a metric for evaluating quality. Most studies rely on retrospective consumer surveys rather then more intensive data collection methods, possibly underestimating the incidence of service quality incidents.

Subjects and Methods. The objective of the study was to characterize patient-reported service quality deficiencies on a general medicine unit. We studied a cohort of 228 adult inpatients at a Boston teaching hospital. Investigators reviewed medical records and interviewed patients during the hospitalization and by telephone after discharge. Physician investigators classified patients’ incident reports. We calculated the rate of service incidents, characterized incident types, and used multivariable Poisson and logistic regression models to examine factors associated with patient reporting and overall rating of the hospitalization.

Results. Eighty-eight (38.6%) of 228 patients experienced 157 service quality incidents during the admission, for a rate of 68.9 incidents per 100 admissions. The most common service quality problems involved waits and delays (n = 45), problems with communication between staff and patients (n = 36), and environmental issues and amenities (n = 35). In the multivariable analysis, men (IRR 1.6, 95% CI 1.1-2.2), patients covered by hospitalists (1.5, 1.1-2.2), and patients with more medication allergies (1.1 per allergy, 1.1-1.2) reported more service incidents; patients with Medicaid or free care reported fewer (0.5, 0.3-0.9). Patients with service quality incidents were more likely to describe the hospitalization as other than excellent (adjusted OR 1.8 per incident, 95% CI 1.3-2.5).

Conclusion. Service quality deficiencies are common among medical inpatients, and are strongly associated with patients’ dissatisfaction with the hospitalization

Keywords: service quality, healthcare quality, patient-centered care, patient satisfaction.
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