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Nursing Management

SEMINAR ON PATIENT SATISFACTION AND UTILISATION REVIEW

PATIENT SATISFACTION Introduction Patients are the foundation of medical practice, it is very obvious that they must be satisfied while in or out of the Hospital. To provide patient-centered care creating a culture that accepts people for, who they are and where, they are in life cycle, by meeting their needs at that point, with the health systems mission to care for the body, mind and spirit of patients. Often long-term duration of interaction Heightened emotional levels - anxiety, fear, pain Purpose is to meet needs Aim is to reduce demand via effectiveness Wide and increasing gap between professional competence and patient understanding Public and private sector competition Open but blurred demarcation between patient and practitioner Ambiguous outcomes for patients and professionals Extraordinary experience rare and intense emotions difficult to describe (personal/abstract) can cause positive/negative care evaluation DEFINITION Patient satisfaction is defined as a health care recipients reaction to salient aspects of the context, process, and result of their service experience. - Pascoe (1983) Patient satisfaction is defined as the extent of the resemblance between the expected quality of care and the actual received care. - Scarding (1994) OBJECTIVE OF PATIENT SATISFACTION Health Care Institutions are primarily patient centric. Patient Satisfaction is the strongest determinant of hospital functioning. Ultimate goal of the hospital is satisfaction of its customers. Patient Satisfaction depends on workers motivation, dedication and duty towards the patients.

PRINCIPLES OF PATIENT SATISFACTION 1. QUALITY OF CARE The quality patient experience doesnt happen by accident but by standardized practice. A consistently great patient experience is not a matter of attitude, awareness or positive intent but a matter of design and continuous quality improvement.

2. MANAGING ANXIETY, FEAR AND PAIN Anxiety is the rust of life, destroying its brightness and weakening its power. (Anon) Patients are highly anxious. To create an exceptional patient experience, we need to focus on preventing or lessening anxiety for patients and families. 3. BETTER COMMUNICATION Some emotions don't make a lot of noise. If we dont communicate our caring, patients and families might think we dont care.

4. PERSONAL ATTENTION Patients and families want personalised care and service

5. STAFF ACCOUNTABILITY All staff must be accountable for their role like: o Clear responsibility o Clear performance

o Sound measurement and feedback

o o

Courageous conversations Consequences reporting

6. SOUND ORGANISATION CULTURE The more strongly your hospitals culture supports the quality patient experience, the more sustainable are impressive levels of patient satisfaction. Effective long-term strategies inevitably involve a fresh look at the hospital culture and how it drives or restrains your patient experience vision. TEN PILLARS OF PATIENT SATISFACTION 1. Leadership Vision and Commitment 2. Process Design and Continuous Improvement 3. Employee Engagement and Empowerment 4. Accountability for all category of staff 5. Monitoring and Feedback 6. Vertical and horizontal Communication 7. Staff Development and Training 8. Reward and Recognition 9. Service Recovery Dissatisfaction to satisfaction 10. Patient Focus and Sustainability (Wendy Leebov 1984, The Ten Pillars) ADVANTAGE OF PATIENT SATISFACTION PATIENT SATISFACTION Greater profitability. Improved patient retention and patient loyalty. Increased patient referrals.

Improved compliance. Improved productivity. Better staff morale.

STAFF SATISFACTION Reduced staff turnover. Improved collections. Greater efficiency. Reduced risk of malpractice suit. Personal and professional fulfillment.

THE PROCESS OF ENSURING PATIENT SATISFACTION: Patient Satisfaction =TQM (Total Quality Management) DETERMINANTS OF PATIENT SATISFACTION

PERCEPTION

EXPECTATION

At exist

After exist

At entry

During stay

Satisfaction

DETERMINANTS OF SATISFACTION

EXPECTATION CLINICAL Correct Diagnosis Adequate Care Prompt Treatment

SATISFACTION Patient Expectation Level Attained Health Status of the patient Socio Economic Status Level of Education Past experience in the same or other hospital

PERCEPTION Patients own experience Experience of relatives and visitors Word of Mouth Advertisements of facilities Financial Schemes

NON- MEDICAL. Appropriate Physical Facility. Functional Service.Component. BEHAVIOURAL To be listened to with patience To be cared about To be sympathetic to the cause To be informed clearly and under stand able language

FACTORS INFLUENCING PATIENT SATISFACTION

APPROPRIATENES S (RELEVANT PATIENT CARE)

AVAILABILITY

CONTIUNITY (TREATMENT & OUTSIDE)

TIMELINESS RIGHT TREATMENT/ RESPONSE AT NIGHT TIME

PATIENT SATISFACTION

EFFECTIVENESS (CORRECTNESS TREATMENT)

RESPECT & CONCERN (SYMPATHY & CONSCIOUSNESS) EFFICIENCY (CAPABILITY & SAFETY OF PATIENT (SAFE ENVIRONMENT) RESOURCE AVAILABILITY) EFFICACY (RESPONSE LEVEL TO TREATMENT)

ROLE OF PROFESSIONALS Understand the importance of patient involvement in their own health and health care, as co-producers, not consumers. Prioritise what is important to patients and their informal carers, whilst maintaining a critical professional view. Maintain what is perceived to be good and improve what needs improving. Involve all staff from the beginning in the effort. Draw comparisons over time and with other care givers.

Cultivate Team Climate o Acknowledge Team Member Contributions o Demonstrate Mutual Respect o Hold members accountable for Outcomes

Develop team work Culture

ROLE OF PATIENT/RELATIVES Discuss with professionals to share information and, if desired, to share decisions. Cooperate with hospital staff. Maintain discipline and cleanliness. Seek help from voluntary and community groups, as well as provide them with feedback. Suggest improvement

ROLE OF SOCIETY Voluntary and community groups can discuss with professionals their ways of communication in relation to specific conditions or population groups. Provide accessible and appropriate educational resources to enable patients and their families to be involved as much as they wish to be. Influence policy and planning to require patient-centred working practices

METHODS OF MONITORING PATIENT SATISFACTION Medical audit Quality assurance committee reviews Indices of nursing performances Judgmental method

COMPONENTS OF EVALUATION OF PATIENT SATISFACTION 1. Evaluation of the programs and activities of various departments including outpatient care, inpatient care, overall health education activities of the hospital 2. Evaluation of the various resources available in the hospital for effective health care 3. Evaluation of effectiveness of hospital personnel including medical, paramedical, nursing as well as non-medical employees of the hospital. 4. Services are relevant to the needs of the population it serves. ULITILISATION REVIEW The utilisation review program includes determining appropriate hospital length of stay and necessary treatments for various illnesses and conditions and reviewing patient medical records on admission and at intervals during hospitalisation to ensure that the patient receives appropriate care.

Goal
The utilization review process supports the agency's mission to purchase only proper and necessary care for injured workers.

Types

Prospective :It is the assessment of the necessity of care before giving service Concurrent: It is the review of the necessity of carewhile the care being given

Retrospective: It is the analysis of the necessity of service received by the client after the care has been given

AIMS AND OBJECTIVES: 1. The main aim is to curb the exploding health care costs with conservative use of hospitalisation and expensive diagnostic and treatment procedures. 2. They work in liason with a business organisation to provide healthcare services to the organisations employees at discounted rates. 3. Cost containment to limit each patients diagnostic and treatment measures to the fewest, least expensive procedures that will relieve patient symptoms, avert costly complications, and return the patient to fullest possible function in the shortest time possible. UTILISATION REVIEW NURSE

confirm that they are getting the most appropriate care.

in specific situations, and they can also work in hospitals.

review situations dispassionately to make decisions which are fair, even if they may be uncomfortable. t cases if the hospital feels that a patient may not be receiving the appropriate treatment.

not they should be paid.

on against the policy held by the patient, the standards of the insurance company, and the costs which may be involved in treatment.

experience in the field. Conclusion Patient Satisfaction is the strongest determinant of hospital functioning. Ultimate goal of the hospital is satisfaction of its customers. Patient Satisfaction depends on workers motivation, dedication and duty towards the patients. Patients are the foundation of medical practice, it is very obvious that they must be satisfied while in or out of the Hospital. To provide patient-centered care creating a culture that accepts people for, who they are and where, they are in life cycle, by meeting their needs at that point, with the health systems mission to care for the body, mind and spirit of patients. A process for monitoring the use, delivery, and costeffectiveness of services, especially those provided by medical professionals. Bibliography 1. S K Joshi, Quality management in hospital, New Delhi, 2009, Jaypee brothers ltd, page no: 370- 374 2. Jogindra Vattia, principles & practice of nursing management and administration for BSc & MSc Nursing Jaypee brothers ltd, page no:105 3. Dr N C Das, hospital administration made easy, available from URL http://www.slideshare.net/NcDas/patient-satisfaction-11778155 4. http://www.medscape.com/viewarticle/472608 5. http://medical-dictionary.thefreedictionary.com/utilization+review

6. http://managedhealthcareexecutive.modernmedicine.com/managed-healthcareexecutive/news/understand-nuances-utilization-review-and-utilization-mangement 7. http://www.lni.wa.gov/ClaimsIns/Providers/AuthRef/UtilReview/