Clinical governance and the use of indicators of satisfaction

Abstract

It is well known that patients views are important in measuring the quality of health care delivery and that their assessments are valuable measures of clinical effectiveness and economic efficiency. Also, taking into account these evaluations is a way to foster health services democratisation. Based on the EUROPEP study and some related concepts - health governance and procedures towards change - , in this paper we present a proposal to classify health centres focused on the assessment their users make of the quality of health care. Departing from this classification system, we will also suggest some possible measures to be taken by health governing organizations. The answers of 11,166 users of all mainland centres were used, in the framework of the EUROPEP study conducted by the CEISUC (Centre for the Study and Research in Health of the University of Coimbra) and proposed by the IQS (Health Quality Institute) in 2003. The indicators resulting from the research project EUROPEP are grouped into 5 major areas: (i) relationship and communication between doctor and patient; (ii) provided health care; (iii) information and support; (iv) health care continuity and cooperation between primary and hospital care; and (v) service organization. We also consider a global satisfaction indicator, resulting from the clustering of the above mentioned indicators according to a set of criteria. On the basis of the values obtained for each indicator, and corresponding quintiles, a classification system for each indicator was created, and the criteria were then applied to the health centres. The results show some existing asymmetry, taking into account the comparison between sub-regions and even inside each sub-region. On the basis of the results obtained and the proposed classification, we propose some actual intervention in the health centres, ranging from new management and organization freedom for the better classified through external intervention for the worse. The system we present is organized to classify the health centres on the basis of their quality assessment, expressed in terms of the satisfaction of the users with the health care received. This assessment largely depends on the expectations of those who perform it and these individual expectations can be low due to several reasons. It is not a perfect system and it always depends on the willingness of the users to answer the questionnaire, which they anonymously fill and send by mail. However, the results are based on the better available information and were obtained in an independent way. We argue that, more than to create an absolute criteria system, there is a need to perform a benchmarking, comparing Health Centres and adjusting the criteria to the scores distribution.