Chapter 7: Client Satisfaction

Importance of Monitoring Client Satisfaction Roots in consumer movement of late 60s, early 70s Accountability to consumers Partnership between consumers and service deliverer Four “R”s in marketing health care services: Relevance of service Response (delivering on expectations) Relationship with consumer Results Consumers more powerful with advent of Internet Disgruntled clients may not return Client satisfaction studies can detect problems before they get too out of control

Importance of Monitoring Client Satisfaction Unhappy consumers will tell others Fisk et al. (1990) found: If patient loyalty was 95%, positive testimonials per 100 patients 3x more than negative reports If patient loyalty 90%, only slightly more positive reports than negative If patient loyalty 80%, there were more negative than positive reports Negative word of mouth occurs more frequently than positive testimonials Client satisfaction alone not sufficient as measure of quality However, universally accepted as necessary Consumer feedback a requirement of many regulatory and certification agencies such as Council on Accreditation (COA) COA accreditation standards available: www.coastandards.org/standards.php

Advantages of Client Satisfaction as form of Evaluation Relatively inexpensive Easy to interpret Can be implemented on short notice Convey to clients that their experiences are important Useful from managerial, public relations, and marketing perspectives

Problems with Client Satisfaction Studies-1 Do not answer questions about outcomes (did clients actually improve?) Vast majority of respondents indicate satisfaction with services Lebow (1983) found an average of 78% of clients reported satisfaction High levels of satisfaction found internationally, not just in US Client satisfaction high even when clients have little choice of facility, type of treatment, or practitioner Clients can indicate satisfaction yet still report unmet needs If satisfaction rate is below 75%, further investigation is warranted

Problems with Client Satisfaction Studies - 2 Not a measure of whether client’s needs met Clients can be satisfied with ineffective programs Consumer evaluations can be influenced by provider’s reputation Clients may be satisfied with treatment but not with the environment Quantitative assessments yield higher satisfaction than qualitative assessments Satisfaction with services positively related to age Those not happy with services tend to drop out Shown to be related to symptom relief and improvement Open-ended questions can provide “illuminating information” Telephone surveys yield higher response than mailed surveys Expect low response rates Clients who returned mailed surveys have higher education levels than those who do not Families ordered by court to obtain services report less satisfaction

Explanations for High Ratings-1 More satisfied, higher functioning clients are more likely to complete the questionnaires? Clients may not know what to expect Threats to reliability and validity include Recall bias Interviewer bias Non neutral setting bias Social desirability Perception by client that answers not anonymous

Explanations for High Ratings-2 Respondents taking medication Clients may feel gratitude or fear of alienating provider Instruments with unknown psychometrics Responders may be in treatment longer than non responders Reduction of cognitive dissonance - Clients who “invest” considerable time, energy and hope may rate services higher

Recommendations for Client Satisfaction Studies-1 Examine literature; use scales with good reliability and validity that have been used successfully in other studies Use same instrument on repeated occasions so findings can be compared Employ at least 1-2 open-ended questions Use “ballot box” approach – every client given survey during a given week, while waiting for appointment

Recommendations for Client Satisfaction Studies-2 Do not focus only on solving problems of dissatisfied customers If do mailed survey, try to get more than 50% response rate; offer small incentives for participation Target specific dimensions Keep expectations realistic; do not over generalize from small samples Look for behavioral indicators to supplement client satisfaction