1
Parent satisfaction in Pediatric Resident
Continuity Clinic at Marshfield Clinic
Sushma Thappeta, MD Mentor Divya-Devi Joshi,
MD Technical Assistance Doug Seubert
2
Background

• The quality of health care services has been a
  matter of increasing importance to health
  authorities and patients alike
• In pediatrics, parental satisfaction is a key
  quality indicator
• However, scant research has been devoted to
  understand the factors that predict satisfaction

3
Background

• Many national and international surveys have
  looked at patient satisfaction in different
  sub-specialties and geographic areas
• No data is offered about parental expectations of
  their pediatrician
• Very few surveys included care provided by
  pediatric resident physicians

4
Why did I do this?

• What are physician qualities that are important
  to parents?
• Do they see these qualities in the resident
  physician caring for their child?
• Does a discrepancy influence parental choice in
  follow-up with the same resident physician?
• Where can we improve?
• What is the parents overall satisfaction?
• What are our strengths and weaknesses?
• How much service is enough to elicit high
  satisfaction?

5
Steps in Process

• Establish goals - what you want to learn?
• Determine sample - who will you ask?
• Choose methodology - how will you ask?
• Create questionnaire - what will you ask?
• Distribute questionnaire - ask the questions
• Enter and analyze data - produce the reports

6
Background Research

• Literature search
• Inpatient Outpatient environment
• International U.S.
• Mostly pediatric population

7
Methods

• Target Population Parents at the resident
  continuity clinic at Marshfield Clinic
• Method Written questionnaire
• Distribution Medical assistant before the visit
  
• Data collection Completed questionnaire and
  returned to front desk

8
Study Process

• Over a 7 month period (December 2007 to June
  2008), 550 surveys were handed out
• 9 questions, presenting parents with a series of
  qualifiers they may or may not wish for in their
  ideal pediatrician
• Grade the resident as to whether they received
  care with these same qualities or not, and
  whether they would visit this physician again
• 307 surveys were completed (response rate of 56)
• Data was entered in a Excel spreadsheet

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(No Transcript)
10
Data Analysis
11
Data Analysis
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Data Analysis
13
Data Analysis
SUMMARY                      
Spends enough time with my child 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit. 71 responders (23.13) ranked this as their number 1 priority. 61 of those responders (85.92) agreed that this priority was met during the office visit.
Is helpful, kind and approachable 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit. 85 responders (27.69) ranked this as their number 1 priority. 75 of those responders (88.24) agreed that this priority was met during the office visit.
Listens to my child and myself 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit. 84 responders (27.36) ranked this as their number 1 priority. 72 of those responders (85.71) agreed that this priority was met during the office visit.
Is on time 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit. 30 responders (9.77) ranked this as their number 1 priority. 22 of those responders (73.33) agreed that this priority was met during the office visit.
Provides clear information 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit. 51 responders (16.61) ranked this as their number 1 priority. 42 of those responders (82.35) agreed that this priority was met during the office visit.
Communicates with my child 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit. 33 responders (10.75) ranked this as their number 1 priority. 29 of those responders (87.88) agreed that this priority was met during the office visit.
Makes me and my child feel confident in his/her skills as a doctor 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit. 79 responders (25.73) ranked this as their number 1 priority. 67 of those responders (84.81) agreed that this priority was met during the office visit.
Allows time for questions 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 35 of those responders (97.22) agreed that this priority was met during the office visit.
Discusses treatment options 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit. 36 responders (11.73) ranked this as their number 1 priority. 29 of those responders (80.56) agreed that this priority was met during the office visit.
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Conclusion

• Parents were highly satisfied with overall care
• Need to analyze the data further
• Basis for further improvement in the quality of
  care provided by the resident physicians
• Further research How to further improve the
  quality of care provided by resident physicians
• Further application Develop tools researching
  problem areas in other departments/facilities

15

References

• Children's and parents' visual perception of
  physicians.
• Patients' preferences for resident physician
  dress style - Department of Medicine, University
  of California, Irvine 92717.
• Preferences of parents for pediatric emergency
  physicians' attire - Department of Pediatrics,
  University of Cincinnati College of Medicine,
  Ohio, USA.
• The white coat in pediatrics link between
  medical history and preference for informally
  dressed physicians - Academisch Ziekenhuis,
  Beatrix Kinderliniek, afd. Infectieziekten,
  Groningen.
• Banerjee AK. Does a doctor's dress-style matter?
  Med J Aust. 1988 Aug 1149(3)168.
• Furlow TW Jr. Clinical etiquette a critical
  primer. JAMA. 1988 Nov 4260(17)25582559.
• Gjerdingen DK, Simpson DE, Titus SL. Patients'
  and physicians' attitudes regarding the
  physician's professional appearance. Arch Intern
  Med. 1987 Jul147(7)12091212.
• Colt HG, Solot JA. Attitudes of patients and
  physicians regarding physician dress and demeanor
  in the emergency department. Ann Emerg Med. 1989
  Feb18(2)145151.
• Doyle BJ, Ware JE Jr. Physician conduct and other
  factors that affect consumer satisfaction with
  medical care. J Med Educ. 1977 Oct52(10)793801.
  
• Effect of physician dress style on
  patient-physician relationship

16

References

• Preferences for medical collaboration
  patientphysician congruence and patient outcomes
  - University of California, Riverside, CA
  92521-0426, USA.
• Center for Primary Care, Prevention, and Clinical
  Partnerships, Agency for Healthcare Research and
  Quality, Rockville, MD, USA.
• Fam Pract. 2004 Dec21(6)630-5. Epub 2004 Nov 1.
  Department of General Practice, Guys Kings and St
  Thomas' School of Medicine, London University,
  London, UK. Budny, A. M., Rogers, L. C.,
  Mandracchia, V. J., Lascher, S. (2006).
• The Physician's Attire and Its Influence on
  Patient Confidence.. J. Am. Podiatr. Med. Asso
• Resident physician attire does it make a
  difference to our patients - Department of
  Obstetrics and Gynecology, Northeastern Ohio
  Universities College of Medicine, Aultman Health
  Foundation, Canton, Ohio 44710, USA.
• Bishop F, Matthews F, Probert C, Billet J,
  Battcock T, Frisby S, et al. Patients' views on
  how to run hospital outpatient clinics. J R Soc
  Med 199184522-3.
• Bannerjee A. Does a doctor's dress style matter?
  Med J Aus 1988149168.
• McCarthy, J. J., McCarthy, M. C., Eilert, R. E.
  (1999). Children's and Parents' Visual Perception
  of Physicians.
• Douse, J, Derrett-Smith, E, Dheda, K, Dilworth, J
  P (2004). Should doctors wear white coats?.
  Postgrad. Med.
• Stone DH. How to design a questionnaire. BMJ
  19933071264-6.
• Dunn J, Lee T, Percelay J, Goldman L. Patient and
  house officer attitudes on physician attire and
  etiquette. JAMA 198725765-8.

17

References

• Donabedian A. The quality of care. How can it be
  assessed? Jama. 198826017431748. doi
  10.1001/jama.260.12.1743. PubMed
• Cleary PD, Edgman-Levitan S. Health care quality.
  Incorporating consumer perspectives. Jama.
  199727816081612. doi 10.1001/jama.278.19.1608.
  PubMed
• Deyo RA, Inui TS. Dropouts and broken
  appointments. A literature review and agenda for
  future research. Med Care. 19801811461157.
  PubMed
• Williams B. Patient satisfaction a valid
  concept? Soc Sci Med. 199438509516. doi
  10.1016/0277-9536(94)90247-X. PubMed
• Ware, J. E., Jr.Snyder, MK.Wright, WR. Davies,
  AR. Defining and measuring patient satisfaction
  with medical care. Eval Program Plann.
  19836247263. doi 10.1016/0149-7189(83)90005-8.
  PubMed
• Asadi-Lari M, Tamburini M, Gray D. Patients'
  needs, satisfaction, and health related quality
  of life Towards a comprehensive model. Health
  Qual Life Outcomes. 2004232. doi
  10.1186/1477-7525-2-32. PubMed
• Sitzia J, Wood N. Patient satisfaction a review
  of issues and concepts. Soc Sci Med.
  19974518291843. doi 10.1016/S0277-9536(97)0012
  8-7. PubMed
• Labarere J, Francois P, Auquier P, Robert C,
  Fourny M. Development of a French inpatient
  satisfaction questionnaire. Int J Qual Health
  Care. 20011399108. doi 10.1093/intqhc/13.2.99.
  PubMed
• Gasquet I, Falissard B, Ravaud P. Impact of
  reminders and method of questionnaire
  distribution on patient response to mail-back
  satisfaction survey. J Clin Epidemiol.
  20015411741180. doi 10.1016/S0895-4356(01)0038
  7-0. PubMed
• Salomon L, Gasquet I, Mesbah M, Ravaud P.
  Construction of a scale measuring inpatients'
  opinion on quality of care. Int J Qual Health
  Care. 1999, 11.6.507. PubMed.

18

References

• Kinnersley P, Stott N, Peters T, Harvey I,
  Hackett P. A comparison of methods for measuring
  patient satisfaction with consultations in
  primary care. Fam Pract. 1996134151. PubMed
• Stump TE, Dexter PR, Tierney WM, Wolinsky FD.
  Measuring patient satisfaction with physicians
  among older and diseased adults in a primary care
  municipal outpatient setting. An examination of
  three instruments. Med Care. 199533958972.
  PubMed
• Hjortdahl P, Laerum E. Continuity of care in
  general practice effect on patient satisfaction.
  Bmj. 199230412871290. PubMed
• Hopton JL, Howie JG, Porter AM. The need for
  another look at the patient in general practice
  satisfaction surveys. Fam Pract. 1993108287.
  PubMed
• Baker R. Development of a questionnaire to assess
  patients' satisfaction with consultations in
  general practice. Br J Gen Pract.
  199040487490. PubMed
• McKinley RK, Manku-Scott T, Hastings AM, French
  DP, Baker R. Reliability and validity of a new
  measure of patient satisfaction with out of hours
  primary medical care in the United Kingdom
  development of a patient questionnaire. Bmj.
  1997314193198. PubMed
• Grogan S, Conner M, Willits D, Norman P.
  Development of a questionnaire to measure
  patients' satisfaction with general
  practitioners' services. Br J Gen Pract.
  199545525529. PubMed
• Howie JG, Heaney DJ, Maxwell M, Walker JJ. A
  comparison of a Patient Enablement Instrument
  (PEI) against two established satisfaction scales
  as an outcome measure of primary care
  consultations. Fam Pract. 199815165171. doi
  10.1093/fampra/15.2.165. PubMed
• Westaway MS, Rheeder P, Van Zyl DG, Seager JR.
  Interpersonal and organizational dimensions of
  patient satisfaction the moderating effects of
  health status. Int J Qual Health Care.
  200315337344. doi 10.1093/intqhc/mzg042.
  PubMed
• Cheng SH, Yang MC, Chiang TL. Patient
  satisfaction with and recommendation of a
  hospital effects of interpersonal and technical
  aspects of hospital care. Int J Qual Health Care.
  200315345355. doi 10.1093/intqhc/mzg045.
  PubMed.

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Questions / Comments