Part Two of a Three-Part Series

H

ow satisfied are your home healthcare patients? Are their needs really being met? Where does service delivery tend to break down in your agency? To monitor these issues on a national level, Press Ganey Associates, the healthcare industry's leading satisfaction measurement firm based in South Bend, Indiana, compiled survey data from 111,008 patients served by 272 home care agencies from January to December 2001.

Graph 1. Patients evaluate various dimensions of their home care experience. Satisfaction ratings are on a 100-point scale.

       Surveys were mailed to patients upon termination of home care service or at the end of one month of service, whichever came first. Long-term care patients received a survey no more than once every six months to avoid over-surveying and irritating them. Respondents' average age was 67 years. Gender make up of the sample was 38 percent male, 68 percent female. Respondents answered 42 questions that were designed to index patient satisfaction on the central service dimensions of their home healthcare experience (see Graph 1).
       In this national sample, all of the highest scoring questions on the survey related to nursing care, specifically nurses' friendliness, skill, respect of privacy, and concern for patient comfort during treatment. This finding illustrates that home care patients are generally pleased with the quality of nursing care they receive.
       Patients were consistently more satisfied with their nurses than with their (non-nurse) aides. Patients rated nurses and aides on the same attributes and behaviors. Interestingly, the attitudes and behaviors that patients rated highly for their nurses, they also rated highly for their aides. Conversely, the characteristics they rated relatively lowly for their nurses, they rated relatively lowly for their aides. Aides' friendliness, skill, respect of privacy, and concern for patient comfort during treatment were also the elements of the aides' care with which patients were most satisfied.

Graph 2. Home care (HC) patients rate their nurses and aides as more friendly than do nursing home (NH) residents. Satisfaction ratings are on a 100-point scale.

       The three issues related to direct care that received the lowest scores were the following:
1. Concern to contact the patient when the aide or nurse was not coming or would be late
2. Amount of attention paid to the patient's own ideas about his/her care
3. How well the aide or nurse taught the patient to care for his/herself.
       The first concern is one of common courtesy and requires no further elaboration. The second and third concerns illuminate home care patients' preference to be actively involved in their own care and their preference to achieve independence--preferences that only assist recovery and should, therefore, be respected and encouraged. Again, patients were more satisfied with their nurses' handling of these matters than with their aides' handling of these matters.
       The first part of this three-part series (ECPN 2002;79:22-23) examined satisfaction in a recent national sample of nursing home residents and also found that friendliness of the nurses achieved the single highest patient ratings as it did in this national sample of home care patients. Comparing across healthcare settings, the home care nurses and aides earned considerably higher ratings on friendliness than did their nursing home counterparts (see Graph 2).
       One gender difference emerged. Overall, home care aides received significantly lower scores from their female patients than from their male patients. But men and women did not differ in their ratings of their nurses or therapists. Graph 3 shows how patient satisfaction ratings differ by type of therapist. Physical therapists earned the highest ratings of all therapists.

Graph 3. Patients rate the therapists from whom they received services. Satisfaction ratings are on a 100-point scale.

       While aides did receive lower and more variable ratings than nurses, it is noteworthy that patients gave the lowest scores to the practical and administrative aspects of home care rather than to the direct care provided.
       The lowest scoring questions on the survey related to patients' experiences with the home care office, specifically complaint and problem resolution, rescheduling, handling of requests to change nurses or aides, and billing and cost explanations.
       Although the single poorest score went to how well the home health office explained service costs, and as such patients have pinpointed this as an area in need of improvement, this issue is not among the top 10 that are most highly correlated with the likelihood of patients' recommending their home care agency to others. Rather, what patients think most important when they consider recommending their agency to others are 1) the quality of the nursing and 2) the agency's ability to promptly and effectively resolve problems. If patients assess the quality of nursing care as high, they will very likely refer their friends and family to the agency. Likewise, if patients perceive the home care office as being concerned about and responsive to their unique situation, the odds are very good that they will refer others. Table 1 lists the specific issues on which home care agencies should focus attention if they are interested in maximizing patient referrals to their agency.
       Focusing on these issues should increase an agency's number of referrals. In this sample, 74 percent of patients surveyed indicated that their overall satisfaction with the services provided was such that they had every intention of giving a positive referral should the occasion arise.
       As noted above, satisfaction can differ based on population characteristics (i.e., differences in aides' scores based on patient gender). Patients who live alone (38% of those surveyed) were significantly less pleased with the direct care provided than those patients who did not live alone. Similarly, patients who required extended care during their use of home care services (defined as four or more hours per day; 7% of those surveyed) were also significantly less satisfied with the care provided by agencies' nurses and aides. Additionally, patients who were evaluating their first use of home care services tended to be more satisfied than those patients who had used home care before. Taken together, it appears that those patients who are more dependent on home care (because they live alone, need extended care, and/or have needed home care in the past) tend to give lower scores to their care providers. While patient demographics are unable to account for much of the variation in satisfaction ratings (1-3% at the most), these analyses do isolate patient types that have different needs and deserve extra attention to ensure that they too become fully satisfied customers. It is important to remember that diversity in patient population is associated with lower satisfaction scores. Different patients have different needs and preferences: One approach to providing care may not satisfy all patients.