Administration and Leadership, Columns, Patient Care

Study Examines Factors that Influence Patient Satisfaction

Issue 9 and Volume 42.

The Research

Bogomolova S, Tan PJ, Dunn SP, et al. Understanding the factors that influence patient satisfaction with ambulance services. Health Mark Q. 2016;33(2):163–180.


The Science

This paper comes from data collected by the Council of Ambulance Authorities Inc., the professional organization representing 11 statewide ambulance services across Australia, New Zealand and Papua New Guinea.

They send annual surveys to a patient and/or their family who had emergent requests for EMS over a randomly selected two-month period. The response rate averages 30%.

The satisfaction questions ask the respondents to rate, on a 5-point scale, the time it took for their call to be answered, call-taker assistance, ambulance response time, ride quality, care and treatment received, the ability of the paramedic to explain what was happening and their overall satisfaction with the service.

They analyzed 50,349 responses collected between 2003 and 2012. This paper examined the “human elements”—those that could be influenced by the dispatchers and paramedics.

They report that respondents were either very satisfied or satisfied with call-taker assistance (97.6%), paramedic care (98%), paramedic explanations (95.9%) and overall satisfaction (97.5%).

Although it’s not a human factor, respondents were two and a half times more likely to be satisfied overall when they were satisfied with the response time.

They concluded that they’d established a baseline of satisfaction, but noted that the 5-point scale resulted in a considerable number of the responses being lumped into the satisfied/very satisfied category, making it difficult to determine areas needing improvement.

Medic Wesley Comments

I was very interested to read and comment on this study from Australia and New Zealand because it looked at real care issues and patient perceptions.

It’s no secret to those who know me well, that my opinion of hospital patient satisfaction surveys in the United States is unfavorable.Based on family and personal experience, I find the surveys to be more suited to a transportation business rather than healthcare.

This research from Australia shows a solid 10 years of patient data that’s directly related to prehospital care issues. It appears that, other than some bumpy roads, these folks are doing well. The U.S. could certainly learn from them in assessing our care on
the ambulance.

So, how are we doing here in the U.S. as far as talking with our patients and providing care through their eyes? Would we rate as high as our Australian counterparts? Or would societal differences kick us to the curb because of higher expectation?

I’d be interested to know how services here assess patient satisfaction. Is it included in the hospital survey, or do you rate your service separately? This would be a great research topic for American researchers to look at.

Doc Wesley Comments

Patient satisfaction scores drive the definition of healthcare quality in the United States. The question is “do patients really know what quality is?” I suspect not.

But Medic Wesley has a point. If your measure of satisfaction is lumped in with that of the hospital’s you may be paying the price in terms of being fairly evaluated. However, I believe that only a handful of services collect such data, and those that do have response rates in the single digits.

Why is this important? Patients are lucky just to have 9–1–1, and if they don’t like it they can move somewhere else or pay higher taxes. Or better yet, they can take a cab!

Seriously now, whether we like it or not, agencies usually don’t have a choice unless the issue is brought before the city council to examine alternatives. That’s not the time to go scrambling for surveys.

In my hospital-based agency, our satisfaction scores influence the scores of the hospitals to which we transport our patients.

Although I can’t prove it, I’d suggest that starting off the patient experience on a positive note improves the likelihood that they’ll be happy with the care they receive.

But let’s examine in closer detail what those “human components” are. Providing clear and helpful information, taking your patient’s concerns seriously, explaining what you’re doing and why are all part of being a professional. It’s what makes the difference between us and the taxi driver whose goal is getting a bigger tip at the end of the ride.

If we provide truly excellent care, we’ll meet the needs of the patient. It means looking your patient in the eye and telling them you know they’re scared, but you’re going to do everything in your power to address those fears and make sure they get the attention they deserve. In many cases, all it takes is a gentle touch and a calm voice.

This can be especially difficult with the recalcitrant drunk or the homeless person who just needs “three hots and a cot.” But that’s what we signed up for.

It’s not all knife-and-gun club and saving beautiful women from burning houses. It’s about truly caring for your patients.