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Pitfalls of Patient Satisfaction Surveys and How to Avoid Them

David Evans's picture

A child has a fever. Her father rushes to his community’s clinic, his daughter in his arms. He waits. A nurse asks him questions and examines his child. She gives him advice and perhaps a prescription to get filled at a pharmacy. He leaves.

How do we measure the quality of care that this father and his daughter received? There are many ingredients: Was the clinic open? Was a nurse present? Was the patient attended to swiftly? Did the nurse know what she was talking about? Did she have access to needed equipment and supplies?

Both health systems and researchers have made efforts to measure the quality of each of these ingredients, with a range of tools. Interviewers pose hypothetical situations to doctors and nurses to test their knowledge. Inspectors examine the cleanliness and organization of the facility, or they make surprise visits to measure health worker attendance. Actors posing as patients test both the knowledge and the effort of health workers.

But – you might say – that all seems quite costly (it is) and complicated (it is). Why not just ask the patients about their experience? Enter the “patient satisfaction survey,” which goes back at least to the 1980s in a clearly recognizable form. (I’m sure someone has been asking about patient satisfaction in some form for as long as there have been medical providers.) Patient satisfaction surveys have pros and cons. On the pro side, health care is a service, and a better delivered service should result in higher patient satisfaction. If this is true, then patient satisfaction could be a useful summary measure, capturing an array of elements of the service – were you treated with respect? did you have to wait too long? On the con side, patients may not be able to gauge key elements of the service (is the health professional giving good advice?), or they may value services that are not medically recommended (just give me a shot, nurse!).

Two recently published studies in Nigeria provide evidence that both gives pause to our use of patient satisfaction surveys and points to better ways forward. Here is what we’ve learned:

Why do finance ministries matter to achieving universal health coverage?

Maxwell Bruku Dapaah's picture
Also available in: Español | 日本語 
コスモクロック21を背景にみなとみらい21地区を歩く「競争力のある都市づくり」実務者研修会合の参加者たち。みなとみらい21地区は、横浜市の中でも付加価値の高い活動が集中し、生活の質の高さに重点をおいた地区となっている。 写真提供:東京開発ラーニングセンター(TDLC)
都市の首長たちの業務を考えるとき、市民に効率的な都市サービスを提供することに加え、雇用創出を行うことは、世界的な経済成長の最優先事項となっています。

こうした中、都市には、市民の雇用と、基礎的なサービスに対応する事業のための税収を生み出す手段が必要になっています。 競争都市に関する世界銀行の主要報告書(2015年発行)では、 早急に大規模な雇用を創出することが不可欠だ と指摘されています。
 
2017年11月 、アルゼンチン、チリ、クロアチア、エジプト、エチオピア、マレーシア、フィリピン、ルーマニア、南アフリカ、チュニジア、ウガンダ等から約30名の都市および国の政府関係者、政策担当者が1週間にわたる「競争力のある都市づくり」実務者研修会合を行いました。世界中の都市を代表する参加者にとって、それぞれの都市や地域が競争力を高める手法を探すことが目的でした。

多くの都市では組織構造の断片化や管轄区域の重複などが起こり、組織内プロセスの透明化が必要となっています。また、経済開発戦略を民間セクターと調整することが困難な都市もあります。根拠に基づく政策課題を推進するための適切な準国家社会経済データの欠如も挙げられます。自治体の首長は、理論上の教訓ではなく、実践的で実現可能な知見を模索しているのです。

日本の横浜市と神戸市で行われた本 実務者研修会合では、都市の競争力に関連し、日本の優れた知見を学ぶことができました。横浜市と 神戸市は特に以下について豊富な知見を有しています。
  • 人口流入
  • 急速な産業化
  • 環境課題への対応
  • 先端技術の取得
  • 住宅バブル
  • 大規模な災害(阪神淡路大震災)と復興

Removing the stigma of mental illness in India

Varalakshmi Vemuru's picture
A report on the economic burden of mental illness argues that depression and anxiety disorders cost the world nearly $1 trillion annually. Conversely, every dollar invested in mental health contributes $4 to the economy. Photo credit: TNMHP

April 7 marked the 70th anniversary of World Health Day. This was an opportunity for the global community to redouble its efforts to ensure that all people can improve their health, including their mental health.
 
When his father died, Gopi, a carpenter in rural Tamil Nadu, India was overwhelmed by an enormous mental and financial burden.

Gopi became depressed, left his job, and isolated himself.

As his condition worsened, Gopi’s two younger sisters dropped out from high school to take on farming jobs to support the family.

However, thanks to medicine, counseling, and livelihood support from the Mental Health Program (TNMHP), Gopi eventually rehabilitated himself and got back to carpentry a year later.

With time, he even took out a Rs. 20,000 loan to start his own carpentry business.

Gopi’s experience—and many others’—illustrate how mental health is integral to well-being.

The World Bank recognizes mental health as a key challenge to sustainable development.

A report on the economic burden of mental illness argues that depression and anxiety disorders cost the world nearly $1 trillion annually. Conversely, every dollar invested in mental health contributes $4 to the economy.

Accordingly, the World Bank-supported the Mental Health Program in the state of Tamil Nadu, India that incorporates best practices in mental health from around the world.

The project is an important instrument in addressing the magnitude of India’s mental health challenges, and provides a successful model for the implementation of the national mental health policy and improve mental health infrastructure and care in Indian states.

By closely involving the community, the project reduced stigma and prejudice attached to mental illness and empowered vulnerable people with mental disabilities to gain respect in their communities.  

People with mental disabilities are diagnosed and treated and provided livelihood support through vocational training, self-help groups, job cards, and identity cards to access social benefits.

7 ideas on how knowledge can help us achieve universal access to safely-managed drinking water and sanitation

Guy Hutton's picture
Photo by Victoria Ojea / World Bank
Photo: Victoria Ojea / World Bank

Invited to think of Buenos Aires, most would probably think of elegant cafés, beautiful architecture, passionate football fans, and buzzing streets. Invited to think harder, you might also think of its villas (slums), street children, and other less gleeful views. But no matter how hard you try, very few would associate Buenos Aires with Indigenous Peoples. Yet, Buenos Aires has the largest concentration of indigenous populations in Argentina, which is itself rarely associated with Indigenous Peoples, but has the seventh largest indigenous population in Latin America (close to one million). In effect, over 40 indigenous communities are officially registered in urban areas of the Buenos Aires Province, and as much as one quarter of all Indigenous Peoples in Argentina make a living in or around the Capital of Tango, whether in communities or not.

What do they do? What conditions they are living in? What is happening to their unique cultures and languages? Are they losing connection with their ancestral lands? Is the special legislation protecting their collective rights relevant in the cityscape? In sum, how is the city changing them and, inversely, how are they shaping the urban landscape? These and other questions were at the heart of the dialogue I had with graduate students from across the Latin America region in FLACSO – University of Buenos Aires, last week, on the occasion of the presentation of the report Indigenous Latin America in the Twenty-First Century, in Buenos Aires.

Amp up your 2018 Spring Meetings experience

Bassam Sebti's picture


Our 2018 Spring Meetings is just around the corner and it’s time to get organized. Mainstage speakers include representatives from top-notch institutions such as LinkedIn, Oxford University, Financial Times, Brookings Institution — in addition to influencers Bill Gates and Jeff Weiner.

Connect, engage and watch to take full advantage of everything the #WBGMeetings has to offer. 

Towards Universal Health Coverage: Tackling the health financing crisis to end poverty

Juhie Bhatia's picture


The Stade Vélodrome in Marseille, France. Photo Credit: Ben Sutherland via Flickr Creative Commons

In June 2016, nearly 2.5 million enthusiastic spectators gathered in France to attend the Euro 2016 soccer tournament.

Those participating in matches in Lille, Bordeaux, Marseille or Nice would have noticed the brand new facilities and bold architectural design, but most probably didn’t realize these stadiums had been either constructed or modernized with financing through the relatively new “Contrat de partenariat” public-private partnership (PPP) scheme.

Sexual harassment – Where do we stand on legal protection for women?

Paula Tavares's picture
Women abused in her home holding her hand up. Stop sexual harassment against women. Violence and abuse in family relations. © Fure/Shutterstock.com
Woman abused in her home holding her hand up. Stop sexual harassment against women, violence and abuse in family relations. © Fure/Shutterstock.com


The #MeToo movement is transforming the way we perceive, and hopefully, deal with sexual harassment.

For too long women have suffered from this type of violence that has negative consequences on their voice and agency as well as their capacity to fully participate in the economy and society. There is ample evidence of the cost of sexual harassment to businesses – in legal settlements, lost work time and loss of business. But sexual harassment also has negative effects on women’s economic opportunities. For example, if no recourse is available to protect them, instead of reporting the problem, women facing sexual harassment in the workplace often say that they have no other choice but to quit. This may mean starting over, missing out on pay raises, career growth opportunities, and earning potential. Studies suggest that sexual harassment reduces career success and satisfaction for women. Yet, many countries still do not afford women adequate legal protection against this pervasive form of gender inequality.

How has Afghanistan achieved better health for its citizens?

World Bank Afghanistan's picture
A local woman has brought her eight-month-old son to the Baidari Hospital in eastern Jalalabad city for vaccination.
A local woman has brought her eight-month-old son to the Baidari Hospital in eastern Jalalabad city for vaccination. Photo Credit: Rumi Consultancy/ World Bank

Over the last 15 years—despite continuing insecurity—Afghanistan has made steady progress to improve the health of its citizens, especially women and children. Health services have expanded as far as remote areas to reach underserved communities thanks to innovative partnerships with Non-Governmental Organizations (NGOs).

To understand what underpins such health gains, we sat down with Ghulam Dastagir Sayed, Senior Health Specialist at the World Bank and one of the authors of the recently published report Progress in the Face of Insecurity.  

"Real governance" in Fragile, Conflict-affected and Violent States - What is that?

Camilla Lindstrom's picture
Children in a school in Kinshasa. Photo © Dominic Chavez/World Bank.

The Fragility Forum was held in Washington D.C. from March 5 to 7. More than 1,000 people from over 90 different countries attended. At one of the events, ‘Real Governance in FCV settings: Engaging State and Non-State Actors in Development’ practitioners and policy-makers discussed which actors to work with in complex FCV situations, and what the choice of actors would mean from a human rights and social accountability perspective.

In Fragile, Conflict-affected and Violent States (FCVs), the formal state typically has a low capacity to deliver basic services, to respond to demands and to impose security. It often does not have full or exclusive authority over its territory and is competing with other groups for legitimacy to exercise state powers.

Maximizing finance for safe and resilient roads

Daniel Pulido's picture


Around the world, roads remain the dominant mode of transport and are among the most heavily-used types of infrastructure, accounting for about 80% of the distance travelled for individuals and 50% for goods.

Despite this intensive use, the funding available for road maintenance has been inadequate, leaving roads in many countries unsafe and unfit for purpose.

To make matters worse, roads are also very vulnerable to climate and disaster risk: when El Niño hit Peru in 2017, the related flooding damaged about 18% of the Peruvian road network in just one month.

It is no surprise then that roads are the sector that will require the most financing. In fact, the G20 estimates that roads account for more than half of the $15 trillion investment gap in infrastructure through 2040.

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