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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:

Equity Is a Must on the Road to Universal Health Coverage

Caroline Ly's picture



Many countries around the world are working to ensure that all people can access the quality health services they need without suffering financial hardship. Countries have committed to reaching universal health coverage (UHC) by 2030 as part of the global Sustainable Development Goals.

Why do finance ministries matter to achieving universal health coverage?

Maxwell Bruku Dapaah's picture



In the sustainable development goals (SDGs) era, the imperative to finance the development agenda from domestic resources has been amplified. Irrespective of a government’s best intentions to achieve universal health coverage (UHC), without adequate financing from its national budget, minimal progress will be made. This is in stark contrast to the Millennium Development Goals (MDGs) era (from 2000- 2015) where emphasis was on effective development cooperation (EDC).  And when it comes to achieving UHC, financing is actually only part of the role ministries of finance can play. Indeed, in a recent Lancet article, H.E Taro Aso, Deputy Prime Minister and Finance Minister of Japan, pointed out that the finance ministry’s “crucial role in Japan’s UHC achievement has not been adequately highlighted”.

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
It is vital that we better manage our knowledge, to make better use of it for delivering universal access to water and sanitation. This requires new ways of capturing, sorting, weighing, curating, and translating knowledge into practical, bite-sized chunks. The Disease Control Priorities project, now in its third edition (www.dcp-3.org), is an excellent example of what this looks like in practice. It aims to compile the best available evidence across multiple areas of health to provide a snapshot of the coverage of services, the problems resulting from lack of services, the effectiveness of interventions, and the cost-effectiveness and cost-benefit of those options.
 
Disease Control Priorities Network (DCPN), funded in 2010 by the Bill & Melinda Gates Foundation, is a multi-year project managed by
University of Washington’s Department of Global Health (UW-DGH) and the Institute for Health Metrics and Evaluation (IHME). 


As authors of the WASH chapter of DCP-3, we wanted to share some of our key takeaways below:

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



World Health Day this year is focused on universal health coverage (UHC) and the urgent need for #HealthforAll. Taking place on April 7, it’s an opportune time to call on world leaders to commit to concrete steps to work towards and support financing for UHC. Many countries have made great strides towards UHC, but it’s not still enough.

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.


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