Knowledge Exchange

Ask a Researcher

Maxime Paquet, PhD, and Serge Gagnon, PhD, Research and Intervention Centre for Healthy Workplaces (CRISO), affiliated with the McGill University Health Centre

How can a patient indicator, such as patient satisfaction, be adapted to be used in an overall improvement effort that targets at once the quality of psychosocial work environment, the stability of health care teams, and the quality/safety of care?

Given the nature of the CRISO/REISS 2008-2012 program (as explained in “Ask a researcher – April 2010”), we wanted to evaluate patient satisfaction aspects that Head Nurses can act upon, and focus as well on aspects of the staff targeted by the health care team stabilization measures (i.e. nursing staff in this instance). Consequently, we settled on patient satisfaction related to nursing care.

Since patient satisfaction evaluations cover, as a general rule, all aspects of “the care experience”, to achieve our goal, we needed to either find a suitable tool or develop it. Rubin (1990) listed all these aspects in his review of the literature on the subject. Primary among them are: the admission process, the quality of medical/nursing staff care, the quality of relations with professional and support staffs, physical environment and services (quality of rooms, food, etc.), and the hospital discharge process (which, in American studies, includes billing).

We decided to set up a research partnership with colleagues from the Centre hospitalier universitaire de Montréal, (CHUM) who developed the « Questionnaire d’appréciation des patients sur les soins infirmiers reçus » (QAPSIR; Patient Satisfaction Related to Nursing Care Questionnaire), which evaluates patient satisfaction related to nursing staff (nurses, auxiliary nurses, and nursing aides) using 36 statements distributed in six dimensions. The QAPSIR was developed from the first six descriptive statements of the document entitled « Perspectives de l’exercice de la profession d’infirmière » (Perspectives from the Nursing Profession), prepared by the Ordre des infirmières et infirmiers du Québec (2004, 2007). These descriptive statements correspond to the six scales in the questionnaire: nurse/patient partnership, health promotion, disease prevention, therapeutic process, functional rehabilitation, and quality of life.

The development of the questionnaire was described in a 2007 article that published the outcomes of the questionnaire’s first application, and suggested the need to repeat the exercise to test the psychometric qualities in a different context and to improve its underlying method (Bellemare, 2007). We quickly adopted the questionnaire for two main reasons. First, we needed to apply a validated measuring tool (instead of a home-scale) targeting the nursing staff so as to maximize the chances of establishing meaningful links with other indicators being investigated. Second, through the CRISO/REISS program, we had the opportunity to make a quality instrument available to the entire Quebec health network.

For all these reasons, we have selected the QAPSIR to achieve three goals:

1. To empirically establish a link between the psychosocial environment, the stability of theams, and the quality/safety of care

2. To provide our partner institution with a measurement tool which can help nursing care management improve the patients’ perception of care, proposing to them the use of an interpretation method adapted to real life situations.

In an environment where decisions should to be evidence-based, QAPSIR is a scientifically validated tool of choice. Furthermore, data resulting from a validated questionnaire can be more easily linked to other indicators and hence provide support to the decision-making process relative to improving the quality and safety of care. As stated by Knott and Wildavsky (1980), to help promote the use of evidence-based data in decision making, it is important to have access to the data, understand it, and share it. The presentation prepared for management and care teams enables them to achieve these steps and adopt measures to improve client satisfaction.

Here is an example of the way patient satisfaction can be linked to other indicators. Using path analysis we discovered that it was possible to predict 32% of the variation in a patients’ average length of stay (LOS) using the six dimensions of satisfaction. Thus, in a one day reduction in average LOS, close to one third of the change may be explained by an increase in the rate of patient satisfaction towards nursing care.

In terms of practical application, and in answer to the question above, these outcomes mean that when a unit experiences a significant drop in average LOS, nursing care might be the reason for up to one third of the reduction. In other words, if nursing care management ensures the rigorous application of practice standards offered by QAPSIR, it is possible to expect an average LOS drop in care units. Consequently, management will be able to divert its focus to other (controllable) sources of concern that affect LOS, such as operational system failures, difficulties in coordinating various job groups, etc.

We turn now to our third objective:

3. To publish an article that will make the entire QAPSIR available and to describe the strategies of outcome presentation and interpretation. As a result, to help management and care teams make evidence-based decisions.

We have now submitted to « Perspective infirmière » a second article that would make available the entire questionnaire to all French institutions in the Quebec network. Until it is published, it is possible to consult a on our website (http://www.criso.ca/Category.aspx?NavID=213&CultureCode=fr-CA) a section dedicated to QAPSIR and its use.

The next research step related to QAPSIR will be its translation to English in order to allow its dissemination throughout Canada. The questionnaire can easily be adapted to fit the practice guidelines adopted by the College of nurses overseeing your region, and the cultural preferences of the population served by your region’s hospital(s). In addition, since many Canadian regions are bilingual, the availability of a scientifically validated satisfaction questionnaire in more than one language enables the questioning of a larger number of patients and consequently helps obtain samples that are more representative of the targeted population.

Do not hesitate to contact us if you are interested in establishing a research partnership to translate, improve or disseminate this questionnaire!

References

Bellemare, D. (2007). Les Perspectives de l’exercice de la profession d’infirmière et l’appréciation des soins infirmiers par les clients. Perspective infirmière, 5(1), 39-44.

Knott, J., & Wildavsky, A. (1980). If dissemination is the solution, what is the problem? Knowledge, Creation, Diffusion, Utilization, 1(4), 537-578.

Ordre des infirmières et infirmiers du Québec (OIIQ). (2004,2007). Perspectives de l’exercice de la profession d’infirmière.

Rubin, H.R. (1990). Patient Evaluation of Hospital Care : A Review of Litterature. In M. Meterko, E.C. Nelson, & H.R. Rubin (Eds.) Patient Judgments of Hospital Quality : Report of a Pilot Study (Numéro supplémentaire). Medical Care, 28(9), S3-S9.