Since National Health Insurance program formally went into effect in March 1995 in Taiwan, the residents enjoy high quality but relatively cheaper medical care compared with the most developed countries. To manage a hospital successfully, the important goals are to attract and then retain as many patients as possible by meeting potential demands of various kinds of the patients. This study first conducted the survey based on SERVQUAL model to identify seven major criteria from patients' or their families' viewpoints at Show Chwan Memorial Hospital in Changhua City, Taiwan. When the key criteria were found, the second survey developed for applying decision-making trial and evaluation laboratory (DEMATEL) method was issued to the hospital management by evaluating the importance of criteria and constructing the causal relations among the criteria. The results show that trusted medical staff with professional competence of health care is the most important criterion and mutually affects service personnel with good communication skills, service personnel with immediate problem-solving abilities, detailed description of the patient's condition by the medical doctor, and medical staff with professional abilities. Therefore, trainings on communication skills and problem-solving abilities would result in positive interaction for patients to trust medical staff. When the trusted medical staff provides professional competence of health care to patients, satisfaction would be increased.

A DEMATEL method in identifying key success factors of hospital service quality

Effects of Actual Waiting Time, Perceived Waiting Time, Information Delivery, and Expressive Quality on Patient Satisfaction in the Emergency Department

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This article reviews the empirical literature on patient satisfaction in the Emergency Department (ED). It explores the implications for clinical practice, discusses limitations and weaknesses of the literature, and provides direction for future research. Articles resulting from a comprehensive electronic search were obtained, their references examined, and all other relevant articles not already discovered via the electronic search were acquired and reviewed. Articles were included if: 1) the stated goal of the study was to investigate satisfaction with at least one aspect of ED care, 2) the study was conducted in the United States, 3) it provided enough information on the study methods, design, and statistical analyses to conduct a critical review, and 4) it used quantitative methods. Fifty studies met the above criteria. Based on the multivariate predictive studies, the most robust predictor of global satisfaction is the quality of interpersonal interactions with the ED provider. Perceived waiting times are more closely associated with satisfaction than actual waiting times. Several methods for improving satisfaction have shown promise, but none has garnered sufficient support to recommend unequivocally. Promising interventions include: providing information on how the ED functions through visual media, improving ED processes through performance improvement methodologies, and improving the interpersonal skills of providers. Interventions designed to reduce actual waiting times have not been sufficiently studied, but results from several well-designed studies suggest that such a strategy is unlikely to have as great an impact as those targeting perceived waiting times. To advance this area of research, investigators must use: 1) larger, more representative samples; 2) reliable and valid assessment instruments; 3) theory-driven hypothesis testing; and 4) randomized, controlled trials.

Patient satisfaction in the Emergency Department: a review of the literature and implications for practice

We investigated predictors of patient satisfaction in a large, municipal emergency department (ED). Patients were telephoned 10 days postvisit, and satisfaction was assessed using a structured survey with 22 items measuring several domains, as well as the estimated length of stay. The dependent variables consisted of ratings of overall satisfaction and likelihood of recommending the ED to others. Data were obtained from 437 (38.7%) patients. Univariate statistics revealed strong relations between indicators of perceived care and both dependent variables, with weaker and mixed findings pertaining to demographics and visit characteristics. The final logistic regression predicting overall satisfaction included the following items (P < .05): degree to which staff cared for the patient as a person, perceptions of safety, understandability of discharge instructions, nurse's technical skills, and satisfaction with wait for physician. Likelihood to recommend was associated with (P < .05): degree to which staff cared for the patient as a person, understandability of discharge instructions, perceptions of safety, age, and insurance status. Patients' perceptions of care, rather than demographics and visit characteristics, most consistently predicted satisfaction. However, differences were observed between the specific predictors for overall satisfaction and likelihood to recommend, providing a possible explanation for inconsistencies observed in the literature.

Determinants of patient satisfaction in a large, municipal ED: The role of demographic variables, visit characteristics, and patient perceptions

The authors conducted a field experiment in which emergency-room patients of a metropolitan hospital were either given or not given an expected waiting time to see a physician. Patients were then surveyed through the mail on their satisfaction and perceptions of service quality. The results revealed that satisfaction levels were higher when patients believed that they had received information on expected waiting time. Regression analysis revealed that service quality dimensions of trust, responsiveness, and staff service were significant predictors of patient satisfaction. In addition, satisfaction was independently influenced by whether patients' prior timeliness expectations were confirmed. The authors discuss the results in terms of the concept that the situational context of the service may influence the quality dimensions that most affect consumer satisfaction.

J McPhail

Papers

Waiting in the emergency room: how to improve patient satisfaction.