Physician and patient assessment of ambulatory care in a university facility

Abstract

Physicians are a largely untapped resource for evaluating medical care delivery in an ambulatory care facility. This study includes the attitudes of physicians in assessing care at the Northwestern University Medical School Clinics (NUMSC). A self-administered questionnaire was mailed to all clinic chiefs, attending physicians, and resident physi--cians who had worked in the clinics during the summer of 1973. Using a similar questionnaire, personal interviews were conducted with a sample of patients in the clinics. Physicians were consistently more critical than patients in their responses to the battery of questions on satisfaction and on indices constructed from these responses. The findings indicate a negative relationship between the physician's position of authority in the organization and his report of satisfaction: clinic chiefs were consistently more critical than either attending physicians or resident physicians, while the comparisons between attendings and residents were more mixed. Further, salaried physicians were more critical than those who received no salary and non-AMA members were more critical than AMA members. Adding the assessment of physicians to those of patients introduces a useful complement and strengthens the utility of such evaluation instruments.Current emphasis on ambulatory care focuses attention on mechanisms for evaluating the delivery and quality of health services. Simple instruments for assessing care can serve to identify problems, aid in their solution, monitor patient and staff reaction to innovations, and facilitate accountability to the public.Subjective measures of satisfaction are widely used mechanisms for assessing ambulatory care and have figured prominently in evaluative research. 1-s Whereas in recent years the patient has been the major focus in the development and use of such instruments, the physician has been central in the measurement of technical aspects of medical care. Physicians play a key role in setting standards of care and judging the extent to which they are met in a variety of ways, such as tissue review committees, medical audit, utilization review, and PSRO.

Satisfaction with the outpatient encounter

“…It appears that physicians were more critical of the quality of their communication than patients. This finding is consistent with other studies 3,10–12,15 . The correlation between patients’ and physicians’ ratings was not high, which indicates that patients and physicians actually judged the consultation differently.…”

“…Although some studies have considered physicians’ satisfaction with provided care, 1,3–11 only a few have explicitly examined whether patients’ and physicians’ visit‐specific satisfaction are congruent 12–15 . The latter studies were conducted in general practice 12–14 and an internal medicine outpatient clinic 15 .…”

Client Satisfaction With Nursing Center Services

“…This finding was consistent with client satisfaction studies related to ambulatory-care services and physician care (Goyne et al, 1973;Hilton et al, 1984;Orden et al, 1978;OrthoGomer et al, 1979).…”

“…The authors, however, reported that the literature revealed no major variances in results when two different methods were used for survey (Orden et al, 1978). In another study on client satisfaction, ambulatory-care physicians perceived that clients would be less satisfied with services than the clients' actual reports indicated.…”

“…Also, clients on public assistance responded less favorably than clients who paid a fee. Clients who lived near the clinic were less satisfied than clients who lived outside the four communities adjacent to the clinic site (Orden et al, 1978).…”