A grounded theory for patients' satisfaction with quality of hospital care

Abstract

Objective: Patient satisfaction with quality of care is a dominant concept in quality assurance and quality improvement programs. Elderly patients are the central users of health care services and therefore the development of a grounded theory that explains how they perceive quality of care is important for strategy planning and health services evaluation. Sample and methods: The study was carried out at two hospitals, a capital hospital and an urban one in Greece. There were 24 elderly patients, with a mean age of 70±6.02 years old. The methodology for the data analysis was similar to the one described by Corbin and Strauss for grounded theory analysis. In order to assure the quality of our qualitative research we used triangulation (in-depth interviews, focus group and direct observation). Content analysis of the interviews was primarily based on conceptual analysis of the two main concepts: patients' perceived quality of care and patients' satisfaction with care. Results: After open coding of the data obtained from the interviews, we identified five categories: food, nursing care, medical care, room characteristics, and treatment/diagnosis. These five categories are common whether we measure elderly perceived quality of hospital care or patient satisfaction. Second-level categorization (axial coding) included patients' feelings regarding each of the five care dimensions that are the subcategories of the previous categories. These feelings could be positive, negative, neutral or they may feel indifferent. The final stage of data analysis was selective coding categorization containing direct comments for each category. This third-level categorization contains specific dimensions of nursing and medical care such as: patients' respect as a human being, staff technical skills, staff effective communication, therapeutic touch and empathy. Discussion: Our findings support the need to develop a conceptual framework for patients' satisfaction interpretation, based on their own quality of care assumptions. This is the first step for the development of a valid and reliable scale for measuring quality of care.