Patients often equate the quality of the service with the quality of health care. How can this perception be changed using survey research?

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The difference between “quality of service” and “quality of health care” can be confusing, as both are oriented toward the public welfare and the provision of the most positive experience for the patient as possible. The distinction, however, does exist, and using standard quantitative analytical methods can be useful in improving public perceptions of this distinction.

“Quality of health care” is a more dispassionate, objective concept than “quality of service.” “Quality of health care” is a broader macro topic that addresses public-wide health care issues, such as rates of vaccination, diagnostic screenings, and other preventive measures, as well as restorative measures like surgical procedures and lifestyle changes. The latter is important in addressing obesity and substance abuse issues.

The US Centers for Disease Control and the National Institutes of Health are instrumental in measuring outcomes of such factors. Through methods such as public surveys, they collect, examine, and analyze a large amount of data. “Quality of health care” can be measured through data that tracks all kinds of health-related issues, much of which can be ascertained through medical records and patient surveys (e.g., “are you a smoker?”, “how much alcohol do you consume on a weekly basis?”, “how much do you exercise?”, etc.) Additionally, data associated with the provision of health care, such as success rates for various medical procedures, can be factored into the equation.

“Quality of service,” in contrast to “quality of health care,” is more subjective and often hinges on emotional responses to interactions with the health care industry. For example, whether a patient feels that his or her concerns were adequately addressed is an element of this discussion. It is important to recognize that an emotionally-positive experience does not necessarily equate to a successful medical outcome. Physicians are like any other category of humanity. There are the good, the bad, and the ugly practicing medicine. A stereotype, with some foundation (having spent the past four years working in a hospital), is that of a gifted physician or surgeon with a notoriously unpleasant demeanor. The medical outcome may be positive, but the emotional response to the physician’s personality (or “bedside manner”) may be entirely negative. As emotions contribute to overall health, this is not an inconsequential consideration.

Now, how can perceptions of the quality of health care and of quality of service be changed through the use of survey research? By the above-discussed use of adequately-worded public surveys that distinguish between the two concepts. Many patients will obviously and logically rank medical outcome over perceptions of provider temperament. After all, many people would think “what do I care if the doctor was rude and uncaring if he cured my condition?”

Satisfaction with the quality of health care, though, is a product of satisfaction with the quality of service, and surveys can be drafted to address this distinction. Negative experiences interacting with health care providers can deter individuals from following up on medical complaints, which can lead to negative medical outcomes for the patients. Doctors, nurses, phlebotomists and other staples of the health care environment are human beings and subject to the same kinds of irritants as anybody else. They are, however, required to act as though their personal travails are extraneous to the concerns of the patients for whom they are caring. Additionally, and strictly as a business matter, negative patient experiences can compel patients to seek alternative sources of medical care. For this reason, it is in an individual health care facility’s interest to track customer satisfaction through surveys, which are a routine practice.

Once data is collected and collated on patient experiences, and once that data is merged with objective analyses regarding health care trends (the data accumulated by the CDC and NIH), the public can better understand the difference between “quality of health care” and “quality of service.” How important will be those findings to the public is a matter for the individual.

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It is not easy to change people’s opinions simply by conducting survey research.  However, if you must try to do this, you would have to do surveys that try to push people towards valuing other aspects of health care.  Two possible examples:

First, you might ask them about their health rather than about how they perceived the service they got.  By doing this, you would be emphasizing the outcomes of the services rather than the services themselves.

Second, you might do surveys asking about quality of life in general.  You could ask what things affect their quality of life.  You would be hoping to find that actual health, rather than quality of service, is more important.  You could then publicize these findings to argue that the quality of service is not the same as the quality of health care.

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