Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale

Abstract

Patient experience measures such as satisfaction are increasingly tracked and incentivized. Satisfaction questionnaires have notable ceiling effects that may limit learning and improvement. This study tested a Guttman-type (iterative) Satisfaction Scale (GSS) after a musculoskeletal specialty care visit in the hope that it might reduce the ceiling effect. We measured floor effects, ceiling effects, skewness, and kurtosis of GSS. We also assessed factors independently associated with GSS and the top 2 possible scores. In this cross-sectional study, 164 patients seeing an orthopedic surgeon completed questionnaires measuring (1) a demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit (GSS). Bivariate and multivariable analyses sought associations of the explanatory variable with total GSS and top 2 scores of GSS. Accounting for potential confounding using multivariable analysis, lower satisfaction was independently associated with greater symptoms of depression (β: −0.03; 95% CI: −0.05 to −0.00; P = .047). The top 2 scores of the GSS were independently associated with women (compared to men: odds ratio [OR]: 2.12, 99% CI: 1.01-4.45, P = .046) and lower level of education (masters’ degree compared to high school; OR: 0.16, 95% CI: 004-0.61, P = .007). The GSS had no floor effect, a ceiling effect of 38%, a skewness of −0.08, and a kurtosis of 1.3. The 38% ceiling effect of the iterative (Guttman-style) satisfaction measure is lower than ordinal satisfaction scales, but still undesirably high. Alternative approaches for reducing the ceiling effect of patient experience measures are needed.

Does Adjusting for Social Desirability Reduce Ceiling Effects and Increase Variation of Patient-Reported Experience Measures?

“…Higher scores indicated greater satisfaction. Additionally, patients completed the short form of the Marlowe-Crowne Social Desirability Scale (MCSDS-SF), which is a 13-item measure of individual-level social desirability, which was defined as the “need for subjects to respond in culturally sanctioned ways”( 8 , 11 , 13 ). Subjects answer true or false to each statement resulting in a score between 0 and 13 with higher scores representing greater social desirability bias.…”

Factors Associated With Patient Satisfaction Measured Using an Iterative Scale

“…One common simplification is the so-called net promotor score, which can often be used for profitably measurement and managing customer loyalty. On a 1- to 10-point scale, customers are asked: “How likely are you to recommend this company to a friend or colleague?” Our prior research has demonstrated that satisfaction measures that are successful at achieving greater spread in the scores will lower net promotor scores 16. In other words, attempts to learn and improve may be at odds with attempts to market and self-promote.…”

“…It would be ideal to measure satisfaction without ceiling effects to analyze factors associated with satisfaction to inform efforts to improve. In previous research, we studied an iterative satisfaction scale, inspired by a Guttman-type scale, which still had a ceiling effect of 38% 16. That is lower than ordinal satisfaction scales, but still undesirably high 16.…”

“…The questions were developed as an alternative to the more common Likert scaling and are most commonly used when there is a need to use a short questionnaire with good discriminant ability. 16,17 Our initial use of this type of scale reduced the ceiling effect to 38%-lower than ordinal satisfaction scales, but still undesirably high. 3,18,19 High ceiling effects with satisfaction measures hinder discrimination between the respective levels of satisfaction of patients, which makes it difficult to learn how to improve satisfaction.…”

Patient satisfaction level and its determinants after admission in public and private tertiary care hospitals in Bangladesh

“…Patients' characteristics like older age, higher educational and economic attainment, previous experience of hospital visit or admission, having multiple comorbidities, behavioral factors like higher expectations and negative attitude toward hospital service, and hospitalrelated factors like hospital size, location, environment, patient-staff ratio, communication with hospital staffs, etc. might shape the level of satisfaction of the patients (6)(7)(8).…”