The ‘secret’ of success part 4

Patient satisfaction as a dimension of success

In the previous three articles we have established that the secret of success is to focus on patient satisfaction. We examined the evidence suggesting a direct link between perceived service quality and profitability. We also examined the close relationship between employee satisfaction and patient satisfaction. Further, we established that success in respect of our primary purpose (oral health) will be indicated partly by patient satisfaction. In addition to this, two studies have suggested a positive link between patient satisfaction with the service they receive and their oral health.

Zimmerman1 found a direct relationship between patient satisfaction with their dental visits, their compliance with oral health advice and actual improvement in dental health. In this regard, Golletz and co-workers2 found that those with a poor self-assessment of their dental health rated their satisfaction with dental care lower than those with higher self-rated dental health. A total of 895 mothers of school-age children with low income in Seattle (Washington State, USA) were interviewed using the Dental Satisfaction Questionnaire (DSQ) developed by Davis and Ware.3 The researchers stated:

So, there is some evidence of a direct relationship between patient satisfaction with the service they receive and achieving our primary purpose (oral health). We would probably make the logical assumption that happy patients are more likely to become healthy patients. Golletz et al continue, however, to speculate that a negative spiral of professional attitude may be in play here. Dental teams may be reacting less positively to those in poor oral health? Even so, the message would be that, if we remain positive and patient focused, especially towards those with poor oral health, success is more likely.

If patient satisfaction is so important to our success, which aspects of our service are most important to patients? A focus on these aspects of our service should make our chances of success greater. In the previous article, we established the importance of good communication in building the relationships with our patients which will lead to success. Further evidence on the importance of our communication skills is presented below, and two other key aspects of our service are identified.

Aspects of service most important to patients

Holt and McHugh,4 in research using a questionnaire given to patients in practice, asked patients to score the importance of 18 factors. A total of 1003 responses were received from a total of 13 general dental practices spread across England and Wales. The top five ranking factors were as follows:

Convenience and comfort factors such as ‘Opening hours’, ‘Waiting time at dentist’ and ’Practice décor’ were ranked as the least important factors of the 18. In this study ‘unhappy with dentist’ was cited as being the main reason for changing dentists. Communication, competence and safety were therefore key issues. Furthermore, Abrahams and co workers5 asked a group of 117 patients to complete a questionnaire on their perceptions of the quality of their previous dental care. They then received a dental examination at which their existing dental restorations were assessed against 14 criteria of professionally-assessed quality. No relationship was found to exist between these two different perceptions of quality. They concluded:

In this regard, Janda and colleagues6 concluded that dentists should not rely on convenience issues such as ease of parking and location, but should emphasize:

Perri 6 et al7 for Demos (the independent think-tank) published their views in Open Wide. They assessed the future for dentistry ahead to the year 2010. This work included a survey of a representative sample of 2000 people across Great Britain. The group was asked to give three or four factors which would give them confidence in a dentist when visiting afresh after some time. The top three factors mentioned were:

The Office of Fair Trading,8 in their report on the private dentistry market in the UK, also carried out interviews with 2000 members of the public. Participants were asked about the most important features that they sought in a dentist or practice. The top three factors mentioned were:

Lahti and co-workers,9 carried out a fairly complex study in Finland, aiming to discover dentist and patient opinions about the ideal dentist and patient. A total of 75 statements about the ideal dentist were tested. From a total of 1200 surveyed, 845 responded (70%). This was a long questionnaire and the researchers expressed disappointment at the response rate, which seems very reasonable to this author. In summarizing their results the researchers stated:

They also concluded that the importance of ‘cost’ was lower than expected. So, once more, the communication skills of the dentist have been shown to be an important factor. On a similar theme, Burke and Croucher10 allowed 30 dentists to propose eight important criteria of ‘good practice’ and also 30 patients to propose eight. The three issues ranked highest by the 334 patients ultimately surveyed were:

These three criteria of good practice were all originally proposed by patients. The criteria proposed by dentists were generally ranked as less important by patients. Dentists considered that ‘Up-to-date equipment’, ‘Pleasant décor and surroundings’, ‘Cost’, ‘Good administration’ and ‘Practice image’ might all be important. However, the patients ranked these all in the bottom seven of the 16 factors. Infection control, communication and competence seemed again to be much more important than convenience and comfort issues.

Gerbert et al11 surveyed a total of 4061 patients of 286 different dentists who volunteered for the study. The dentists were also surveyed. This study again examined the dentist and patient view of the ideal dentist. On average, the patients had been in care with their dentist for 7.7 years. When rating their own dentist, patients placed ‘Professional competence’ and ‘Implementing all infection control protocols’ as the top two issues in importance from a list of 15 qualities. Dentists also rated these two as most important to them. ‘Explaining dental procedures’ was very highly rated by patients (the 4th most important issues) but not by dentists. Their ranking for this was 8th placing ‘Having a pleasant office environment’ above this issue of communication. Yet again communication, competence and infection control are placed as more important than comfort and convenience issues by patients. Karydis et al12 assessed the expectations and perceptions of 200 consecutive patients attending the Dental Clinic of the School of Dentistry, University of Athens, Greece. They, once more, found that the patients' top priority was adherence to the rules of antisepsis and sterilization. On a similar topic, Klingenberg et al13 surveyed 1317 patients being cared for by 18 dentists, with the results indicating that the highest statistical correlation to overall satisfaction was with positive responses around whether the patients perceived that they were listened to, and whether they perceived good results from their dental treatment.

Hill and colleagues14 investigated patient perceptions of NHS dental services through semi-structured face-to-face interviews. A total of 28 patients were selected to give a spread of opinion across a range of ages, sex and occupation. These patients commented on the qualities of a good dentist which were summarized as:

These 11 studies seem to be telling a consistent story. Our clinical competence is naturally very important to patients, in much the same way that we would rate the technical competence of our pilot as very important, when we are flying. (See the discussion in article 2.) So, focusing on the development of our clinical competence is indeed a vital cornerstone of success. Cleanliness is important to our patients. Patient perceptions of our cleanliness may even impact on their perceptions of our competence too. So, a clear and obvious focus on infection control in practice is likely to be very good for business! Finally, the evidence suggests that we may have been guilty, in the past, of underestimating the vital importance of our communication skills in our success. Patients probably make many judgements based on these skills fairly or unfairly. This would include judgements about our competence. Our communication skills are an important aspect in helping patients comply with our advice in achieving our primary purpose, oral health.

Figure 1 summarizes these relationships and represents a compound model for practice success. At the very centre is patient satisfaction.

Conclusion

The key role of patient satisfaction in financial success and oral health outcomes has been established.

The most important aspects of our service to patients seem to be cleanliness, competence and communication.