Quality of care from the patients' perspective: from theoretical concept to a new measuring instrument

TLDR

Patient perspectives on quality of care are crucial for quality assurance and improvement, yet their relevance is often questioned due to conceptual and methodological issues. The study aims to develop a patient‑centered conceptual framework for measuring quality of care and recommends a category‑specific approach using focus groups to select relevant aspects. The framework is built on a sequence of performance, importance, and impact, deriving quality judgments from importance and performance scores of healthcare aspects and illustrated with empirical evidence. The model treats satisfaction as a multidimensional construct based on expectations and experiences, and its indices derived from importance and performance scores can guide QA and QI programs from the patient perspective.

Abstract

Introduction Patient views on quality of care are of paramount importance with respect to the implementation of quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary. Objective To develop a conceptual framework for measuring quality of care seen through the patients' eyes, based on the existing literature on consumer satisfaction in health care and business research. Results Patient or consumer satisfaction is regarded as a multidimensional concept, based on a relationship between experiences and expectations. However, where most health care researchers tend to concentrate on the result, patient (dis)satisfaction, a more fruitful approach is to look at the basic components of the concept: expectations (or `needs') and experiences. A conceptual framework – based on the sequence performance, importance, impact – and quality judgements of different categories of patients derived from importance and performance scores of different health care aspects, is elaborated upon and illustrated with empirical evidence. Conclusions The new conceptual model, with quality of care indices derived from importance and performance scores, can serve as a framework for QA and QI programmes from the patients' perspective. For selecting quality of care aspects, a category‐specific approach is recommended including the use of focus group discussions.