Outpatient Satisfaction

The Role of Nominal Versus Perceived Communication

Parents were most satisfied with care their children received for upper respiratory infections when the parents perceived that most, or all elements of expected parent-doctor communication occurred. Communications noted by trained observers but unrecognized by parents had no effect on parent satisfaction.

Research has shown communication is a key component of patients’ satisfaction with health care; and satisfaction is regarded as an indicator of care quality. This novel survey was designed to determine whether parent perception of certain communications was as important as whether the communications actually occurred. After a visit to a pediatrician with a child confirmed to have an upper respiratory infection, parents completed a survey indicating whether four specific issues, previously identified as leading to parent satisfaction, had been discussed. Later, two trained observers viewed video of each visit and recorded whether those issues had been covered. The study involved 517 patient visits between October 2000 and June 2001 with 38 pediatricians in Los Angeles County, Calif. Only English-speaking parents were surveyed.

Key Findings:

  • Parents who perceived at least three of the four topics had been covered were significantly more satisfied than those who perceived two or fewer; it did not matter which three topics were discussed.
  • In 22 percent of visits, coders observed one specific communication event that parents did not perceive. Rarely, coders recorded two or more events parents did not perceive (6% of visits).
  • There was no correlation between parent satisfaction and communications observed only by the coders. If parents did not perceive the topic had been covered, then even if a trained observer thought it had been covered, it did not increase their satisfaction.
  • On two of the issues, parent and coder observations differed significantly. Parents more frequently believed doctors had discussed both the parents’ ideas of how to manage the child’s illness (parents, 70%; coders, 32%) and the cause of illness (parents 56%; coders 32%). Parents and coders reported more similar observations regarding discussion of a child’s symptoms (parents, 96%; coders, 98%) and what to do to make the child feel better (parents, 81%; coders, 77%).

Although this study is limited to parents of patients with upper respiratory illness, the results suggest that how information is presented is more important to parent/patient satisfaction than the specific content of what a doctor says. Doctors must find ways to successfully engage with parents in a limited time. Further research may help identify what makes for effective communication with patients.