Older patients have higher expectations and are more satisfied with healthcare

Patients’ experiences of their healthcare in relation to their expectations and satisfaction: A population

From Journal of the Royal Society of Medicine

This paper on patients’ experiences of health services and how these relate to their expectations and satisfaction reveal that older people have higher expectations of their care and that they believe that their expectations are being met. The research questions prevailing stereotypes that characterise older patients as being satisfied with their care because their expectations are lower. Patients visiting their GP and hospital outpatient departments were surveyed before and after their consultations. They were asked about their experiences of the physical environment, finding their way around, communication with the doctor, the content of the consultation, the information given and the outcome of the consultation.

The leading researcher concluded that this research, chiming with the finding that satisfaction with the NHS among the general public is now at an all-time high, has implications for health professionals, managers and politicians. “There is no room for complacency, given that the delivery of healthcare in England is undergoing profound and unprecedented change, with many services facing severe cuts,” said Bowling and colleagues. “It will be essential for those who are delivering care in the midst of organisational and, frequently, personal turbulence, to remain focused on what matters most for patients, which means most of all effective communication, adequate information and good outcomes.”




Objectives To investigate patients’ experiences of health services, and how these related to what they had expected to receive, and satisfaction with their care.

Design Surveys of patients before and after their consultations in general practice and hospital outpatients departments.

Setting Greater London and Essex

Participants In total, 833 patients attending 21 hospitals (434 patients; 52%) and 22 general practices (399 patients; 49%) across Greater London and Essex sampled in clinics and a population survey.

Main outcome measures Patient expectations of care, patient satisfaction.

Results Compared with younger people, and those in black and ethnic minority groups, older people (aged 65+) and White British people had significantly higher overall realistic expectations of their care (pre-visit realistic expectations score: age 60+: mean 53.26 [standard deviation 13.73]; age <60: 56.20 [15.17]; White British: 54.41 [13.50]; Black and other ethnic groups: 56.90 [16.15]) and greater satisfaction post-consultation (satisfaction score age 60+: 1.71 [0.80]; age <60: 1.97 [0.97]; White British: 1.79 [0.89]; Black and other ethnic groups: 2.01 [0.95]). Pre-visit ideal and realistic expectations of care was not significantly associated with patient spaperatisfaction, although met expectations (post-visit experiences) were. Elements of these which was predictive of satisfaction were communication with the doctor, information conveyed and clinical outcomes. Factors associated with satisfaction included having a sense of control over one’s life, being older, female, White British and attending general practice, compared with hospital outpatient clinics.

Conclusions It is the ability of the system to meet patients’ expectations in respect of the emotional and human features of the consultation, and the clinical outcomes, that matter most to people. This research also questions prevailing stereotypes of older age: it is not the case that older patients are more satisfied with their care because their expectations are lower. In fact, they are higher, but they believe that they are being met.

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Article details
Bowling, A., Rowe, G., & McKee, M. (2013). Patients’ experiences of their healthcare in relation to their expectations and satisfaction: a population survey JRSM, 106 (4), 143-149 DOI: 10.1258/jrsm.2012.120147

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