Lean thinking and customer focus: Patient centred perspectives on hospital quality.

Abstract

Objectives: In order to be able to make a differentiated choice between healthcare providers, people require information about their quality. An understanding of patient needs and preferences is crucial in providing helpful information regarding hospital quality. This study is the first comprehensive investigation in this field in Germany, focused on patient involvement in, and preferences for, information on hospital quality.

Methods: A patient involvement scale was developed to measure the subjective interest in hospital information. To analyse what particular information on hospital quality patients prefer a relatively new variant of choice experiment a Best–Worst Scaling (BWS) task was integrated into the questionnaire. Goodness of fit tests show good constructs quality. A total of 276 respondents participated including hospital patients and healthy persons (response rate 71 %, representative sample regarding the variables age, gender and social class).

Results: The analysis showed a high involvement in information regarding hospital quality. A second-order confirmative factor analysis revealed three reliable components: general importance of information (0.70), need of certainty (0.85) and need of participation (0.57). In the measurement of information preferences (35 attributes/quality indicators), patients rated indicators of structure quality as the most important attributes. Information about process quality was moderately relevant from the patients’ point of view. Objective results of outcome quality were more important for patients than subjective quality indicators. We identified two patient clusters (two-step cluster analysis): outcome-orientated and service-orientated patients.

Conclusion: Both the assessment of patient involvement in hospital quality information and the measurement of patient preferences in order to rank patients’ perception provide important insights into information needs of patients. The BWS experiment is useful to investigate patient preferences, particularly in research designs with a larger number of items and a focus of the relative ranking of complete attributes (not just levels within attributes).