Page 135 - The Handbook for Quality Management a Complete Guide to Operational Excellence

122 I n t e g r a t e d P l a n n i n g U n d e r s t a n d i n g C u s t o m e r E x p e c t a t i o n s a n d N e e d s 123

The study of service quality and patient satisfaction was performed at
a 213-bed community hospital in the southwestern United States. The
hospital is a nonprofit, publicly funded institution providing services to
the adult community; pediatric services are not provided. The purpose of
the study was to:

• Identify the determinants of patient quality judgments.
• Identify internal service delivery processes that impacted patient
quality judgments.
• Determine the linkage between patient quality judgments and
intent-to-patronize the hospital in the future or to recommend the
hospital to others.

To conduct the study, the author worked closely with a core team of
hospital employees, and with several ad hoc teams of hospital employees.
The core team included the nursing administrator, the head of the Quality
Management Department, and the head of nutrition services.
The team decided to develop their criteria independently. It was
agreed that the best method of getting information was directly from the
target group, in-patients. Due to the nature of hospital care services, focus
groups were not deemed feasible for this study. Frequently, patients must
spend a considerable period of time convalescing after being released
from a hospital, making it impossible for them to participate in a focus
group soon after discharge. While the patients are in the hospital, they are
usually too sick to participate. Some patients have communicable dis-
eases, which makes their participation in focus groups inadvisable.
Since memories of events tend to fade quickly (Flanagan, 1954, p. 331),
the team decided that patients should be interviewed within 72 hours of
discharge. The target patient population was, therefore, all adults treated as
in-patients and discharged to their homes. The following groups were not
part of the study: families of patients who died while in the hospital, patients
discharged to nursing homes, and patients admitted for psychiatric care.
The team used the Critical Incident Technique (CIT) to obtain patient
comments. The CIT was first used to study procedures for selection and
classification of pilot candidates in World War II (Flanagan, 1954). A bibli-
ography assembled in 1980 listed over seven hundred studies about or
using the CIT (Fivars, 1980). Given its popularity, it is not surprising that
the CIT has also been used to evaluate service quality.
CIT consists of a set of specifically defined procedures for collecting
observations of human behavior in such a way as to make them useful in
addressing practical problems. Its strength lies in carefully structured data
collection and data classification procedures that produce detailed infor-
mation not available through other research methods. The technique,
using either direct observation or recalled information collected via inter-

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