Page 138 - The Handbook for Quality Management a Complete Guide to Operational Excellence

124 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 125

Interpretation of Data Inter-judge agreement, the percentage of critical
incidents placed in the same category by both groups of judges, was
93.5 percent. This is well above the 80 percent cutoff value recom-
mended by experts. The setting aside of a random sample and trying to
place them in established categories is designed to test the comprehen-
siveness of the categories. If any of the withheld items were not classifi-
able it would be an indication that the categories do not adequately
span the patient satisfaction space. However, the team experienced no
problem in placing the withheld critical incidents into the categories.
Ideally, a critical incident has two characteristics: (1) it is specific and
(2) it describes the service provider in behavioral terms or the service product
with specific adjectives (Hayes, 1992, p. 13). Upon reviewing the critical
incidents in the General category, the team determined that these items
failed to have one or both of these characteristics. Thus, the 11 critical inci-
dents in the General category were dropped. The team also decided to
merge the two categories “Care provided by staff” and “Attitude of staff”
into the single category “Quality of staff care.” Thus, the final result was a
five-dimension model of patient satisfaction judgments: Food, Quality of
physician, Quality of staff care, Accommodations, and Discharge process.
A rather obvious omission in the above list is billing. This occurred
because the patients had not yet received their bill within the 72-hour time
frame. However, the patient’s bill was explained to the patient prior to
discharge. This item is included in the Discharge process dimension. The
team discussed the billing issue and it was determined that billing com-
plaints do arise after the bills are sent, suggesting that billing probably is
a satisfaction dimension. However, the team decided not to include bill-
ing as a survey dimension because (1) the time lag was so long that wait-
ing until bills had been received would significantly reduce the ability of
the patient to recall the details of their stay, (2) the team feared that the
patients’ judgments would be overwhelmed by the recent receipt of the
bill, and (3) a system already existed for identifying patient billing issues
and adjusting the billing process accordingly.

Survey Item Development As stated earlier, the general aim was to pro-
vide the service provider with information on what patients remem-
bered about their hospital stay, both pleasant and unpleasant. This
information was then to be used to construct a new patient survey
instrument that would be sent to recently discharged patients on a peri-
odic basis. The information obtained would be used by the managers of
the various service processes as feedback on their performance, from
the patient’s perspective.
The core team believed that accomplishing these goals required that
the managers of key service processes be actively involved in the creation
of the survey instrument. Thus, ad hoc teams were formed to develop

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