Theory: Determine any expectations or predictions observed, associated with the paper.

PATIENT SATISFACTION IN ER CARE: QUALITIATIVE ANALYSIS 1

Patient Satisfaction in Emergency Room Care A Qualitative Analysis

INTRODUCTION

Health Care Administrators of hospitals with Emergency Rooms have a constant responsibility to improve the emergency care patients receive. Patient satisfaction measures are some of the more insightful and beneficial tools an administrator can use to improve their ER, which can be accomplished via qualitative analysis. Qualitative analysis is an “umbrella term covering an array of interpretative techniques which seek to describe, decode, translate and otherwise come to terms with the meaning, not the frequency, of certain more or less naturally occurring phenomena in the social world.” (Al-Busaidi, para 1, 2008). To visualize and analyze qualitative data, it must be collected and compared to create a foundation for study. A common and functional way to achieve this is by using themes and codes.

Themes are the reoccurring variables in a specific scenario. The Social Science Queries is a system of theme development in which patients then can be asked their opinions of chosen variables. It uses various interview techniques to determine conditions of a scenario that can subsequently be compared through analysis. (Ryan & Bernard, n.d.) Coding is searching data for themes and categorizing the qualitative data further to make it comparable. Codes can be based on themes, topics, ideas, concepts, terms, phrases or keywords. (Taylor & Gibbs, 2005) Combining theme creation with coding will create enough retrievable data that can be identified, sorted, and analyzed. In this paper, we will use this process to analyze the following three papers to determine the level of satisfaction that patients have with their Emergency Room experiences.

List of selected papers

1. Patient Satisfaction in Emergency Medicine by Catherine Taylor and Jonathan Benger

2. Quality of emergency rooms and urgent care services: user satisfaction by Lima et al

3.

PAPER SUMMARIES

-EACH PAPER NEEDS 3-5 THEMES, 5-10 CODES

Patient Satisfaction in Emergency Medicine- C Taylor ,  J R Benger

Taylor and Benger (2004) identified seven controlled intervention studies with the aim to identify and evaluate factors which impact patient satisfaction in emergency room care. The seven studies found that the three most prevalent factors affecting satisfaction are the interpersonal skills and attitudes of staff members, availability and delivery of information or explanation of care received and conditions diagnosed, and the perceived waiting times. This suggested that “increased information on ED arrival, and training courses designated to improve staff attitudes and communication are capable of improving patient satisfaction,” (Taylor & Benger, abstract, 2004) Below we have detailed the themes and codes for this paper:

Table 1- Themes and codes, Patient Satisfaction in Emergency Medicine

First order	Second order	Relevant Codes	Definitions/Comments
Theme A: Interpersonal skills/perceived staff attitudes
A. Staff Training	A. Communication B. Attitude and professionalism	a. Communications skills for various patient populations b. Friendly attitude and pleasant bedside manner	A. Communication: Staff members must be trained on how to deliver information freely and in a manner the patient understands. B. Attitude: Keep it professional, polite and friendly; promote trust and a feeling of ease
Theme B: Delivery / explanation of information
B. Attentiveness towards patient needs		a. Improve intrapersonal skills   b. Ensure patient is informed of all treatment information c. Education about diagnosis received	Employees need to be aware of patient needs for information and give freely without patient request, and thoroughly in a manner the patient comprehends so that treatments and follow on care can be done accurately
Theme C: Perceived and actual wait times
c. Decreasing trends		a. Communication about wait times	a. There is a need to decrease wait times in order to improve satisfaction. More study needed in this area.

Quality of emergency rooms and urgent care services: user satisfaction- Lima et al

In this study, Lima et al (2015) used a cross-sectional descriptive study with a quantitative approach to evaluate the quality of emergency room care according to the patients served. Wait time, hospitality, and infrastructure were found to be the more important factors.

Table 2- Themes and codes, Quality of emergency rooms and urgent care services: user satisfaction

First order	Second order	Relevant Codes	Definitions/Comments
Theme A: Wait time
A.  easy admission / Reception	A. Registration B. interactions with reception staff	a. Complete registration b. Simple/ accurate interactions with reception staff   c. Comfort of waiting room (temperature, furniture etc)	Admission errors by both patients (because of misunderstanding of forms etc) and reception staff (incomplete information gathered) can cause an increase in waiting time and / or confusion for patients and staff alike, further stalling treatments.
Theme B: Hospitality
B. Attentiveness, attitude	A. Communication B. Attitude C. Competence	a.  Thorough and timely communication with patient b. Friendly, trustable countenance c. Knowledgeable about symptoms and treatment options	“professional-patient relation should be based on attention, care, friendship, competence, warmth, and skills, besides good dialogue between the parts, in which the professional respects the fragility of the user, in order to contribute, as well, to quality care” (Lima et al, para 23, 2015)
Theme C: Infrastructure
c. Cleanliness, atmosphere		a. Cleanliness b. Calm or inviting atmosphere c. Comfortable waiting accommodations d. Privacy during examination and treatment e. Adequate equipment availability	Facilities are rated based on cleanliness, equipment, appropriate furniture, and sufficient ventilation so as to provide dignified care which can be private

Paper 3

· Codes and Table with info

The most pressing needs of patients in the emergency department include, being treated with a positive attitude, proper communication with the attendants, quality technical skills, availability of privacy and confidentiality and general quality care. Nurses and physicians may not be able to take care of all these needs; hence patient satisfaction may not be perfect. The research population is the patients being attended in the hospital and the data collected is purely qualitative. This research requires interviews or questionnaires that employ the coding methodology technique (Taylor, 2006).

The purpose of the study is to help the health facility make improvements. This includes the staff, equipment used and work ethics employed, since they determine the kind of attitude the patients are treated with. After identifying the patients’ perspective of the services offered, the facility can improve on specific areas, especially those that raised a concern, regarding the patients’ feedback (Muntlin et al., 2006).

Variable	Description	Example
Gender	Gender of the patient	M-Male F- Female
Age	Age of the patient	Age in years
Race	Race based on Nationality	W- White B- Black I- Indian A-Asian O- Other
Location	Residential area of the patient	Name of town, street or estate
Emergency	Nature of the emergency	Emergency of the patient such as, accident, maternity or personal care
Staff	Staff that attended the patient	Physician, nurse, pharmacist, doctor or hospital aid
Condition	Condition of the patient	Critical or normal
Technicality	Perspective of staff’s technical skills	A-Excellent B-Good C-Average D- Below Average
Equipment	General rating of the equipment used	Hygienic and technicality of the equipment used such as, the equipment was sterilized and used correctly
Patient satisfaction	Patient satisfaction rating	A-Excellent B-Good C-Average D- Below Average

The above code is used in the research.

To get correct responses to aid the research, patients should understand how to give responses for specific variables of the research. During data analysis, the facility can note areas of concern, that require quality improvement. For instance, if many patients had an accident emergency, were treated by a nurse and had a below average satisfaction, then it is the role of the hospital to consider the work ethics of their staff. In this instance, they would consider the nurses of the accident emergency department (Taylor, 2006).

To utilize the data obtained from the research, the areas of quality improvement are noted and the procedure for ethical considerations followed. Since the major themes of the research are captured in the codes, one can analyze which specific areas require improvement, for instance, if a large percentage of the patients had negative responses on the Equipment code, the health facility then works towards improving the quality of the equipment used.

Index calculations of the group of respondents such as the balance high, excess quality and inadequate quality are done to predict areas of change. Respondents that omitted the variables are not included since the index is calculated with respect to the number of people that gave their feedback. The importance of carrying out the qualitative research is crucial since the information obtained after data analysis is used for quality improvement. It is considered as real and subjective, hence directly reflects the amount of improvements that are required. Responses are also considered honest, thus reflect the true perspective of patients (Muntlin et al., 2006).

CONCLUSIONS

DISCUSS ANY SIMILARITIES OR DIFFERENCES IN CONCLUSIONS

CONTRIBUTION TO HEALTH SERVICES RESEARCH

1-2 paragraphs

REFERENCES

Al-Busaidi, Z. Q. (2008). Qualitative Research and its Uses in Health Care. Sultan Qaboos University Medical Journal, 8(1), 11–19.

Taylor, C & Gibbs, G. (2005). How and what to code. Retrieved December 08, 2016, from http://onlineqda.hud.ac.uk/Intro_QDA/how_what_to_code.php

Lima, C. de A., dos Santos, B. T. P., Andrade, D. L. B., Barbosa, F. A., da Costa, F. M., & Carneiro, J. A. (2015). Quality of emergency rooms and urgent care services: user satisfaction. Einstein, 13(4), 587–593. http://doi.org/10.1590/S1679-45082015GS3347

Ryan, G., & Bernard, H. (n.d.). Techniques to Identify Themes in Qualitative Data. Retrieved December 08, 2016, from http://www.analytictech.com/mb870/readings/ryan- bernard_techniques_to_identify_themes_in.htm

Taylor, C. (2004). Patient satisfaction in emergency medicine. Emergency Medicine Journal, 21(5), 528-532. doi:10.1136/emj.2002.003723

Muntlin, A., Gunningberg, L., & Carlsson, M. (2006). Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement. Journal of Clinical Nursing, 15(8), 1045-1056. doi:10.1111/j.1365-2702.2006. 01368.x

Quality Improvement Initiatives for the Care of Geriatric Patients in the Emergency Department. (2016). Annals of Emergency Medicine, 68(3), 404. doi: 10.1016/j.annemergmed.2016.06.038

Taylor, D. (2006). A multifaceted intervention improves patient satisfaction and perceptions of emergency department care. International Journal for Quality in Health Care, 18(3), 238-245. doi:10.1093/intqhc/mzl002