1. Dr. Shahram Yazdani Responsiveness in Health System

2. Relations between functions and objectives of a health system Stewardship (oversight) Financing (collecting, pooling And purchasing) Creating resources (investment And training) Delivering services (provision) Responsiveness (to non-medical expectations) Fair (financial) contribution Health Functions the system performsObjectives of the system

3. Dr. Shahram Yazdani Patient satisfaction “… is a human experience, appraised subjectively by an individual, regarding the extent to which care received has met certain expectations… underlying this assumption is a belief in the patient’s basic right to participate in decisions about clinical care, and a recognition of the importance of patients as sources of information about their own values and preferences… patient satisfaction is, in essence, a human judgment..”

4. Dr. Shahram Yazdani Patient satisfaction = meeting patient’s expectations

5. Dr. Shahram Yazdani Structure, Process and Outcome Structure  “...the attributes of the setting in which care occurs.” Process  “...what is actually done in giving and receiving care.” Outcome  “...the effects of care on the health status of patients and populations.”

6. Dr. Shahram Yazdani How is patient satisfaction linked to outcomes of care? Satisfaction with care affects a patient’s decision to:  Seek medical advice  Comply with diagnosis and treatment  Maintain greater involvement in their own care

7. Dr. Shahram Yazdani Modifiable elements which affect patient satisfaction Provider communication style, warmth, overall compassion Provider understanding and acknowledgement of patient needs and expectations Provider fulfilling those needs

8. Dr. Shahram Yazdani Can patients assess technical aspects of care? Patients have difficulty distinguishing between the art of care and the technical aspects of care  Patients have poor ability to assess technical performance  Patients satisfied with interpersonal aspects of care tended to rate their physicians as technically superior as well  Patient satisfaction was higher when tests were ordered, and treatments were administered, even if they were of no value

9. Dr. Shahram Yazdani Key satisfaction elements: Humaneness (65%) Informativeness (50%) Overall quality (50%) Technical competence (43%) Bureaucracy (28%) Access/availability (27%) Cost (18%) Physical facilities (16%) Care continuity (6%) Outcome (4%) Handling of non-medical problems (3%) Meta analysis of 221 studies (1988)

10. Dr. Shahram Yazdani Patient priorities in general care Humaneness 86% Competence/accuracy 64% Involvement in decisions 63% Time for care 60% Informativeness 58% Explore patient needs 57% Continuity 50% Effectiveness 33% Counseling 29% Waiting time 25% Flexibility, physical and financial accessibility, premises, telephone consultation all 0% Meta analysis of 57 studies (1999)

11. Dr. Shahram Yazdani Satisfaction vs. preferences, and utility Preferences: “patients’ views about the quality of life experienced with different states of health” Utility: “a quantitative assessment of the desirability of a health state”, usually from 0 to 1, where 0 is death and 1 is ideal health.

12. Dr. Shahram Yazdani What is responsiveness? Responsiveness in the context of a system can be defined as the outcome that can be achieved when institutions and institutional relationships are designed in such a way that they are cognizant and respond appropriately to the universally legitimate expectations of individuals.

13. Dr. Shahram Yazdani The concept of responsiveness has been defined so as to encompass the non- health enhancing, non-financial aspects of the health system.

14. Dr. Shahram Yazdani Patient, Consumer or Customer The use of the word patients is considered to underrate the status of the individual, as it implicitly crates a hierarchy. Sitzia and Wood (1997) argue that the term consumer dignifies the professional-patient relationship in a way that the traditional term patient with its association of powerlessness against the medical establishment does not. Carr-Hill (1992) argues that the term customer has the connotation of an individual where rights are concerned while consumer suggests that the individual is part of a group of users who can act together to safeguard rights.

15. Dr. Shahram Yazdani Difference Between Responsiveness And Patient Satisfaction 1. Scope: patient satisfaction focuses on clinical interaction in specific health care settings whereas responsiveness evaluates the health system as a whole; 2. Range: patient satisfaction generally covers both medical and non-medical aspects of care while responsiveness focuses only on the non-health enhancing aspects of the health system; 3. Rationale: patient satisfaction represents a complex mixture of perceived need, individually determined expectations and experience of care. Responsiveness evaluates individual’s perceptions of the health system against ‘legitimate’ universal expectations.

16. Dr. Shahram Yazdani Difference Between Responsiveness And Patient Satisfaction In particular, responsiveness moves towards getting individuals to rate their health systems against objectively set standards rather than evaluate their satisfaction. Much of the literature up to date has been on patient satisfaction. Many of the surveys too are biased towards measuring satisfaction rather than responsiveness,

17. Dr. Shahram Yazdani Responsiveness To Legitimate Expectations Thompson and Sunol (1995) cite four types of expectations:  Ideal: similar to aspirations, desires or preferred outcomes  Predicted – realistic, practical or anticipated outcomes that result from personal experiences, reported experiences of others and sources of knowledge such as the media  Normative – expectations that are based on what should or ought to happen  Unformed – the situation that occurs when individuals are unable or unwilling for various reasons to articulate their expectations, which may either be because they do not have expectations, have difficulty expressing their expectations or do not wish to reveal their expectations due to fear, anxiety or conforming to social norms. The difference between patient satisfaction and responsiveness as cited above is in focusing on normative rather than ideal or predicted expectations.

18. Dr. Shahram Yazdani Responsiveness To Legitimate Expectations It is not responsiveness per se, but responsiveness to universally legitimate expectations that is of importance in assessing the health system. Expectations of individuals seem to be formulated mainly according to personal or societal experience. For instance, for a given health condition a six month waiting period for non-emergency surgery can be deemed satisfactory, if individuals consider this to be the norm for a particular health system. Individuals in another country may however feel that a health system that expects individuals to wait for six months for non-emergency treatment is by no means a responsive health system.

19. Dr. Shahram Yazdani Relevant Non-medical Elements of The Health System Dignity Autonomy Confidentiality Prompt Attention Quality of Basic Amenities Access to social support networks during care Choice of Care Provider

20. Dr. Shahram Yazdani Thank You ! Any Question ?