1. Chapter 7: Client Satisfaction

2. Importance of Monitoring Client Satisfaction
Roots in consumer movement of late 60s, early 70s
Accountability to consumers
Partnership between consumers and service deliverer
Four “R”s in marketing health care services:
Relevance of service
Response (delivering on expectations)
Relationship with consumer
Results
Consumers more powerful with advent of Internet
Disgruntled clients may not return
Client satisfaction studies can detect problems before they get too out of control

3. Importance of Monitoring Client Satisfaction
Unhappy consumers will tell others
Fisk et al. (1990) found:
If patient loyalty was 95%, positive testimonials per 100 patients 3x more than negative reports
If patient loyalty 90%, only slightly more positive reports than negative
If patient loyalty 80%, there were more negative than positive reports
Negative word of mouth occurs more frequently than positive testimonials
Client satisfaction alone not sufficient as measure of quality
However, universally accepted as necessary
Consumer feedback a requirement of many regulatory and certification agencies such as Council on Accreditation (COA)
COA accreditation standards available:

4. Advantages of Client Satisfaction as form of Evaluation
Relatively inexpensive
Easy to interpret
Can be implemented on short notice
Convey to clients that their experiences are important
Useful from managerial, public relations, and marketing perspectives

5. Problems with Client Satisfaction Studies-1
Do not answer questions about outcomes (did clients actually improve?)
Vast majority of respondents indicate satisfaction with services
Lebow (1983) found an average of 78% of clients reported satisfaction
High levels of satisfaction found internationally, not just in US
Client satisfaction high even when clients have little choice of facility, type of treatment, or practitioner
Clients can indicate satisfaction yet still report unmet needs
If satisfaction rate is below 75%, further investigation is warranted

6. Problems with Client Satisfaction Studies - 2
Not a measure of whether client’s needs met
Clients can be satisfied with ineffective programs
Consumer evaluations can be influenced by provider’s reputation
Clients may be satisfied with treatment but not with the environment
Quantitative assessments yield higher satisfaction than qualitative assessments
Satisfaction with services positively related to age
Those not happy with services tend to drop out
Shown to be related to symptom relief and improvement
Open-ended questions can provide “illuminating information”
Telephone surveys yield higher response than mailed surveys
Expect low response rates
Clients who returned mailed surveys have higher education levels than those who do not
Families ordered by court to obtain services report less satisfaction

7. Explanations for High Ratings-1
More satisfied, higher functioning clients are more likely to complete the questionnaires?
Clients may not know what to expect
Threats to reliability and validity include
Recall bias
Interviewer bias
Non neutral setting bias
Social desirability
Perception by client that answers not anonymous

8. Explanations for High Ratings-2
Respondents taking medication
Clients may feel gratitude or fear of alienating provider
Instruments with unknown psychometrics
Responders may be in treatment longer than non responders
Reduction of cognitive dissonance - Clients who “invest” considerable time, energy and hope may rate services higher

9. Recommendations for Client Satisfaction Studies-1
Examine literature; use scales with good reliability and validity that have been used successfully in other studies
Use same instrument on repeated occasions so findings can be compared
Employ at least 1-2 open-ended questions
Use “ballot box” approach – every client given survey during a given week, while waiting for appointment

10. Recommendations for Client Satisfaction Studies-2
Do not focus only on solving problems of dissatisfied customers
If do mailed survey, try to get more than 50% response rate; offer small incentives for participation
Target specific dimensions
Keep expectations realistic; do not over generalize from small samples
Look for behavioral indicators to supplement client satisfaction