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Abstract
The health care industry is going through tumultuous and turbid times. With health care costs increasing and limited resources, health care organizations are redefining and restructuring themselves. Mergers, acquisitions, and networking of health care organizations are constantly seen in Oregon. The success of these adventures will determine the landscape of the health care market and how care will be delivered in the next 10 years. The purpose of this study is to investigate the impact of restructuring in one organization and its influence on quality of care as perceived by patient satisfaction surveys.
The primary research question is: Will patients' overall level of satisfaction with quality of care change when an HMO restructures its organization? The follow up questions include: (1) Are there differences in perception of quality of care by patient characteristics? (2) Is there a difference in response to quality of care by frequent versus infrequent users of health care services? (3) Do patients with chronic illness versus those without chronic illness respond differently to changes in care? (4) Will satisfaction differ between patients who would be directly impacted by the change versus those patients not affected by the change?
The methodology included analysis of secondary data from the Center for Health Research, Kaiser Permanente, Northwest. Patient satisfaction surveys from 1994 (prior to change) and 1995 (immediately after change) were analyzed. A number of statistical analyses were done to determine satisfaction with access to care, competency (technical quality), continuity of care, interpersonal manner (relationship), and communication.
The findings showed that overall satisfaction increased slightly from 1994 to 1995. Differences in mean scores among the various groups who were affected and not affected by the change were minimal. Intervening variables were examined to determine which were predictors of satisfaction. None of the demographic variables, frequency of visits to Kaiser Permanente, and presence of a chronic condition were found to be significant predictors of overall satisfaction. Strong predictors of overall satisfaction were members' self-assessed health and their ratings on overall satisfaction with quality of service and with access to care. In addition, indices that correlated with quality of care were attributes that focused on the physician—communication, technical skills, and interpersonal manner.
Thus, this study demonstrated that health care organizations could restructure without affecting patient satisfaction provided that access to care and quality of care are maintained.
