Measuring Client Satisfaction in Residential Aged Care Settings: A Narrative Review of Instruments

摘要

Background: The aim of this paper is to provide a narrative review of validated instruments measuring client satisfaction in residential aged care facilities, including key attributes of the identified instruments. Methods: A systematic literature search was conducted using scientific journal databases (Medline, ProQuest Health and Medical, ProQuest Social Science and CINAHL), specialist journals and websites, and Google. The search was limited to peer-reviewed and research or instrument development articles published between January 1990 and November 2009. ‘Snowballing’ and hand searching of the references of the selected articles were also used to ensure all relevant articles were examined.Results: Ten instruments were identified as relevant for the in-depth review. The review suggested instrument development to date has tended to include the development of new domains, many of which broadly draw on the literature but are honed to the specific objectives of the study or the organization being evaluated. This has led to a diverse range of domains with broadly congruent characteristics but often with different nomenclature. Seven domains were thematically identified based on the most commonly captured aspects of the satisfaction measures reviewed; Interpersonal manner of the provider, Technical quality of care providers, Physical environment, Meals/dining, Socializing opportunities/activities/relationships with others, Spiritual services, and Organization/policy/administration. Conclusion: Further work is required to develop an instrument which addresses the gap caused by the inherently different goals of the service provider, staff and the individual client, and the differences which exist among individual clients. To assess truly person-centered approaches of care, satisfaction instruments should reflect individual client’s perceived importance and expectation on different domains of care/services. Introduction The past several decades have seen a rapid increase in the volume of health care research focusing on the measurement of patient (or consumer) satisfaction as an indicator of quality care (1). Patient satisfaction refers to the patient’s subjective view of various aspects of health care and service provided, such as the availability of personal and technical resources, interpersonal characteristics of care providers, and the care environment (2), and often depends on their level of expectation toward such care (1, 3, 4). In his seminal work on the assessment of quality care, Donabedian aptly asserts that “… information about patient satisfaction should be as indispensible to assessments of quality as to the design and management of health care systems” (5, p. 1746). Much of the existing research on the measurement of patient satisfaction as a quality care outcome indicator has taken place in the hospital (both in-patient and out-patient) and primary care settings (2, 3). However, coinciding with a growing ageing population and ever expanding consumer expectations in society, measuring the satisfaction of care recipients in residential aged care (or long-term care) is gaining more interest in the health care literature (6). There has also been an increase in the popularity and recognition of the importance of person-centered care for older people, in particular those with dementia, as a means to ensure and improve care quality (7, 8). Within a person-centered approach to care, respecting clients’ needs and wishes and involving them in care and decision making is vital, and has been linked to more positive encounters with health care services and potentially better health outcomes (9-11). However, with a few exceptions (12, 13), there has been little debate as to how the quality of aged care, underpinned by the philosophy of person-centeredness, can be reliably assessed by residents and their relatives/families (‘clients’ hereafter). Notably, the meanings attached to ‘health care’ and ‘care quality’ in residential aged