Nursing Report: Improving Patient Satisfaction Using PDSA Methodology

This report investigates patient satisfaction as a key indicator of healthcare quality, focusing on the impact of wait times. It proposes the implementation of a Plan-Do-Study-Act (PDSA) quality improvement model to address this issue. The report outlines a three-cycle PDSA approach, starting with data collection through questionnaires, refining the data collection based on initial feedback, and then incorporating stakeholder perspectives to implement changes. The goal is to improve patient satisfaction by addressing wait times and enhancing communication. The methodology involves statistical analysis of patient feedback to identify areas for improvement, with a post-intervention data collection phase to assess the effectiveness of the implemented changes. The report emphasizes the advantages of the PDSA model, including its disciplined approach, focus on improvement, and ease of implementation, and concludes by highlighting the importance of direct patient feedback and improved communication in enhancing patient satisfaction. The report references several key publications to support its claims.

Running head: THEORETICAL PERSPECTIVES FOR ADVANCE PRACTICE
Nursing; Theoretical Perspectives for Advance Practice
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THEORETICAL PERSPECTIVES FOR ADVANCE PRACTICE
Introduction
The current research paper seeks to address the technology to use to improve patient
satisfaction because it is a major indicator for measuring the quality in healthcare. According to
Arslanian et al. (2013) ensuring that patients are properly satisfied is wide and there is no
similarity amongst the current literature on how we are supposed to define patient satisfaction in
healthcare.
Background
Patient satisfaction as per the quality model developed by Donabedian, patient
satisfaction is defined as an outcome measure which is measured as the patients give feedback on
their experiences after being attended to. There are different definitions of patient satisfaction by
different authors.Mitchell (2013) noted that satisfaction of clients in healthcare settings majorly
gave a representation of the patient attitudes towards the care and its aspects. Moreover,
Litchfield and Jónsdóttir (2013) defined satisfaction as the emotions of the patients, their feelings
in addition to the ken of the accorded healthcare services.
There are authors for example Higgins et al. (2015) who defined it as a proportion of
congruency that shows the expectations of the patient with regards to ideal care and their
perceptions of actual care that they obtained. In reference to Grol, Berwick and Wensing (2008),
the satisfaction of patients has an impact on the clinical outcomes, the retention of patients and as
well as malpractice claims that are reported by patients. This is believed to thoroughly affect the
effective and patient-centered delivery of high quality health care. The patient satisfaction is
therefore a very efficient indicator to determine the success of the nurses, the doctors and
hospitals in general.

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Problem:
Waiting time (approximate time taken by a patient as they wait in the hospital before
being attended to by any of the hospital medical staff) greatly affects patient satisfaction
according to a research done in the Orthopedic Clinic (10th June 2016).
Research Question:
Would implementation of a Plan-Do-Study-Act (PDSA) Quality Improvement model improve
patient satisfaction?
Plan-Do-Study-Act (PDSA)
You can use the Plan-Do-Study-Act (PDSA) model of quality improvement as the
baseline measurement. The first PDSA cycle can act as the pilot study to help gather incipient
data which is very vital in gauging the scale of the particular problem (Boaden, Harvey ,
Moxham , and Proudlove., 2008). In PDSA cycle one, you can hand in questionnaires to a
sample of patients, say 50 random patients, and request them to give feedback on all aspects of
the care that they felt was lacking including the wait time. You should ensure that there are no
leading questions and most preferably use blank comment boxes to ensure that there is no
ambiguity.
Based on data gotten from the first cycle, you can refine the questionnaire and probably
use comments as the basis of the questions in the refined questionnaire. Moving on to the PDSA
cycle 2, you can gather data after distributing the refined questionnaires over a given period of
time to anonymous patients and getting their feedback. The design of the questionnaire is very
important because it will determine the kind of results that you will get. Ensure you have a
sample size that is reasonable to represent all the patients evenly in terms of gender, age and

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other factors. You can divide the questionnaire into questions regarding the doctors, nursing staff
and general hospital services.
The phrasing of the questions is also very vital whereby for the question on whether the
patient is satisfied, you can have several response options for example “not at all” , “no” , “yes”
and “yes to a certain extent”. You can arrange them as score of 1 to 4 respectively. All the data
entry and analysis can be done in statistical software for example SPSS. You then analyze the
data and come up with appropriate recommendations especially based on the negative feedback.
You are likely to come up with recommendations such as improvement in communication skills
and improvise a system whereby the patients can be attended to at a faster rate ( Boaden, et al.,
2008).).
Having such information, the third cycle would be inclusion of the right stakeholders and
get their perspective on the matter at hand. You can send an email to all the staff members with
details of the work done and all the inadequacies that were noted. You can thereafter hold
meetings with the respective staff members to discuss more on the matter and plan on how to go
about implementing the changes needed. The main goal should be to solve the patient
satisfaction problem about wait time.
After going through all those necessary steps, a post-intervention data collection should
be made over a certain period of months. The analysis should be done to check the change in the
results, if any. This would help to model the improvement strategy and to learn the lessons
necessary. It would also help you notice the challenges faced and on which area to improve on.
Finally, you would draw all the necessary conclusions; for example, a study can show that an
effecient way to ensure that there is improvement in patient satisfaction is through simple

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measures such as having direct patient feedback and having reminders continually for better
communication skills.
Why I preferred using PDSA (QI Methodology) over Theoretical Model:
 It offers a very disciplined model for testing improvements based on the four simple steps
namely; plan, do, study, act. When you use this approach, chances of achieving your aim
are very high.
 PDSA involves small-scale testing and in most cases, it focuses on the theme and aims of
improvement.
 PDSA can be completed very quickly and with minimal expenses without taking great
risks.
 PDSA provides clarity about who does what, when and what materials hence makes the
research easier.
 PDSA assists staff members to gain a lot of new knowledge and very fresh experience
and hence the working environment is conducive for success.

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Figure 1 PDSA Cycle Model

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References:
Arslanian-Engoren, C., Hicks, F. D., Whall, A. L., Algase, D. L. (2013). An ontological view of
advanced practice nursing. In Cody, W. K. (Ed.), Philosophical and theoretical
perspectives for advanced nursing practice (5th ed., pp. 361-368). Burlington, MA: Jones
& Bartlett.
Boaden R, Harvey G, Moxham C, and Proudlove N. (2008). Quality improvement: theory and
practice in healthcare. NHS Institute for Innovation and Improvement, University of
Warwick, Coventry UK.
Grol R, Berwick D, Wensing M. (2008). On the trail of quality and safety in health care. BMJ,
336:74-76.
Higgins TC, Crosson J, Peikes D, McNellis R, Genevro J, Meyers D. (2015). Using Health
Information Technology to Support Quality Improvement in Primary Care. AHRQ
Publication No. 15-0031-EF. Rockville, MD: Agency for Healthcare Research and Quality.
Litchfield, M. C., Jónsdóttir, H. (2013). A practice discipline that’s here and now. In Cody, W.
K. (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (5th ed.,
pp.51-68). Burlington, MA: Jones & Bartlett.
Mitchell, G. J. (2013). Evidenced-based practice: Critique and alternative view. In Cody, W. K.
(Ed.), Philosophical and theoretical perspectives for advanced nursing practice (5th ed., pp.
321-330). Burlington, MA: Jones & Bartlett.