Through the Patients' Eyes 
A patient's experience of illness and health care greatly affects how he or she perceives the health care services provided. Unless patients' needs are understood and met, it is impossible to build their trust and confidence in any institution or health care system. To this end, Aga Khan University Hospital (AKUH) has encouraged seeking its patients' views on services received at the Hospital, and using these as a tool for self-examination and improvement. Here we examine the application of one such feedback tool -  the survey.

Patient Satisfaction Surveys have been in use at AKUH for a long time. However, for the first time in 1996, based on the criteria of the prestigious Malcolm Baldridge Quality Award, interns from the Psychology Department of Karachi University conducted a 'Needs Survey' for the Hospital's inpatient and outpatient services, to identify patient needs, expectations and key satisfaction indicators.

In 1997, based on these findings, questionnaires for measuring satisfaction levels on key service factors for the Emergency Room (ER), lnpatients, Consulting Clinics (CC), and Diagnostic Services were developed by the Hospital's Patient Satisfaction Survey Task Force. A second Needs Survey was undertaken by the Hospital's Marketing Department in 1999, to determine if there was any change in patients' needs and expectations. The services being examined were expanded to include Surgical Day Care (SDC) and the Executive Clinic (EC). Face validity, content validity and construct validity of the measurement instruments was examined to assess the reliability and validity of the questionnaires.

AKUH's Marketing Department collects and stores patient satisfaction data, computes satisfaction scores and analyses data by using standard statistical techniques on an ongoing basis. It has been using the questionnaires developed in 1997 to regularly conduct Patient Satisfaction Surveys for ER, Inpatients, CC, Laboratory (both Main Laboratory and Collection Units), Radiology, Community Health Centre (CHC), SDC and EC. Patients from whom feedback is sought are selected randomly from the Hospital's computerized patient database. Interviews for all services, excluding Laboratory and Radiology (for which face-to-face interviews are conducted due to a large number of outside referrals), are done over the telephone within 5-7 days of a patient's utilization of the services.

The Department also prepares and circulates comprehensive yearly reports, showing the methodology, sample size, findings, conclusions, limitations and recommendations for each Hospital service, as well as quarterly satisfaction indicators comparing satisfaction levels within different areas of a service. Furthermore, on a monthly basis, it compares areas of patient dissatisfaction indicated in its ongoing surveys with the complaints received through the Hospital's complaint boxes, and communicates this information to all service providers. The Department has accumulated a large quantity of valuable patient satisfaction data, which it is currently analyzing to see the trends over the last four years.

AKUH strives to provide high quality health care that meets or exceeds the needs and expectations of its patients. Patient Satisfaction Surveys are an invaluable tool for pinpointing whether or not this quality vision is being met.