Patient involvement in the evaluation of health care: identifying key issues and considering the way forward

Patients have become increasingly involved in the evaluation of care, most often through attempts to measure their satisfaction. However, difficulties in conceptualizing and measuring satisfaction have led to a questioning of the validity and usefulness of this approach. This paper identifies the main difficulties in measuring satisfaction and considers the implications for individuals working in the area of coronary health care. It reports the findings of a study which explored the expectations and experiences of a group of cardiac patients and constructed a two-part questionnaire in an attempt to measure these experiences. This paper focuses on the qualitative findings which identified the complexity of patient expectations. Expectations were found to be multidimensional in nature and to vary in content and strength. The paper also reports the feasibility of using patient-identified expectations as the basis for developing a two-part questionnaire. Despite the popularity of the concept of satisfaction, cardiac patients rarely evaluated their care in terms of a satisfaction response during interviews. These findings contribute to current concerns that satisfaction as a concept may not adequately capture the way patients judge or evaluate their care. If we are to develop a better understanding of evaluation from the patients’ perspective, greater emphasis needs to be placed on the clarification or identification of concepts which may be of more relevance and utility to both patients and health care professionals before attempts at quantitative measurement are undertaken.