Client Satisfaction: The Easiest Outcome to Measure
Michael Brickey, Ph.D.
Editor's Note: This is the last article of a four part series on Outcome Measurers by Associate Editor Michael Brickey.
One of the outcomes of most interest to lay audiences (which includes clients and employers) is client satisfaction. It is the easiest and most common form of outcomes measurement.
Why do them
Satisfaction surveys are valuable to independent practitioners because:
What they measure
Satisfaction surveys appear to primarily measure whether the clients like the therapist and the office atmosphere. Theoretical constructs include: 1) satisfaction is a measure of attitudes, 2) it a measure of fulfillment of needs, and 3) it represents a discrepancy between what was expected and what was received. Note that cognitive dissonance theory suggests that relatively small discrepancies may be adjusted to the expectation to prevent cognitive dissonance.
Satisfaction surveys may just focus on whether the client liked the services and practice or may venture into whether the client believes they got good results (e.g., behavior changes, problem resolution). The Consumer Reports (1995) study, for example, solicited retrospective information on symptom improvement in addition to general satisfaction. Research on the correlation between client satisfaction and behavioral outcomes have correlations of less than .40 (Lunnen & Ogles, 1997). This may not seem strange when we consider that many physician visits do not result in cures but the patient may still believe the physician was very competent and provided excellent services. Research suggests that general life satisfaction does not appear to have much of a correlation with satisfaction ratings. The provider's perceived competence, however, does correlate positively with satisfaction. There is a modest correlation between length of therapy and satisfaction.
Managed care organizations place a lot of emphasis on satisfaction surveys because the data are easy to collect, easy to understand, and liked by employer. Further, the data are usually very positive. All the managed care organizations report very positive data on consumer satisfaction. Many surveys have low return rates and clients who choose to respond to surveys may be a selective population. There also is the possibility that these reports selectively report only the most highly rated items. Accreditation organizations like the National Committee on Quality Assurance (NCQA) emphasize data collection on satisfaction measures such as promptness in getting the initial appointment, promptness in answering phone calls, 24 hour accessibility, and the office environment. These fit well with the managed care agenda and are measurable. To try to determine changes in behavior, health, and overall functioning, managed care organizations use standardized instruments like the Brief Symptoms Inventory (BSI) as well as proprietary instruments.
There are many issues that may compromise validity. These include:
Developing a satisfaction survey
Keep the survey simple and to one page.
For most practices, once a year surveys are sufficient.
In designing a survey, a good starting point is to gather surveys from a variety or organizations including behavioral healthcare practices, and to note what you like and do not like. Then decide what your purpose is in conducting the survey, e.g., gathering impressive marketing data, finding out what your clients really think, continuous quality improvement, providing data for a quality assurance program. Have several colleagues and clients review the survey to see if it is well designed and measuring what you want it to. Decide how to conveniently administer the survey and get a high return rate, e.g., if your receptionist is the key person, how do I get him or her enthusiastic and committed to doing the survey? One option is to include an item asking the client to cite the practice's two main strengths and two areas to improve. In offices with more than one therapist, consider an item for the client to check whether it is OK to share responses with the clinician.
While satisfaction surveys should not be confused with clinical effectiveness outcomes measures, they are an important outcome measure in their own right and the easiest, least expensive form of outcomes measurement.
Consumer Reports. (1995). Mental health: Does therapy help? 734-739.
Lunnen, Kirk, & Ogles, Benjamin. (1997). Satisfaction ratings: Meaningful or meaningless? Behavioral Healthcare Tomorrow, 6, 49-51.