Quality of care and patient satisfaction: a new theoretical and methodological approach.

PURPOSE: The paper's purpose is to develop a care-context adapted version of the emotional stress reaction questionnaire (ESRQ), which is based on the cognitive-phenomenological writings of Lazarus, and, using this instrument, to explore the relationship between quality of care from a patient perspective and patient satisfaction while taking key antecedent conditions into account. DESIGN/METHODOLOGY/APPROACH: Data were collected from 624 patients at 16 Swedish out-patient clinics (75 per cent response rate). Patients responded to the ERSQ, the quality from the patient's perspective questionnaire (QPP), the single-item measures of personality (SIMP), and questions related to the outcome of the visit. Dimensionality of the ESRQ was analysed using exploratory factor analysis and structural equation modelling. The relationship between the theoretical concepts was explored with logistic regression analysis.
FINDINGS: A care-context adapted version of the ESRQ was developed with meaningful factors and satisfactory psychometric properties. Care-episode specific appraisal and coping processes covaried as predicted with emotional responses. The theoretical model was partly confirmed when assessed against two outcome criteria: intention to follow the doctor's advice and hesitation to visit the same out-patient clinic again. PRACTICAL IMPLICATIONS: The scales used are easy to administer and interpret. ORIGINALITY/VALUE: The suggested theoretical model of the relationship between quality of care from a patient perspective and patient satisfaction is new, as is the emotion-oriented approach to assessing patient satisfaction.