Langenbeck's Archives of Surgery

, Volume 392, Issue 6, pp 747–760 | Cite as

How to improve satisfaction with hospital stay of severely injured patients

  • C. Janssen
  • O. Ommen
  • E. Neugebauer
  • R. Lefering
  • H. Pfaff
Original Article



In the context of medical quality assurance, patient satisfaction with medical and organisational aspects of health care service is considered to be a relevant outcome of patient surveys after a stay in hospital. Within quality research, it is assumed that assessments of patient satisfaction represent a direct measure of the quality of health care received. Furthermore, there is evidence that satisfied patients demonstrate higher levels of compliance for the course of their treatment and that the probability of successful treatment completion thus considerably increases. The present analysis aims to identify determinants of satisfaction of seriously injured patients with regard to their acute hospitalisation.

Materials and methods

One hundred twenty-one seriously injured survivors of work-related or traffic-related accidents treated in two hospitals in Cologne during the years 1996 to 2001 were sent a survey questionnaire. In addition to socio-demographic details, the survey covered the subjective evaluation of organisational and structural aspects of the acute hospitalisation and the psychosocial care provided by the medical staff.


Employing the “tailored design method”, a response rate of 74.4% (n = 90) was obtained. Three highly significant factors influencing the satisfaction of seriously injured patients were identified by means of logistic regression: (1) patients’ perception of being involved in treatment, (2) patients’ feeling of being neglected by physicians and (3) patients’ perception of trust in physicians.


In the present study, the perceived quality of psychosocial care proved to have a significant effect on patients’ satisfaction with their hospital stay. Results of the current analysis thus indicate that psychosocial aspects of physician–patient interaction are of considerable importance in the medical care of seriously injured patients. Although this study is mainly based on subjective patient reported outcome, there is evidence that the subjective view of a patient is relevant in many aspects of medical treatment and outcome. These results already gave the motivation to develop a prospective interventional study with a training programme of communication skills to improve subjective and objective outcome parameters of severely injured patients.


Patient satisfaction Severely injured patients Psychosocial care Quality assurance 


  1. 1.
    Cleary PD (1998) Satisfaction may not suffice! Int J Technol Assess Health Care 14(1):35–37PubMedGoogle Scholar
  2. 2.
    Mirvis DM (1998) Patient satisfaction: can patients evaluate the quality of health care? Tenn Med 91:277–279PubMedGoogle Scholar
  3. 3.
    Urden LD (2002) Patient satisfaction measurement: current issues and implications. Lippincotts Case Manag 7:194–200PubMedCrossRefGoogle Scholar
  4. 4.
    van Campen C, Sixma H, Friele RD, Kerssens JJ, Peters L (1995) Quality of care and patient satisfaction: a review of measuring instruments. Med Care Res Rev 52(1):109–133PubMedCrossRefGoogle Scholar
  5. 5.
    Brown JB, Boles M, Mullooly JP, Levinson W (1999) Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial. Ann Intern Med 7:822–829Google Scholar
  6. 6.
    Gross DA, Zyzanski SJ, Borawski EA, Cebul RD, Stange KC (1998) Patient satisfaction with time spent with their physician. J Fam Pract 47 (2):133–137PubMedGoogle Scholar
  7. 7.
    Rao J, Weinberger M, Kroenke K (2000) Visit-specific expectations and patient-centered outcomes: a literature review. Arch Fam Med 9:1148–1155PubMedCrossRefGoogle Scholar
  8. 8.
    Williams B (1994) Patient satisfaction, a valid concept? Soc Sci Med 38:509–516PubMedCrossRefGoogle Scholar
  9. 9.
    Eickstädt U, Mager G (2003) In: Lauterbach KW, Schrappe M (eds) Gesundheitsökonomie, Qualitätsmanagement und Evidence-based Medicine. Schattauer-Verlag, StuttgartGoogle Scholar
  10. 10.
    Hall JA, Dornan MC (1988) What patients like about their medical care and how often they are asked: a metaanalysis of the satisfaction literature. Soc Sci Med 27:935–939PubMedCrossRefGoogle Scholar
  11. 11.
    Trojan A, Nickel S, Oppolzer A (1999) Qualität des Krankenhauses. Die Sicht der MitarbeiterInnen und PatientInnen im Vergleich. In: Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (eds) Prävention arbeitsbedingter Gesundheitsgefahren und Erkrankungen in Pflegeberufen. Wirtschaftsverlag NW, BerlinGoogle Scholar
  12. 12.
    Klotz T, Zumbe R, Velmans R, Engelmann U (1996) Die Bestimmung der Patientenzufriedenheit als Teil des Qualitätsmanagements im Krankenhaus. Dtsch Med Wochenschr 121:889–895PubMedGoogle Scholar
  13. 13.
    Carr-Hill R (1992) The measurement of patient satisfaction. J Public Health Med 14(3):236–249PubMedGoogle Scholar
  14. 14.
    Ross CK, Steward CA, Sinacore JM (1995) A comparative study of seven measures of patient satisfaction. Med Care 33(4):392–406PubMedCrossRefGoogle Scholar
  15. 15.
    Sitzia J, Wood N (1997) Patient satisfaction: a review of issues and concepts. Soc Sci Med 45(12):1829–1843PubMedCrossRefGoogle Scholar
  16. 16.
    Sitzia J (1999) How valid and reliable are patient satisfaction data? An analysis of 195 studies. Int J Qual Health Care 11:319–328PubMedCrossRefGoogle Scholar
  17. 17.
    Dür W, Grossmann W, Schmied H (2000) Patientenzufriedenheit und Patientenerwartung im Krankenhaus-Statistische Analysen als Hilfsmittel im Benchmarking. In: Bullinger M, Siegrist J, Ravens-Sieberer U (eds) Lebensqualitätsforschung aus medizinpsychologischer und-soziologischer Perspektive. Hogrefe-Verlag, GöttingenGoogle Scholar
  18. 18.
    Thompson AG, Sunol R (1995) Expectations as determinants of patient satisfaction: concepts, theory and evidence. Int J Qual Health Care 7(2):127–141PubMedCrossRefGoogle Scholar
  19. 19.
    Neugebauer B, Porst R, (2001) Patientenzufriedenheit. Ein Literaturbericht. ZUMA-Methodenbericht, ZUMA, MannheimGoogle Scholar
  20. 20.
    Kravitz RL, Callahan EJ (1997) Assessing patients’ expectations in ambulatory medical practice. Does the measurement approach make a difference? J Gen Intern Med 12(1):67–72PubMedCrossRefGoogle Scholar
  21. 21.
    Nettleman MD (1998) Patient satisfaction—what’s new? Clin Perform Qual Health Care 6(1):33–37PubMedGoogle Scholar
  22. 22.
    Trojan A, Satzinger W (2001) Bilanz: Was ist zu beachten, damit Patientenbefragungen die Patientenversorgung verbessern helfen? In: Satzinger W, Trojan A, Kellermann-Mühlhoff P (eds) Patientenbefragungen in Krankenhäusern. Konzepte, Methoden, Erfahrungen. Asgard-Verlag, Sankt AugustinGoogle Scholar
  23. 23.
    Raspe H, Voigt S, Herlyn K, Feldmeier U, Meier-Rebentisch K (1996) Patienten-Zufriedenheit in der medizinischen Rehabilitation-ein sinnvoller Outcome-Indikator? Gesundheitswesen 58:372–378PubMedGoogle Scholar
  24. 24.
    Schwermann T, Grotz M, Blanke M, Ruchholtz S, Lefering R, Graf von der Schulenburg JM, Krettek C, Pape HC, AG-Polytrauma der DGU (2004) Evaluation der Kosten von polytraumatisierten Patienten insbesondere aus der Perspektive des Akutkrankenhauses. Unfallchirurg 107:563–574PubMedCrossRefGoogle Scholar
  25. 25.
    Schmittdiel J (2000) Effect of physician and patient gender concordance on patient satisfaction and preventive care practices. J Gen Intern Med 15(11):761–769PubMedCrossRefGoogle Scholar
  26. 26.
    Hall JA, Irish JT, Roter DL, Ehrlich CM, Miller LH (1994) Satisfaction, gender, and communication in medical visits. Med Care 32(12):1216–1231PubMedCrossRefGoogle Scholar
  27. 27.
    Ehnfors M, Smedby B (1993) Patient satisfaction surveys subsequent to hospital care: problems of sampling, non-response and other losses. Qual Assur Health Care 5(1):19–32PubMedGoogle Scholar
  28. 28.
    Vieder JN (2002) Physician–patient interaction: what do elders want? J Am Osteopath Assoc 102(2):73–78PubMedGoogle Scholar
  29. 29.
    Owens DJ, Batchelor C (1996) Patient satisfaction and the elderly. Soc Sci Med 42(11):1483–1491PubMedCrossRefGoogle Scholar
  30. 30.
    Frederickson LG (1995) Exploring information-exchange in consultation: the patients’ view of performance and outcomes. Patient Educ Couns 25:237–246CrossRefGoogle Scholar
  31. 31.
    Olandt H, Krentz H (1998) Patient satisfaction—subjective quality assessment by patients and success factor for clinics. Gesundheitswesen 60(12):721–728PubMedGoogle Scholar
  32. 32.
    Stroebe W, Stroebe M (1994) Partnerschaft, Familie und Wohlbefinden. In: Abele A, Becker P (eds) Wohlbefinden. Theorie-Empirie-Diagnostik. 2. Aufl. Juventa-Verlag, WeinheimGoogle Scholar
  33. 33.
    Berkman LF, Syme SL (1979) Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 109(2):186–204PubMedGoogle Scholar
  34. 34.
    Gärtner K (1990) Sterblichkeit nach dem Familienstand. Z Bevölkwiss 1:53–65Google Scholar
  35. 35.
    Carlson MJ, Blustein J, Fiorentino N, Prestianni F (2000) Socioeconomic status and dissatisfaction among HMO enrollees. Med Care 38(5):508–516PubMedCrossRefGoogle Scholar
  36. 36.
    Hall JA, Dornan MC (1990) Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med 30(7):811–818PubMedCrossRefGoogle Scholar
  37. 37.
    Cleary PD, Edgman-Levitan S, Roberts M, Moloney TW, McMullan W, Walker JD, Delbanco TL (1991) Patients evaluate their hospital care: a national survey. Health Aff 10(4):254–267CrossRefGoogle Scholar
  38. 38.
    Charles C, Gauld M, Chambers L, O’Brien B, Haynes RB (1994) How was your hospital stay? Patients’ reports about their care in Canadian hospitals. CMAJ 150(11):1813–1822PubMedGoogle Scholar
  39. 39.
    Wüthrich-Schneider E (2000) Patientenzufriedenheit-Wie verstehen? Schweiz Ärzteztg 81:1046–1048Google Scholar
  40. 40.
    Raspe H, Weber U, Voigt S, Kosinski A, Petras H (1997) Qualitätssicherung durch Patientenbefragungen in der medizinischen Rehabilitation: Wahrnehmungen und Bewertungen von Rehastrukturen und-prozessen (Rehabilitandenzufriedenheit“). Rehabilitation (Stuttg) 36:XXXI–XLIIGoogle Scholar
  41. 41.
    Spießl H, Cording C, Klein HE (1997) Qualitätssicherung durch Patientenbefragungen. ZaeFQ 91:761–765Google Scholar
  42. 42.
    Blum K (1998) Patientenzufriedenheit bei ambulanten Operationen. Einflussfaktoren der Patientenzufriedenheit und Qualitätsmanagement im Krankenhaus. Juventa-Verlag, WeinheimGoogle Scholar
  43. 43.
    Geyer S (1999) Macht Unglück krank? Die Konsequenzen belastender Lebensereignisse. Juventa-Verlag, WeinheimGoogle Scholar
  44. 44.
    Baberg HT, Jager D, Bojara W, Lemke B, von Dryander S (2001) Expectations and satisfaction of patients during inpatient treatment. Gesundheitswesen 63(5):297–301PubMedCrossRefGoogle Scholar
  45. 45.
    Cassier-Woidasky AK (1998) What do people expect from their hospital? Results of a visitor survey at open house in a general hospital. Pflege 11(5):248–254PubMedGoogle Scholar
  46. 46.
    Siegrist K, Schlebusch P, Trenckmann U (2002) Let us ask the consumer. Psychiatr Prax 29(4):201–206PubMedCrossRefGoogle Scholar
  47. 47.
    Bertakis KD, Callahan EJ, Helms LJ, Azari R, Robbins JA (1998) Physician practice styles and patient outcomes: differences between family practice and general internal medicine. Med Care 36:879–891PubMedCrossRefGoogle Scholar
  48. 48.
    Flocke A, Miller WL, Crabtree BF (2002) Relationships between physician practice style, patient satisfaction, and attributes of primary care. J Fam Pract 51:835–840PubMedGoogle Scholar
  49. 49.
    Stewart M (1984) What is a successfull doctor–patient interview? A study of interactions and outcomes. Soc Sci Med 19:167–175PubMedCrossRefGoogle Scholar
  50. 50.
    Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R (2002) Efficacy of a cancer research UK communication skills training model for oncologists: a randomised controlled trial. Lancet 359(9307):650–656PubMedCrossRefGoogle Scholar
  51. 51.
    Delbanco TL (1992) Enriching the doctor–patient relationship by inviting the patient’s perspective. Ann Intern Med 116(5):414–418PubMedGoogle Scholar
  52. 52.
    Stewart M, Brown J, Donner A, McWhinney I, Oates J (2000) The impact of patient-centered care on outcomes. J Fam Pract 49:796–804PubMedGoogle Scholar
  53. 53.
    Siegrist J (2005) Medizinische Soziologie. Urban & Schwarzenberg, MünchenGoogle Scholar
  54. 54.
    Lerman CE, Brody DS, Caputo GC, Smith DG (1990) Patients’ perceived involvement in care scale: relationship to attitudes about illness and medical care. J Gen Intern Med 5:29–33PubMedCrossRefGoogle Scholar
  55. 55.
    Mahler H, Kulik J (1990) Preferences for health care involvement, perceived control and surgical recovery: a prospective study. Soc Sci Med 31:743–751PubMedCrossRefGoogle Scholar
  56. 56.
    Scheibler F, Janßen C, Pfaff H (2003) Shared decision making: ein Überblicksartikel über die internationale Forschungsliteratur. Soz- Präventivmed 48:11–23PubMedGoogle Scholar
  57. 57.
    Adams RJ, Smith BJ, Ruffin RE (2001) Impact of the physician’s participatory style in asthma outcomes and patient satisfaction. Ann Allergy Asthma Immunol 86: 263–271PubMedCrossRefGoogle Scholar
  58. 58.
    Donabedian A (2003) An introduction to quality assurance in health care. Oxford University Press, New YorkGoogle Scholar
  59. 59.
    Jackson JL, Chamberlin J, Kroenke K (2001) Predictors of patient satisfaction. Soc Sci Med 52(4):609–620PubMedCrossRefGoogle Scholar
  60. 60.
    Jatulis DE, Bundek NI, Legorreta AP (1997) Identifying predictors of satisfaction with access to medical care and quality of care. Am J Med Qual 12(1):11–18PubMedGoogle Scholar
  61. 61.
    Anderson JG, Wixson RL, Tsai D (1996) Functional outcome and patient satisfaction in total knee patients over the age 75. J Arthroplast 11(7):831–840CrossRefGoogle Scholar
  62. 62.
    Jamison RN, Ross MJ, Hoopman P, Griffin F, Levy J, Daly M, Schaffer JL (1997) Assessment of postoperative pain management: patient satisfaction and perceived helpfulness. Clin J Pain 13(3):229–236PubMedCrossRefGoogle Scholar
  63. 63.
    Robertsson O, Dunbar MJ (2001) Patient satisfaction compared with general health and disease-specific questionnaires in knee arthroplasty patients. J Arthroplast 16 (4):476–482CrossRefGoogle Scholar
  64. 64.
    Dillman DA (2000) Mail and internet surveys. The tailored design method. Wiley, New YorkGoogle Scholar
  65. 65.
    Horn W (1983) Leistungsprüfsystem LPS. Handanweisung für die Durchführung, Auswertung und Interpretation (2. erweiterte und verbesserte Aufl.) Hogrefe-Verlag, GöttingenGoogle Scholar
  66. 66.
    Oswald WD, Roth E (1978) Der Zahlenverbindungstest (ZVT). Handanweisung. Hogrefe-Verlag, GöttingenGoogle Scholar
  67. 67.
    Reitan RM (1958) Validity of the trailmaking test as an indication of organic brain damage. Percept Mot Skills 8:271–276CrossRefGoogle Scholar
  68. 68.
    Pfaff H, Freise D, Mager G, Schrappe M (2003) Der Kölner Patientenfragebogen (KPF): Entwicklung und Validierung eines Fragebogens zur Erfassung der Einbindung des Patienten als Kotherapeuten. Asgard-Verlag, Sankt AugustinGoogle Scholar
  69. 69.
    Ahrens W, Bellach BM, Jöckel KH (1998) Messung soziodemographischer Merkmale in der Epidemiologie. RKI-Schrift 1/98, MMV Medizin-Verlag, MünchenGoogle Scholar
  70. 70.
    Bullinger M, Kirchberger I (1998) SF-36 Fragebogen zum Gesundheitszustand. Handanweisung. Hogrefe-Verlag, GöttingenGoogle Scholar
  71. 71.
    Lefering R, Sauerland S (2004) Statistische Analysen. In: Neugebauer E, Mutschler W, Claes L (eds) Von der Idee zur Publikation. Thieme-Verlag, Stuttgart, pp 117–125Google Scholar
  72. 72.
    Katz MH (1999) Multivariable analysis: a practical guide for clinicians. Cambridge University Press, CambridgeGoogle Scholar
  73. 73.
    Janssen C, Ommen O, Pfaff H (2006) Combining patient satisfaction, fulfilment of expectations and importance—an integrative approach in quality assurance. Eur J Public Health 15(Suppl 1):139–140Google Scholar
  74. 74.
    Kunin T (1955) The construction of a new type of attitude measure. Pers Psychol 8:65–77CrossRefGoogle Scholar
  75. 75.
    Clausen G, Borchelt M, Janßen C, Loos S, Mull J, Pfaff H (2006) Unterstützende Versorgung und Zufriedenheit geriatrischer Patienten mit der stationären Behandlun-Ergebnisse einer systematischen Patientenbefragung. Z Gerontol Geriatr 39:48–56PubMedCrossRefGoogle Scholar
  76. 76.
    Helmert U, Mielck A, Classen E (1993) Social inequalities in cardiovascular disease risk factors in East- and West-Germany. Soc Sci Med 35:1283–1292CrossRefGoogle Scholar
  77. 77.
    AAAM (2006) Available online at: Cited November 15, 2006
  78. 78.
    Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196PubMedGoogle Scholar
  79. 79.
    Kanz KG, Linsenmaier U, Pfeifer KJ, Mutschler W (2002) Standardisierte Bewertung von Unfallverletzten: Anforderungen an die bildgebende Diagnostik. Radiologe 42(7):515–521PubMedCrossRefGoogle Scholar
  80. 80.
    Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB (1999) Outcome after major trauma: 12-month and 18-month follow-up results from Trauma Recovery Project. J Trauma 46:765–771PubMedCrossRefGoogle Scholar
  81. 81.
    Callahan EJ, Stange KC, Bertakis KD, Zyzanski SJ, Azari R (2003) Does time use in outpatient residency training reflect community practice? Fam Med 35(6):423–427PubMedGoogle Scholar
  82. 82.
    Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T (2002) Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care 11(4):335–339PubMedCrossRefGoogle Scholar
  83. 83.
    Williams S, Weinman J, Dale J (1998) Doctor–patient communication and patient satisfaction: a review. Fam Pract 15:480–492PubMedCrossRefGoogle Scholar
  84. 84.
    Stötzner K (2001) Einbindung von Patienten und ihren Anliegen in die evidenzbasierte Medizin. ZaeFQ 95:131–136Google Scholar
  85. 85.
    Edgman-Levitan S, Cleary PD (1996) What information do consumers want and need? Health Aff 15(4):42–56CrossRefGoogle Scholar
  86. 86.
    Künzi B (2002) Der Patient und die Qualität der ärztlichen Leistung. Prim Care 2:125–131Google Scholar
  87. 87.
    Lezzoni L (1994) Risk adjustment for measuring health care outcomes. Health Administration Press, Ann Arbor, MichiganGoogle Scholar
  88. 88.
    Kaplan SH, Greenfield S, Ware JE (1989) Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care 27:110–127CrossRefGoogle Scholar
  89. 89.
    Wallston KA, Wallston BS, DeVellis R (1978) Development of the multidimensional health locus of control (MHLC) scales. Health Educ Monogr 6:160–170PubMedGoogle Scholar
  90. 90.
    Antonovsky A (1987) Unraveling the mystery of health: how people manage stress and stay well. Jossey-Bass, San FranciscoGoogle Scholar
  91. 91.
    Thomas WI, Thomas DS (1928) The child in America: behavior problems and programs. Knopf, New YorkGoogle Scholar
  92. 92.
    Ommen O, Janßen C, Pfaff H (2006) Patientenzufriedenheit. In: Berth H, Balck F, Brähler E (eds) Medizinische Psychologie und Medizinische Soziologie von A bis Z. Göttingen, Hogrefe (im Druck)Google Scholar
  93. 93.
    Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W (1997) Communication patterns of primary care physicians. JAMA 277:350–356PubMedCrossRefGoogle Scholar
  94. 94.
    Editorial (2004) The soft science of medicine. Lancet 363:1247Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • C. Janssen
    • 1
  • O. Ommen
    • 2
  • E. Neugebauer
    • 3
  • R. Lefering
    • 3
  • H. Pfaff
    • 1
    • 2
  1. 1.Department of Medical Sociology, Institute and Polyclinic for Occupational and Social MedicineSchool of Medicine and Dentistry, University of CologneCologneGermany
  2. 2.Center of Health Services ResearchCologneGermany
  3. 3.Institute for Research in Operative MedicineUniversity of WittenHerdeckeGermany

Personalised recommendations