The Patient - Patient-Centered Outcomes Research

, Volume 7, Issue 3, pp 301–312 | Cite as

Examining Patients’ Perceptions of Care to Identify Opportunities for Quality Improvement in Psychiatric Inpatient Hospitals

  • Glorimar OrtizEmail author
Original Research Article



Our objectives were to examine patients’ perceptions with psychiatric care to prioritize action for quality improvement (QI), and to explore differences in care experiences across domains of care by sample subgroups in psychiatric inpatient hospitals.


Analysis of frequency, central tendency, and variation examined the distribution of 11,778 Inpatient Consumer Surveys (ICS), from 67 psychiatric inpatient hospitals, by domain of care and Likert scale. The percentage of patients responding positively to each domain of care was evaluated. A performance–importance matrix was constructed to identify key drivers and prioritize action for QI. Chi-squared, t test, and analysis of variance (ANOVA) analyses evaluated the experiences of care by sample subgroups.


Overall, patients tended to be satisfied with the care received. However, patients perceived their care differently across hospitals. Hospitals scored lower in the rights domain, mainly attributed to problems with communication between patients and hospital staff. Patients’ care experiences varied among sample subgroups; however, four sample characteristics were common to all domains of care. Patients who were Latinos, aged 65 years and older, who completed the survey at discharge, before leaving the hospital, had a higher perception of care across all domains of care.


Either an examination of the individual items on the ICS or the aggregation of them by domain of care, the ICS could be a significant tool for hospitals that continuously strive to improve the quality of care provided to psychiatric patients in a time driven by the needs and expectations of consumers.


Care Experience Psychiatric Inpatient Mental Healthcare High Perception Survey Scale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The study design, collection, analysis, interpretation of the data; and the writing, review, and approval of the manuscript were fully funded by the National Association of State Mental Health Program Directors Research Institute, Inc. (NRI).

The author also acknowledges the key contribution of Lucille Schacht, PhD, for her guidance through the development of this research study; and Kristin Nelyon, MA, for proofreading the manuscript.

No potential conflicts of interest need to be disclosed.

Supplementary material

40271_2014_52_MOESM1_ESM.docx (60 kb)
Supplementary material 1 (DOCX 59 kb)


  1. 1.
    Holcomb WR, Parker JC, Leong GB, Thiele J, Higdon J. Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients. Psychiatr Serv. 1998; 49(7):929–934.Google Scholar
  2. 2.
    Urden LD. Patient satisfaction measurement: Current issues and implications. Outcomes Manag. 2002;6(3):125–131.Google Scholar
  3. 3.
    Friedman MM. ORYX: the next evolution in accreditation. Home Healthc Nurse. 1998;16(4):236–239.Google Scholar
  4. 4.
    Kuosmanen L, Hätönen H, Jyrkinen AR, Katajisto J, Välimäki M. Patient satisfaction with psychiatric inpatient care. J Adv Nurs. 2006;55(6):655–663.Google Scholar
  5. 5.
    Meehan T, Bergen H, Stedman T. Monitoring consumer satisfaction with inpatient service delivery: the Inpatient Evaluation of Service Questionnaire. Aust N Z J Psychiatry. 2002;36(6):807–811.Google Scholar
  6. 6.
    Donabidean A. The Lichfield lecture: quality assurance in health care: consumers’ role. Qual Health Care. 1992;1(4):247–251.Google Scholar
  7. 7.
    Sishta DK, Rinco S, Sullivan J. Client’s satisfaction survey in a psychiatric inpatient sample attached to a general hospital. Can J Psychiatry. 1986;31(2):123–128.Google Scholar
  8. 8.
    York AS, McCarthy KA. Patient, staff, and physician satisfaction: a new model, instrument and their implications. Int J Health Care Qual Assur. 2011;24(2):178–191.Google Scholar
  9. 9.
    Längle G, Baum W, Wollinger A, Renner G, Uren R, Schwärzler F, et al. Indicators of quality of in-patient psychiatric treatment: the patients’ view. Int J Qual Health Care. 2003;15(3):213–221.Google Scholar
  10. 10.
    Gruyters T, Priebe S. Evaluation of psychiatric treatment by patients: results and problems of systematic research. Psychiatr Prax. 1994;21(3):88–95.Google Scholar
  11. 11.
    Ruggeri M. Patients’ and relatives’ satisfaction with psychiatric services: the state of the art of its measurement. Soc Psychiatry Psychiatr Epidemiol. 1994;29(5):212–227.Google Scholar
  12. 12.
    Ortiz G, Schacht L. Psychometric evaluation of an Inpatient Consumer Survey measuring satisfaction with psychiatric care. Patient. 2012;5(3):163–73.Google Scholar
  13. 13.
    The Joint Commission. About The Joint Commission [online]. Accessed 1 Nov 2013.
  14. 14.
    Schacht L. NRI/MHSIP Inpatient Consumer Survey: results of pilot implementation. Alexandria: National Association of State Mental Health Program Directors Research Institute Inc.; 2001.Google Scholar
  15. 15.
    Davies E, Shaller D, Edgman-Levitan S, et al. Evaluating the use of a modified CAHPS® survey to support improvements in patient-centred care: lessons from a quality improvement collaborative. Health Expect. 2008;11(2):160–176.Google Scholar
  16. 16.
    SPSS Inc. SPSS® Statistics [computer program]. Version 17. Chigaco: SPSS, Inc.; 2008.Google Scholar
  17. 17.
    Dodek PM, Heyland DK, Rocker GM, Cook DJ. Translating family satisfaction data into quality improvement. Crit Care Med. 2004;32(9):1922–1927.Google Scholar
  18. 18.
    Zastowny T, Stratmann W, Adams E & Fox M. Patient satisfaction and experience with health services and quality of care. Qual Manag Health Care. 1995;3(3):50–61.Google Scholar
  19. 19.
    Edgman-Levitan S, Shaller D, McInnes K, et al. The CAHPS® improvement guide: practical strategies for improving the patient care experience. Department of Health Care Policy, Harvard Medical School. October 2003Google Scholar
  20. 20.
    Schröder A, Larsson BW, Ahlström G. Quality in psychiatric care: an instrument evaluating patients’ expectations and experiences. Int J Health Care Qual Assur. 2007;20(2–3):141–160.Google Scholar
  21. 21.
    Howard PB, Clark JJ, Rayen MK, Hines-Martin V, Weaver P, Littrell R. Consumer satisfaction with services in a regional psychiatric hospital: a collaborative research project in Kentucky. Arch Psychiatr Nurs. 2001;15(1):10–23.Google Scholar
  22. 22.
    Woodring S, Polomano RC, Haagen BF, et al. Development and testing of patient satisfaction measure for inpatient psychiatric care. J Nurs Care Qual. 2004;19(2):137–148.Google Scholar
  23. 23.
    McIntyre K, Farrell M, David AS. What do psychiatric inpatients really want? BMJ. 1989;298(6667):159–160.Google Scholar
  24. 24.
    Marriage K, Petrie J, Worling D. Consumer satisfaction with an adolescent inpatient psychiatric unit. Can J Psychiatry. 2001;46(10):969–975.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.National Association of State Mental Health Program Directors Research Institute, Inc. (NRI)Falls ChurchUSA

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