威海市就诊病人反应性分析

世界卫生组织在《2000年世界卫生报告》中提出了卫生系统反应性（health system responsiveness）的概念和测量方法，并将其作为评价卫生绩效的三个方面之一。卫生系统反应性是指医疗卫生机构以个体普遍合理期望的认知和适当的反应。卫生系统的反应性由7个方面组成，分为两个部分。第一部分为对个人的尊重，包括尊严、保密性和自主性3个方面；第二部分为以病人为中心，包括及时性、社会支持、基本设施质量和选择性4个方面。本文根据成海实地调查情况，对当地的卫生系统反应性进行分析，了解其卫生系统绩效现状，为其合理制定当地卫生发展政策和战略提供依据。     

浅谈卫生系统非医疗因素反应性与健康促进

卫生系统反应性是指医疗卫生机构对公众普遍合理期望与需求的认知，并能及时准确地作出适当反应，以满足人们的合理需求与期望。反应性是为评价卫生系统运作绩效而设计的，是卫生系统的产出之一。目前，WHO提出的反应性主要评价人们在接受医疗卫生服务过程中对某些非医疗因素的合理期望与满意程度，这些非医疗因素主要包括：对待病人的尊严，主要体现病人应有的权利；在病人的需要为中心，主要提高病人对卫生服务的满意度。     

山西省公立和私立医疗机构反应性比较

《2000年世界卫生报告—卫生系统:改善绩效》中提出对卫生系统绩效评价的新框架包括3个主要目标,即健康、反应性和筹资的公平性。卫生系统反应性(responsiveness of health system)是卫生系统的产出之一,反映卫生服务提供过程的公平性,它是指医疗卫生机构对个体普遍合理期望的认知和适当的反应。一方面,好的反应性可以吸引消费者;另一方面,反应性与保护病人的权利、为病人提供及时、     

世界卫生组织关于卫生系统反应性测量的策略

反应性是WHO评价卫生系统运行绩效的三个内在目标之一,WHO对卫生系统反应性测量的基本策略是：（1）达到对反应性概念的理解和指导反应性测量的共识;（2）形成反应性测量可靠与有效的方法;（3）确保反应性资料收集的负担及费用经济有效;（4）促使反应性测量与反应性改善联系在一起。     

黄石市社区卫生服务反应性评价

反应性是指卫生系统在运行中能认识并设法适当满足个人的普遍、合理期望时的结果。根据反应性的定义,这种期望是一种普遍的、不受个人的经验和价值左右的现象,所有卫生系统有义务满足利用者的这类期望。目前,居民对社区卫生服务反应性已经成为判断社区卫生服务是否到位的基本指标之一。对黄石市社区卫生服务反应性进行了测量,明确反应性存在的问题,对提高社区卫生服务反应性具有重要的现实意义。     

辽宁省农村地区卫生系统反应性评价与分析

目的2000年世界卫生组织首次将卫生系统反应性作为卫生绩效评价的三大指标之一，它重点强调卫生系统在多大程度上满足了人群对卫生系统改善非健康方面的普遍的合理的期望。本次调研旨在了解与评价辽宁省农村地区的反应性水平，寻找差距，提出改善的对策。方法：采用世界卫生组织2000年对191个成员国进行的卫生系统反应性调查问卷(KIS)的方法，对八个方面的具体问题又采用Likert量化法，由调查对象根据就医时的感受进行回答。结果：我省农村地区的反应性水平为6．56，低于山东省和上海市，但又优于35个国家的平均水平。在反应性的总体评价中，八个方面由高到低的排序依次为社会支持、保密性、尊重、选择医护人员、候诊时的及时关注、维护个人自主权、沟通交流和就医环境的舒适度。结论：公众对卫生系统反应性水平的评价基本上是肯定的，但在就医环境的舒适度、尊重患者的自主权和参与治疗方案的决策权、满足患者就医时对健康相关问题的咨询权等方面仍有待于进一步提高。     

西部地区农村居民卫生系统反应性评价调查分析

本次研究采用分层随机抽样的方式在西部地区12个省(市/自治区)抽取36个样本县的居民作为调查对象,运用问卷调查法收集数据,研究我国西部地区农村居民卫生系统反应性评价现状,并为改善西部地区医疗卫生服务质量以及改善医患关系提供建议。调查发现,西部地区农村居民就医可及性还较差,医疗卫生服务反应性水平未能完全满足居民要求。建议进一步完善西部农村地区基层卫生服务体系建设,建立稳定的农村卫生投入机制;优化医疗服务流程,缩短居民候诊时间,提升卫生系统反应性水平,提高居民的就医满意度。     

郑州市卫生系统反应性评价及影响因素分析

目的 初步评价郑州市卫生系统反应性,探讨性别、年龄、婚姻、文化程度、职业、家庭收入等人口学特征与卫生系统反应性评分的相互关系。方法 用分层随机抽样的方法,抽取郑州市5家综合医院,采用世界卫生组织制订的〈居民健康和卫生系统反应性调查〉问卷进行调查。采用秩和检验方法对反应性进行初步评价,用典型相关分析方法探讨人口学特征和反应性评分之间的关系。结果 郑州市卫生系统反应性各方面中对基本环境的评价相对较低;人口学特征与卫生系统反应性评分之间呈典型相关,典型相关系数为0．286（P〈0．05）。结论 应进一步加强就医环境的改善,反应性各方面的提高是持续变化的过程。     

辽宁省农村地区卫生系统反应性评价与分析

目的2000年世界卫生组织首次将卫生系统反应性作为卫生绩效评价的三大指标之一,它重点强调卫生系统在多大程度上满足了人群对卫生系统改善非健康方面的普遍的合理的期望.本次调研旨在了解与评价辽宁省农村地区的反应性水平,寻找差距,提出改善的对策.方法采用世界卫生组织2000年对191个成员国进行的卫生系统反应性调查问卷(KIS)的方法,对8个方面的具体问题又采用Likert量化法,由调查对象根据就医时的感觉进行回答.结果我省农村地区的反应性水平为6.56,低于山东省和上海市,但又优于35个国家的平均水平.在反应性的总体评价中,8个方面由高到低的排序依次为社会支持、保密性、尊重、选择医护人员、候诊时的及时关注、维护个人自主权、沟通交流和就医环境的舒适度.结论公众对卫生系统反应性水平的评价基本上是肯定的,但在就医环境的舒适度、尊重患者的自主权和参与治疗方案的决策权、满足患者就医时对健康相关问题的咨询权等方面仍有待于进一步提高.     

贫困地区供需双方对县乡医疗机构反应性评价对比分析

卫生系统反应性(responsiveness of health system)是指卫生系统在多大程度上满足了人们对卫生系统中改善非健康方面普遍、合理的期望.<2000年世界卫生报告>将反应性作为评价卫生系统绩效的三大主要目标之一,其意义和作用已为国内外所公认.     

How do patients expect the mental health service system to act? Testing the WHO responsiveness concept for its appropriateness in mental health care

The World Health Organisation (WHO) concept of responsiveness has been defined as a measure of how well the health system responds to the population's legitimate expectations of non-health aspects of health care provision. It comprises eight domains: dignity, prompt attention, autonomy, choice of health care provider, clear communication, confidentiality, quality of basic amenities, and access to social support networks. The concept is of particular relevance to mental health care systems because of the specific dependency and vulnerability of their users. We tested its applicability to mental health care with five focus groups of experienced mental health care users in Hannover, Germany. The focus groups revealed 492 statements about users' expectations in mental health care. Most concerned attention (115), dignity (108) and autonomy (86). The quotations were assigned to the eight responsiveness domains. In addition, the domain of prompt attention was extended and renamed attention, and the new domain continuity was created. The findings correspond with the literature on health care expectations of non-mental health patients, but differ slightly from the results of a WHO study on overall health care responsiveness. The need for widening the concept of continuity and extending the attention domain reflects the nature of mental health care of providing predominately long-term care. Our analysis indicates the feasibility of the responsiveness concept (if altered as proposed) as a tool for assessing the quality of mental health service from the users' point of view. It should also be further developed to quantitatively evaluate mental health care systems and to benchmark system performance.     

Meeting patient's expectations in primary care consultations in Lithuania.

OBJECTIVE: Patient satisfaction with health care services is considered an important factor of health care. Although research on patient satisfaction has become standard in Western Europe, in countries such as Lithuania the concept of patient satisfaction is still a relatively new one. This study aimed to investigate how the meeting of patients' expectations is related to increased satisfaction with medical consultation. STUDY DESIGN: The methodology used by Williams et al. in the UK was applied to the Lithuanian health care setting. Forty physicians from 22 primary health care centres attending courses on general practice at Vilnius University were recruited for the study. Every third adult patient coming to a practice during a 5-day period was invited to participate in the study. In all, 609 patients coming to meet their physician regarding health problems were included in the study sample. The patients were asked to complete three standardized questionnaires: the Patient Intentions Questionnaire prior to the consultation, and the Expectations Met Questionnaire and Medical Interview Satisfaction Scale after the consultation. Cronbach's alpha statistic was used for the validation of the questionnaires and principal components analysis was used to determine the factors of patient expectations. RESULTS: The response rate was 78%. ANALYSIS: of 460 sets of questionnaires revealed that satisfaction with medical consultation is higher among patients who have a greater number of expectations met. Physicians' success in meeting different types of patient expectations also had different influences on patient satisfaction. The most important expectations to be met were "understanding and explanation", followed by expectations of "emotional support", while "getting information" was less important. CONCLUSIONS: The most frequently reported expectations on the Patient Intentions Questionnaire were for "getting information" and "understanding and explanation" of the patients' health problem items, and the least mentioned were for emotional support items. Patients with more expectations met were found to have significantly higher scores on the satisfaction index. Satisfaction with the consultation is best predicted by meeting the patient's expectations for understanding and explanation, and for emotional support. Providing desired information to the patient as well as meeting the patient's expectations for diagnostic procedures and treatment is less associated with patient satisfaction.     

The relationship between expectations and satisfaction: a qualitative study of patients' experiences of surgery for gynaecological cancer

It is important that a patient perspective is introduced to the identification and measurement of the outcomes of health care. The aim of this study was to use qualitative methods to examine the presence or absence of expectations prior to the experience of health care and the relationship between expectations, satisfaction and dissatisfaction in a group of women undergoing surgery in a large teaching hospital. Nineteen women with a diagnosis of gynaecological cancer were interviewed on two occasions, before and after surgery. A thematic analysis was undertaken. The results suggest that there is not a clear relationship between expectations and satisfaction. Women had different levels of expectations about different types of care and different aspects of care. Unfulfilled expectations did not lead to less satisfaction. The women were able to express satisfaction either with the care overall or with specific aspects of care, as well as being able to distinguish aspects of care with which they were dissatisfied.     

European patients' views on the responsiveness of health systems and healthcare providers

BACKGROUND: Responsiveness to patients is now seen as a key characteristic of effective health systems. This study aimed to learn more about European people's views on the responsiveness of their country's health systems and healthcare providers. METHODS: Telephone survey with random samples of the populations in Germany, Italy, Poland, Slovenia, Spain, Sweden, Switzerland and the UK using random digit dialling. RESULTS: Responses were obtained from 8119 people aged 16 and over. Just over half the respondents said that doctors always listened carefully to them, gave them time for questions and provided clear explanations. Respondents from Switzerland and the UK reported consistently high rates of satisfaction with doctors' communication skills, while respondents from Poland were significantly less satisfied. Younger people were more critical than older people. Expectations of patient involvement in treatment decisions were high, particularly among younger people, with 74% indicating a desire to be actively involved. Most respondents felt they should have a choice of primary care doctor, specialist doctor and hospital, but less than half felt they had sufficient information to make an informed choice. There were significant variations between the countries in reported levels of involvement and in satisfaction with opportunities for choice. CONCLUSIONS: The results suggest that many European patients want a more autonomous role in health care decision-making. Policy-makers and clinicians should consider how to narrow the gap between public expectations and patients' experience.     

The challenges to transparency in reporting medical errors

In an ideal health care environment, physicians and health care organizations would acknowledge and factually report all medical errors and "near misses" in an effort to improve future patient safety by better identifying systemic safety lapses. Truth must permeate the health care system to achieve the goal of transparency. The Institute of Medicine has estimated that 44,000 to 98,000 patients die each year as a result of medical errors. Improving the reporting of medical errors and near misses is essential for better prevention of medical errors and thus increasing patient safety. Higher rates of reporting can permit identification of the root causes of errors and create improved processes that can significantly reduce errors in future patient care. Multiple barriers exist with respect to reporting medical errors, despite the ethical and various professional, regulatory, and legislative expectations and requirements generating this obligation. As long as physicians perceive that they are at risk for sanctions, malpractice claims, and unpredictable compensation of injured patients as determined by the United States' tort law system, legislative or regulative reform is unlikely to affect the underreporting of medical errors, and patient safety cannot benefit from the lessons derived from past medical errors and near misses. A new infrastructure for creating patient safety systems, as identified in the Patient Safety and Quality Improvement Act of 2005 is needed. A patient compensation system guided by an administrative health court that includes some form of no-fault insurance must be studied to identify benefits and risks. Most urgent is the development of a reporting system for medical errors and near misses that is transparent and effectively recognizes the legitimate concerns of physicians and health care providers and improves patient safety.     

Quality of care and patient satisfaction in budget-holding clinics

A budget-holding program was implemented in nine primary care clinics in the Negev district of Kupat Holim Clinic, Israel's largest sick fund. This study, carried out from 1991 to 1994, evaluates the impact of this program on patient satisfaction and other selected indicators of quality of care, using a controlled case study methodology. Structured questionnaires were used in face-to-face interviews with a representative stratified sample of 523 patients registered in the clinics. Patient reports were used to measure patient satisfaction, accessibility of services, comprehensiveness of care, responsiveness to patients' needs and performance of preventive medicine activities. Other research tools included staff surveys, in-depth interviews and administrative data on transfer among sick funds. The findings counter fears that budgetary control and cost-containment negatively affect quality of care and patient satisfaction. However, the program did not fulfill expectations regarding improvement in clinic services and patient satisfaction.     

Optimizing primary care telephone access and patient satisfaction

Telephone medicine is often preferred by patients to meet primary care needs and may be associated with high patient satisfaction. This article presents findings about incoming patient calls to primary care for medically based reasons during office hours and reports factors independently associated with telephone encounter satisfaction, considering patient characteristics, call reasons, and staff responsiveness, for a national cohort of primary care users. Interviews were conducted with patients from 18 nationwide primary care clinics during the fall of 2009. Calling for an urgent medical issue was associated with dissatisfaction. Odds of call satisfaction were greater when patients thought staff was friendly (10×), call answer was timely (5×), and needed medical information was provided (7×). These findings can be used for interventions to optimize telephone access and patient satisfaction which is beneficial because satisfactory telephone encounters reduce primary care use and satisfied patients are more likely to be engaged in their health care.     

Satisfaction and responsiveness with health-care services in Qatar—evidence from a survey

BackgroundSatisfaction and responsiveness with health care are some of the main outcome variables of a health system. Although health outcomes have been studied in countries with different levels of economic development, there is limited information on the health provision/satisfaction/responsiveness nexus in countries where rapid transitions from middle to high-income status have occurred.MethodsUsing a 2012 survey conducted in Qatar (amongst both Qatari and non-Qatari respondents), we analysed satisfaction and responsiveness of health care. The sample consisted of 4083 respondents. We use logit analysis [as well as robustness checks involving ordered logit, ordered probit, ordinary least squares (OLS) and probit analysis] in order to estimate the determinants of satisfaction and responsiveness.ResultsBoth, satisfaction and responsiveness rates were high. Gender, nationality and, to some extent, income and age were significant sociodemographic determinants of satisfaction, with non-Qataris and females, having higher levels of satisfaction. Cost, previous experience with the same health provider and provision of medical insurance for a particular health provider were the attributes significantly correlated with general satisfaction. The results are consistent when the analysis is applied to the correlates of responsiveness.ConclusionsSociodemographic factors explain the satisfaction with quality of health care in the state of Qatar (both from the general population point of view and from the patient point of view).     

卫生系统反应性研究概况

卫生系统反应性是卫生系统的产出之一。《2000年世界卫生报告》将反应性作为评价卫生系统绩效的三大主要目标之一。本文对反应性的概念、构成、测量工具及评价方法等进行简单介绍,并对目前国内对于卫生系统反应性的研究现状进行了简要回顾和讨论。     

The role of understanding customer expectations in aged care

PURPOSE: The purpose of this paper is to argue that understanding and exceeding customer expectations in the aged care services is more complex than other health services and general services because of the multiple stakeholders and additional intimacies that exist. DESIGN/METHOD/APPROACH: The author first explores expectation theory and how it links to customer behaviour and then discusses confirmation/disconfirmation theory. FINDINGS: The author builds an argument that aged care service providers must understand consumer needs and expectations so that customer satisfaction is generated. ORIGINALITY/VALUE: Exploring patient and relative expectation and satisfaction in different theoretical contexts.