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Author List:
Meterko M (HSR&D COLMR and Boston University School of Public Health)
Mohr DC (COLMR)
Young GJ (COLMR & BUSPH)
Objectives:
The ability of healthcare staff to accurately gauge patient’s reactions is crucial to the provision of “patient-centered” care. Successful service encounters depend on employees’ unbiased assessment of the impact of their actions in real time. The present study had two objectives: (1) to examine the degree of congruence between staff and patient perceptions of quality in VA, and (2) to examine individual and organizational characteristics that may affect degree of congruence.
Methods:
This study involved three VA national databases: (1) employee evaluations of the overall quality of care provided at each facility, obtained from the 2001 employee survey; (2) patient evaluations of overall quality of care, obtained from the 2001 national inpatient and ambulatory care surveys administered by the Office of Quality and Performance; (3) organizational culture, obtained from the 2000 National Quality Improvement Survey.
Correlations were computed at the facility level between employee and patient perceptions of the quality of healthcare provided at each facility. Stratified analyses were conducted by level of managerial responsibility and organization culture; the significance of the differences between strata were computed.
Results:
Staff and patient judgments of overall quality of care were correlated at .65 (inpatient) and .46 (outpatient). Front-line staff judgments of quality were more similar to patient judgments (r=.61) than middle (r=.46) or senior (r=.36) managers; differences between front-line staff and senior managers were significant (p<.01). A less bureaucratic culture was associated with more accurate staff perceptions (effect size substantial, but the difference was not significant). No interaction between culture and managerial level was observed.
Implications:
Staff and patients were in substantial agreement regarding the quality of VA care. Front-line staff were the most accurate and senior managers the least. A more bureaucratic organization culture appeared to blunt accuracy of staff perceptions. Results are discussed in terms leniency bias in performance assessment, proximity to the customer, and role theory.
Impacts:
Front-line staff largely agree with their customers regarding the quality of care provided at VA facilities and can thus serve as a valuable source of ideas regarding both areas of excellence and opportunities to make care even patient-centered. Facilities with more highly bureaucratic cultures may need to make extra efforts to stay in touch with patient needs and expectations.
