Patients want quality, quantity time with PTs

Research shows patients care less about wait times

Conventional wisdom — and indeed, much literature — supports the idea that satisfied patients are impressed with short waiting times, good parking, convenient locations, and sophisticated equipment. But a new study looking at patient satisfaction with physical therapy clinics found that what patients really care about is the quality and quantity of time they spend with their therapist.

According to the study, published recently in the journal Physical Therapy, patients rate first in importance the amount of time the therapist spends with them, along with the therapist’s listening and communication skills and the therapist’s willingness to give clear explanations of treatment.1 The quality of patient-therapist interaction counts for much more than high-tech medical hardware, accessible parking, and convenient location and office hours. Researchers surveyed a sample of 1,868 worker’s compensation patients from clinics in 17 states in an effort to measure the effectiveness of a patient satisfaction survey instrument the authors developed.

Study findings defy conventional wisdom

"Based on the current literature regarding customer satisfaction, as well as conventional wisdom, we asked questions about things like parking, location, equipment quality, things that arguably would be of interest to a consumer," says Paul Beattie, PhD, PT, OCS, clinical associate professor in the department of exercise science at the University of South Carolina’s School of Public Health in Columbia. "We found that none of those things correlated significantly with the overall satisfaction with care. The big things were that they wanted to have quality time with the therapist and to have that person answer their questions, provide information, and spend adequate time with them.

"Our primary objective was to develop an instrument and determine its measurement properties," Beattie says, "but when I saw these results, it was almost astonishing. It was a very strong relationship, and I think it’s significant in terms of practice."

The waiting time issue might be the most surprising. "As a patient, you may say that a lengthy waiting time was worth it if the therapist really paid attention to you, answered all your questions, and provided high-quality care," Beattie says. "On the other hand, you could go to a palatial clinic where you are quickly moved through without adequate time or attention from your therapist, and you’re going to be dissatisfied with that experience."

Maximizing income, minimizing time

Diminishing reimbursement and increasing demands for patient care, which face all health care providers in today’s market, motivated the researchers to do the study. "There has been a trend in many clinics to try to maximize income by seeing more patients and using care extenders to get more patients in, and that often results in decreased one-on-one time between the patient and the therapist," Beattie says. "One of the messages from the study is that as we progress through this wacky health care delivery system we have now, everybody on the team needs to come up with strategies to maximize the time with patients to remain competitive."

Beattie recalls that in the late 90s, when he worked in a large orthopedic practice in upstate New York, there was a gradual demand to see more and more patients. "Pretty soon, I was clearly seeing more patients than I felt like I could do and provide quality work. And yet I was told that was the nature of practice in the current millennium," he says. "So when I saw the results of this study, it really confirmed my own bias and my own observations that patients don’t like it either."

The problem of increasing patient volume is particularly difficult in physical therapy, Beattie says, because the treatment is so time-intensive. He suggests to his students and the clinics with whom he consults that they look at ways to lower overhead expenses such as administrative costs, office space, and equipment. "Physical therapists can be quite successful in a low-overhead environment," Beattie says. "They also need to look at how much time is allotted to each patient. At what point, by reducing patient time to increase revenue, do you ultimately wind up hurting your business?"

This is a purely theoretical exercise unless you have objective data to measure patient satisfaction, which historically has been difficult for physical therapy clinics in the absence of instruments specifically designed for them. Because patients come for frequent visits over a short period of time and tend to stay longer at each visit than they would at a typical physician visit, the satisfaction surveys used by other providers may not be appropriate. Several recent instruments, including the one designed in this study, can alleviate that problem, as long as therapists realize the importance of making the effort to measure satisfaction, the authors say.

"In the United States, physical therapists are really under the gun. They’re having to see a lot of people, and the documentation has become absurd," Beattie says. "People hesitate to start to do anything else they feel will detract from their already stressed-out time with patients. The trick is to administer the survey during non-patient-care time, such as when the patient is getting ready to leave. I think most clinics really want to measure patient satisfaction, but they just don’t know how to do it."

Satisfied patients follow regimes better

High patient satisfaction also benefits the clinical side of the practice. "Patients who are satisfied come back, and they refer others to your clinic, but they also are more likely to follow through on their therapeutic regime," says Roger Nelson, PhD, PT, another survey author and chairman of the department of physical therapy at Lebanon Valley College in Annville, PA. Nelson also is vice president of Expert Clinical Benchmarks, part of King of Prussia, PA-based MedRisk Corp., which is offering the survey instrument to physical therapy clinics. "Physical therapists have a unique responsibility. We teach patients how to get better themselves. It does no good to only do the exercises while they’re in the office. They have to do it at home as well."

Physical therapy providers might balk at the extra time and effort it would take to measure satisfaction, but they should consider it in order to ensure their long-term viability, says Mary Beth Pinto, PhD, another of the study’s authors and an assistant professor of marketing in the School of Business at Penn State Erie in Erie, PA. "If we think of health care as a free market, if patients really have the opportunity to choose providers, then they’re not going to go to people who don’t demonstrate caring. In the long run, these people are going to have problems," she says. "To be a successful health care provider, you have to function as a business that cares about its customers. Service is the key."

The marketing literature is filled with evidence that customer satisfaction is multidimensional, Pinto says, and that’s true for health care just as in business. But the difference is that the environmental issues don’t seem to be as important in a health care setting as they are in a lawyer’s office. "A lot of people don’t have the technical ability to evaluate the services. So when I go into a lawyer’s office, how do I know I’m getting a good divorce? Well, I look around for cues that suggest this person is going to give me a good divorce. If I see folding chairs, what am I going to think?" Pinto says. "But what we found in this study is that it’s not the most important thing for physical therapy clinics. The most important thing is the therapeutic alliance, the patient-provider interaction."

Another key point to remember is that physical therapists will probably define quality differently from their patients. Therapists might think in terms of the quality of the specific treatment given, but consumers don’t know how to judge that because they don’t have the medical knowledge or training. Patients are more likely to judge the physical therapist’s attitude or the way questions are answered. And since patients are the ones with the pocketbooks, their opinions are the ones that are likely to ensure the ongoing success of the practice, according to another of Pinto’s studies.2

References

1. Beattie P, Pinto MB, et al. Patient satisfaction with outpatient physical therapy care: Instrument validation and identification of important components. Phys Ther 2002; 82:557.

2. Pinto MB. Outcome measures in assessing physical therapy. Orthop Phys Ther Clin North Am 1995; 4:269-281.

Need More Information?
  • Mary Beth Pinto, Assistant Professor of Marketing, School of Business, Penn State Erie, The Behrend College, 5091 Station Road, Erie, PA 16563-1400. Telephone: (814) 898-6348. E-mail: mxp49@psu.edu.
  • Paul Beattie, Clinical Associate Professor, Department of Exercise Science, School of Public Health, University of South Carolina, Columbia, SC 29208. Telephone: (803) 777-5028. E-mail: pbeattie@sph.sc.edu.
  • Roger Nelson, Vice President, Expert Clinical Benchmarks, MedRisk Corp., 640 Freedom Business Center, Suite 300, King Of Prussia, PA 19406-1332. Telephone: (800) 814-8712. Web site: www.medrisknet.com.