Maîtrise de la qualité dans les hôpitaux universitaires: satisfaction des patients

[Table des matières] Introduction et présentation des projets / B. Burnand, JP. Vader, F. Paccaud. - La satisfaction du patient hospitalisé : un petit guide / M. Lorenzini, Y. Eggli. - "Satisfaction du patient hospitalisé": enquête exploratoire par entretien / M. Lorenzini. - Patientenzufriedenheit, Studie Kardiologie Bern/Basel: Schlussbericht / M. Langenegger. - Notfallstation und Spitalaufenthalt aus der Sicht des Patienten : eine kundenorientierte, repräsentative Erhebung / W. Langewitz, H. Weber, M. Zierath. - Satisfaction des patients hospitalisés pour cardiopathie ischémique aiguë / B. Burnand, K. Dupriez, T. Pernegger, MD. Schaller, JM. Gaspoz. - Commentaires et recommandations / B. Burnand, JP. Vader, F. Paccaud. Annexes: Questionnaire "Appréciation critique de votre séjour hospitalier". - Questionnaire de satisfaction du Service des hospices cantonaux "Votre séjour à l'hôpital - votre point de vue"; etc.

Stress et satisfaction au travail des cadres intermédiaires dans les hôpitaux de Suisse romande dans un contexte de réformes

L'article vise à identifier les déterminants du stress et de la satisfaction au travail parmi une population de cadres intermédiaires exerçant dans des établissements hospitaliers de Suisse romande. Il vise également à combler un vide dans les études sur les administrations publiques suisses: mieux saisir, au moyen d'une enquête par questionnaires, quels sont les principales variables qui se trouvent à l'origine de la satisfaction au travail et qui peuvent être des ressources pour les acteurs afin de faire face au stress. L'étude confirme des résultats de recherches internationales, montrant que des facteurs relationnels et des caractéristiques du travail sont les principaux déterminants du stress et de la satisfaction. Elle souligne dès lors l'importance d'adopter une lecture « structurelle » et « organisationnelle » du stress et de la satisfaction, soulignant aussi que les caractéristiques individuelles de la population étudiée n'expliquent qu'une très infime variance de ces phénomènes.

Enquête préliminaire et évaluation de la satisfaction globale des soins dans une structure ambulatoire psychiatrique pour enfants et adolescents

The complexity and difficulty of assessing psychiatric care for children and adolescents is a widely accepted reality. However, this should not discourage necessary efforts to stress the richness and efficiency of clinical practices, regardless of their theoretical models. We present the results of a quality-like survey addressing patient satisfaction and therapeutic alliance conducted in 2007 in an outpatient ward of the department of psychiatry for children and adolescents of the University of Lausanne (Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent - SUPEA, Lausanne). We developed a questionnaire on the basis of a "traditional" patient satisfaction survey, consisting of questions dealing with a range of different types of ambulatory settings and evaluating: access to care, quality of reception, patient's perception of the type of care and support offered, the therapeutic alliance and global satisfaction. Questions regarding the therapeutic alliance were based on the Revised Help Alliance Questionnaire (HAQ-II, Lester Luborski). Questionnaires were anonymous and self-administered by children from 10 years old up and parents separately. High levels of global satisfaction were reported (80% satisfied or very satisfied). Certain specific aspects seem to influence the global satisfaction level and therapeutic alliance. Patients with self-reported anxiety problems were less satisfied than those with selfreported conduct problems. The mode of reference of the patient, self or by parents versus by school or social workers, affected the perceived alliance. A higher frequency of sessions was also related to a better perceived alliance and satisfaction.

Marital satisfaction: Psychometric properties of the PFB and comparison with the DAS

This study examines the French versions of two marital satisfaction scales: the Dyadic Adjustment Scale (DAS) and the Partnership Questionnaire (PFB). 127 couples, married or living together for at least 3 years, participated in this research and each partner responded individually to both scales. The analysis revealed high internal consistencies for both scales and most of the subscales. Concerning the DAS, the factorial structure did not replicate the theoretical structure. Moreover, the structure underlying this scale seems unstable across cultures. On the other hand, the structure of the PFB seems reliable and stable through cultures. The correlation between the DAS and the PFB is high (r=.80) and the three canonical correlation variates explain about 60% of the variance of both scales. Both scales are sensitive to demographic variables and couple characteristics. The agreement within couples is high. The PFB seems well suited to assess marital satisfaction for clinical and research purposes.

Satisfaction of patients hospitalised in psychiatric hospitals: a randomised comparison of two psychiatric-specific and one generic satisfaction questionnaires.

BACKGROUND: While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital. METHODS: We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed. RESULTS: 728 out of 1550 eligible patients (47%) participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08), average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005), the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P < 0.001) and the Perceptions of Care questionnaire showed the highest ceiling effect (Saphora-Psy: 17.1%, Perceptions of Care: 41.9%, Picker: 36.3%; P < 0.001). There were no differences in the patients' evaluation of the questionnaires. CONCLUSION: Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients. However, if comparison across medical services or hospitals is desired, using a generic questionnaire might be advantageous.

Assessment of youth-friendly health care: a systematic review of indicators drawn from young people's perspectives.

PURPOSE: To review the literature on young people's perspectives on health care with a view to defining domains and indicators of youth-friendly care. METHODS: Three bibliographic databases were searched to identify studies that purportedly measured young people's perspectives on health care. Each study was assessed to identify the constructs, domains, and indicators of adolescent-friendly health care. RESULTS: Twenty-two studies were identified: 15 used quantitative methods, six used qualitative methods and one used mixed methodology. Eight domains stood out as central to young people's positive experience of care. These were: accessibility of health care; staff attitude; communication; medical competency; guideline-driven care; age appropriate environments; youth involvement in health care; and health outcomes. Staff attitudes, which included notions of respect and friendliness, appeared universally applicable, whereas other domains, such as an appropriate environment including cleanliness, were more specific to particular contexts. CONCLUSION: These eight domains provide a practical framework for assessing how well services are engaging young people. Measures of youth-friendly health care should address universally applicable indicators of youth-friendly care and may benefit from additional questions that are specific to the local health setting.

Organisational PSM Antecedents. Do HRM Practices Matter? Testing the Mediating Role of Job Satisfaction and Organisational Commitment

The present study aims to identify organisational antecedents of public service motivation (PSM). Numerous research has been devoted to the identification of socio-demographic PSM antecedents, or to its outcomes. However, organisational antecedents are understudied thus far. In order to fill this research gap, we question whether human resources management practices, whether intrinsic or extrinsic ones, might be related to PSM. Drawing on person-environment fit theoretical assumptions, we depart from the idea that PSM may be developed or sustained by HRM practices, which might contribute to create an environment allowing public employees to fulfill their needs or personal aspirations. Based upon a survey in an important Swiss municipality (N = 859), our findings surprisingly highlight that extrinsic HRM practices are significantly related to PSM, whereas intrinsic ones are not. Furthermore, when taking into account work-related outcomes, such as job satisfaction and organisational commitment, there is evidence of full mediation effects towards extrinsic HRM practices from organisational commitment. Astonishingly, neither job satisfaction nor intrinsic HRM practices are significantly related to PSM.