Recorded presentation

Miguel Madueño, MSc, M&E Component, PHRplus Peru, Antequera 777, San Isidro, Lima, Peru, 51 1 4225544, mmadueno@phrplus.org.pe

Context and objectives: The definition of hospital policies to improve quality of health services requires information regarding the impact of quality management program on client satisfaction levels. Measures of client satisfaction levels based on headcount have been particularly weak in three respects: they have low sensitivity to changes on quality management programs; they bias geographic and cross-facility comparisons; and finally, they have aggregation problems. This study proposes an alternative methodological approach to assess performance of quality management program in health facility based on client dissatisfaction index.

Method: This index is built on the basis of the FGT poverty measures proposed by Foster, Thorbecke and Greer and presents good properties for impact assessment purposes (i.e. monotonic, reflexivity and additive decomposition properties). The client dissatisfaction measure is a compound index and is responsive to changes in the headcount measure (FGT0), the dissatisfaction gap (FGT1) and the variability of dissatisfaction among health clients (FGT2). Econometrics techniques, such as, Principal Components, Optimal Scaling, and Alternated Least Squares, appear to be suitable to estimate (a) the overall client dissatisfaction index; (b) the client dissatisfaction index for each type of health services and attribute levels (for example; waiting times, responsiveness of the provider, cleanliness, comfort, etc.); and (c) the partial contribution of each attribute level to the overall client dissatisfaction index. The latter is particularly relevant to facility’s manager because it provides key information for defining quality management priorities. This methodology has been empirically tested in hospitals at selected sites of Peru using external and internal client surveys.

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