From Volume 9, Issue 4, October 2016 | Pages 150-152
The aim was to assess patient satisfaction with orthodontic treatment at John Radcliffe Hospital, Oxford. A questionnaire was handed out to patients undergoing orthodontic treatment. Results show great satisfaction with orthodontic treatment but the audit standard was not met in relation to facilities, the surgery environment and waiting times.
In the modern National Health Service (NHS), patients are consumers and can choose their healthcare provider. The careful shaping of healthcare to meet patients' needs and demands can lead to improved clinical outcomes and fewer complaints.1,2
Auditing patient satisfaction has become routine, with NHS management insisting on information on patients' experiences and perceptions of service3 and is now becoming mandatory under the Care Quality Commission guidance.4
The aims of this audit were to assess patient satisfaction with orthodontic treatment at the John Radcliffe Hospital, Oxford. In addition, it was to highlight areas of patient dissatisfaction and propose measures to mitigate against these.
Although a standard of 100% patient satisfaction would be the ideal, a gold standard of 90% was set, as used in previous audits on patient satisfaction with orthodontic treatment.5,6,7
This was a prospective questionnaire-based audit. A questionnaire that has been used in several other orthodontic patient satisfaction audits across the UK was used.7 It was handed out to patients undergoing a course of fixed or removable appliance treatment at the John Radcliffe Hospital, Oxford between April and May 2014. The exclusion criteria were patients who have completed or were yet to commence treatment. This included patients of all ages and treatments. Those under the care of trainees, staff grades and consultants were included. Patients were given the questionnaire on arrival at their appointment and requested to complete the form in the waiting room, place it in a blank envelope for the sake of anonymity and then post it into a letterbox by reception on completion.
The survey contained questions on a number of categories to include the orthodontist/patient relationship, technical quality of care, surgery environment, patient waiting times and facilities. Patients were requested to rate each answer in a tick box format with the possible options of ‘always’, ‘most of the time’ or ‘never’. Patients were also invited to make any further comments.
There was an 80% response rate as 64 questionnaires were returned out of the 80 that were handed out.
The results for the questionnaire are shown in Table 1. A number of positive comments can be seen in Figure 1. Negative comments and suggestions for improvement were based around the themes of:
| Question | ‘Always or most of the time’ responding | ‘Never’ responding | ‘Unanswered’ responding | Audit standard achieved |
|---|---|---|---|---|
| Orthodontist patient relationship | ||||
| My orthodontist treats me with respect | 100% (64) | 0% (0) | 0% (0) | Yes |
| My orthodontist is friendly | 98% (63) | 2% (1) | 0% (0) | Yes |
| My orthodontist provides me with the information that I need | 95% (61) | 5% (3) | 0% (0) | Yes |
| Technical quality of care | ||||
| My orthodontist pays attention to detail | 93% (60) | 5% (3) | 2% (1) | Yes |
| I have complete confidence in my orthodontist | 100% (64) | 0% (0) | 0% (0) | Yes |
| The treatment I receive is of a high standard | 98% (63) | 2% (1) | 0% (0) | Yes |
| Surgery environment | ||||
| I think my orthodontist and staff work well together | 90% (58) | 6% (4) | 3% (2) | Yes |
| The clinical areas are neat and clean | 90% (58) | 6% (4) | 3% (2) | Yes |
| The surgery has all the equipment necessary for my treatment | 84% (54) | 14% (9) | 2% (1) | No |
| Patient waiting times | ||||
| I am seen within 15–20 minutes | 89% (57) | 11% (7) | 0% (0) | No |
| I am happy waiting even when the clinic is running late | 89% (57) | 9% (6) | 2% (1) | Yes |
| I am certain my clinician knows I have arrived | 94% (60) | 6% (4) | 0% (0) | Yes |
| Facilities | ||||
| The waiting room is neat and clean | 81% (52) | 12% (8) | 7% (4) | No |
| The waiting room has a nice environment | 78% (50) | 15% (10) | 7% (4) | No |
| The toilets are accessible and clean | 92% (59) | 3% (2) | 5% (3) | Yes |
It is pleasing to note that almost all respondents appear to be satisfied with the relationship with their orthodontist. This high level of satisfaction continues into patient perceptions of the technical quality of care. Although the validity of the question can be challenged in that it would be assumed that most patients know very little about the technical aspects of care, the responses indicate that the overall perception of technical quality of care by patients is very favourable.
The audit standard was not met in relation to the availability of equipment in the surgeries. This may be explained by the current layout of the department in which there are two separate treatment rooms and a larger ‘poly’ clinic made up of four units. The majority of equipment is kept within the poly clinic. On some occasions when treating patients in the treatment rooms, nurses have to leave the rooms to collect equipment from the poly clinic, which may contribute to the delayed running of clinics and give rise to the response that the surgeries are not fully equipped.
The standard was not met in relation to waiting times. This is an issue that has been recurrently highlighted in other satisfaction audits.5,6,7 The reasons for patients not being seen on time can include; clinicians not booking adequate time for various procedures; double booking of appointments; surgeries not having adequate equipment; unforeseen or urgent care required during an appointment for which insufficient time may be available and also patients being seen after they have arrived late. Joint clinics often run late due to multiple consultants and trainees seeing the patients, with an emphasis on joint planning and teaching. Despite the late running of these clinics, patients felt that adequate time was taken for the best treatment to be provided and they were satisfied with the attention to detail and the quality of the treatment that they received.
The audit standard was not met in relation to the waiting room. Despite the waiting area having a television, drinking water, books and children's toys, the waiting room is now old and appears tired, especially in comparison to other areas of the hospital which have recently been refurbished. However, there are current plans to refurbish the orthodontic and maxillofacial surgery department.
There is an excellent orthodontist-patient relationship which department staff have worked hard to achieve and should strive to maintain and improve. However, an old and tired department reduces patient satisfaction, together with the late running of clinics, and lack of communication relating to this. Refurbishment of the department with an improved layout should aid in an efficient running of the clinic and improve satisfaction.
It is planned to carry out a re-audit following refurbishment of the department. However, if there are delays in refurbishing, a re-audit should be planned for early 2016. The re-audit is planned to be carried out as part of a regional audit on patient satisfaction and is planned to collect additional data on:
