Consumer Feedback and Determining Satisfaction with Services

Abstract

The World Health Organisation (WHO) philosophy of primary health care, as articulated in the Declaration of Alma Ata (1978), stresses the importance of involving the community in development, implementation and evaluation of services. The WHO principles of equity, accessibility, acceptability and cost-effectiveness echo Maxwell’s criteria for quality in health care (Maxwell, 1984). There is, however, little evidence to suggest that public participation in the determining and evaluation of primary health care services is widespread (Ashton and Seymour, 1988). Although the focus of this chapter is around gaining feedback from service users on the quality of the primary health care they receive, this is an integral part of the whole issue of ‘user-involvement’ in health care. The term ‘user-involvement’ encompasses a broad range of relationships between those who provide health care services and those who receive them. These relationships can be located on a continuum from simple information-giving, through consultation and establishing consumer satisfaction, to, at the highest level, user-participation in decision-making. Barnes and Wistow (1992) suggest that such user-involvement falls into two broad categories of purpose: 1. A desire to improve quality of health services to make them more sensitive to the needs and preferences of the individuals who use them; 2. A strategy to extend the capacity of users to participate in decisions about the design, management and review of health services.