Along with the capability to access patient data from electronic medical records (EMRs), these researchers are also conducting clinical interviews with inpatients, at admission and at discharge, using the Brief Psychiatric Rating Scale Expanded Version (BPRS-E)10 and administer a 10 item self-report satisfaction measure, the Rome Opinion Questionnaire for Psychiatric Wards (ROQPW), to these same inpatients at discharge.11 While the BPRS-E has been shown to be sensitive to symptom changes over the course of an acute psychiatric admission,12 the ROQPW consists of three factors that measure the professional qualities of staff, information received by the patient, and the physical environment of the unit.11

The John George Hospital sample (N = 125, so far) comprises inpatients diagnosed with affective and non-affective psychotic disorders. At admission to John George Hospital, the mean BPRS-E total score for the sample is suggestive of severe psychopathology,13 while the mean BPRS-E change score demonstrates significant symptom improvement.14 At discharge, the mean BPRS-E total score signifies sub-acuity and is similar to BPRS-E scores reported in studies of outpatient populations with psychotic disorders.14 

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While the John George sample was highly satisfied as measured by the ROQSW total score, the general trend shows that total satisfaction does not correlate with BPRS-E admission or discharge total scores. Furthermore, overall symptom improvement, one of the most trusted outcome measures of successful treatment, was not significantly associated the total mean ROQSW satisfaction score at discharge. As the data reduction process unfolds, the researchers are finding that the determinants of inpatient satisfaction are complex and multidimensional.


Researchers will continue to uncover the determinants of satisfaction by dismantling satisfaction data in large samples and then testing satisfaction components for associations with patient, illness, treatment and provider variables, easily stored and accessed in EMRs. Determinants of satisfaction are likely broad, ranging from characteristics of the patients, providers, treatment processes, and therapeutic relationships, to the ward atmosphere, the clinical built environment, and social phenomena, such as mental illness stigma.

After decades of research on patient satisfaction, we have just begun to make strides in understanding the complex underpinnings of satisfaction among psychiatric inpatients. What we do know is that patient satisfaction is associated with numerous positive health outcomes, including quality of life and good prognosis.8 As a construct, the meaning of patient satisfaction is not yet fully understood. However, we are confident it will be revealed as researchers continue to uncover the underlying determinants of patient satisfaction.

David Sugarbaker, MS, MPH, is a clinical psychology doctoral candidate at Stanford University and a clinical intern at John George Psychiatric Hospital. Doug Cort, PhD, is a psychologist in private practice in Vallejo, Calif. Scott Zeller, MD, is Chief of Psychiatric Emergency Services at Alameda Health System in Oakland, California, and past president of the American Association for Emergency Psychiatry. He is also a member of the Psychiatry Advisor editorial board.


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