Results from the focus groups show differences between Hispanics and blacks in several dimensions of satisfaction with hospital care. We also found newly observed racial and ethnic differences in the importance of each dimension and its effect on overall experiences with hospitalization. Participants identified two additional themes that are not commonly examined in many patient satisfaction instruments: attitudes of social workers and nursing staff, and availability and quality of translators.
Numerous studies have demonstrated racial and ethnic differences in experiences with care but the processes that account for these differences are not well understood. In a prior study, we found that some differences may be due to the medical or surgical services providing care during hospitalization.20
We found that medical patients were less satisfied with their care overall than surgical or obstetrical patients; however, black and Hispanic patients who received their care on obstetrical and surgical services were more likely than white patients to perceive that their preferences were not well respected. We hypothesized that those racial and ethnic differences in perceived respect for patients’ preferences among obstetrical and surgical patients might reflect differences in unmeasured patient expectations to receive differential therapies when hospitalized for surgical procedures. This hypothesis is consistent with our finding that Hispanic women in our obstetrics focus groups reported feeling pressure to have surgical procedures (such as tubal ligation) performed and that black women often noted that their preferences for postpartum length of stay were not respected. These findings are particularly important, as prior research has demonstrated that Hispanic and black women are more likely to terminate breast feeding their infants earlier than non-Hispanic white women and that these differences may be attributable to differences in postpartum length of stay.25
Prior studies have documented racial and ethnic differences in satisfaction with provider communication and management, the adequacy of pain management, and in patients’ perceptions of their ability to participate in their care.4,13,14,26–28
To our knowledge, ours is the first study to describe the relative importance of each dimension of care in forming patients’ overall experiences with their hospitalization and that these dimensions differ by race/ethnicity. If confirmed in larger studies, our findings may help hospital administrators and staff to prioritize areas better for quality improvement when seeking to improve overall patient satisfaction. Examining reports of patients’ satisfaction by dimensions of their experiences may provide a guide to developing interventions to reduce racial disparities in satisfaction with hospital care.
Both black and Hispanic participants in our focus groups emphasized the importance of the availability and attitudes of social workers in determining their overall experiences of care. There have been several studies that have examined the role of perceived provider attitudes, including perceptions of provider prejudice, in determining patients’ experiences of the patient–physician relationship.10,29–30
For example, in a study of African-American and white Veteran’s Affairs patients with coronary artery disease29
, participants rated provider communication and attitudes as a major theme potentially related to racial/ethnic differences in cardiovascular outcomes. Our study, however, demonstrates that attitudes of nonphysician staff may also play a critical role in inpatients’ experiences with care. If confirmed, our findings suggest that hospital administrators should focus programs, such as training on patient-centered counseling techniques, on allied health professionals and social workers in addition to nurses and physicians.
Hispanic participants from both discharge services also emphasized the importance of having well qualified interpreters readily available as a major predictor of satisfaction with care. These findings are supported by prior studies that have examined the link between limited English proficiency among patients and their difficulty with navigating a complex health care delivery system.31–32
These findings further underscore the need for health care systems to recruit a diverse work force that is culturally competent and emphasizes the need for hospitals to increase staffing to provide adequate interpreter services.
There are several potential limitations to our study. Although focus group research is a valuable and effective method for exploring patients’ health-related needs and perception of health care quality, they may include a self-selected group of individuals who may be more articulate about their opinions than nonparticipants or may have had more extremely negative or positive experiences than the norm, potentially leading to biased results. The majority of our cardiovascular disease participants (73%) were women; as a result, if gender differences in cardiovascular disease patient experiences exist, information regarding these patients’ experiences may be biased toward the women in our groups. As well, we recruited a small number of patients from a larger sample who received their care at a single large urban teaching hospital. As a result, our findings may not be representative of the larger sample or generalizable to smaller, rural, or public hospitals where there may be differences in the racial and ethnic mix of patients or in processes of inpatient care. The results do demonstrate the feasibility of conducting a study of racial and ethnic differences in processes and outcomes of care within a single institution to examine potentially modifiable variables to target for intervention.33