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Monday, July 9, 2018

Innovation To Patient's Satisfaction In The Romanian Healthcare

Image result for patients satisfactionThe word is evolving since the 1980s with many influential forces. For instance, globalization, technology innovations or demographic changes have contributed to the economic, political and social transformation worldwide. Globalization represents a multi-faceted phenomenon today in the modern society that has an impact on the global healthcare system(Burcea, Toma and Papuc, 2014). This is considered an important topic in a health care system because it constitutes to the fact that some of its effects such as; disparities among the health infrastructure in different countries, the free movement of doctors, the increase rate of disease burden and the medical tourism have raised governmental difficulties all over the world (Azevedo and Johnson, 2011)

The healthcare service is a market that is confronted with many challenges and competition in the sense of the development of the private medical providers. Meanwhile, the patients have become increasingly more informed of the various options of treatment because of the availability of the medical information provided by many online platforms. This results in high expectations of patients towards their physicians to be able to provide the necessary information which is suitable to answer the questions of the patients. They as well expect politeness, empathy and attention from their doctors which brings them very close to the traditional meaning of consumer profile (Coțiu and Sabou, 2017).
Gradually, the healthcare system has become more of a complex political, social and economic environment in the recent globalized world. It undergoes pressures (for example; financial, demographic and technological) in order to deliver good quality services to the patients. As a consequence, the protection of patients’ rights has evolved within the key aspect of the agenda of the new global health (Ahoobim et al., 2012). The national public health organizations, health promotion agencies, health service providers, scientific research institutions and consumers association have put significant efforts to promote and support the patients’ rights protection around the world. In the last decades, researchers have conducted analysis on the rights of patients, their protection and its direct/indirect link with the healthcare quality and its improvement(Green et al., 2012).

There are studies that indicate the importance of customer expectations in the healthcare system. This is described as a means of desires to seek for the assistance from the doctor, demands or wants and preferences. Expectations from patients is important because it implies their involvement and creates the possibilities to better access of health services. Patients expectations from the Romanian healthcare providers are based on, firstly the model on active passivity which describes the physician-patient relationship in Romania. Within years of passivity, the Romanian system has moved to a more democratic approach. This is a new approach that focuses on the call for more client-centred orientation in the healthcare services. Therefore, the knowledge and awareness are expected to meet the needs of the patients. Secondly, patients measure their expectations based on their level of satisfaction with the healthcare services. This is mostly used as an indicator of the medical care outcome. Thirdly, the first step to prevent dissatisfied patients is through the knowledge of the patients’ needs, because this may result to discontinuity of care and cost ineffectiveness of the healthcare(Ionilã, Ana-Claudia, A-C Bara, WJA van den Heuvel, 200AD).

Patients satisfaction is an important part of the quality assessment of the healthcare system (Williams et al., 1995)

There are two dimensions used to improve the patient satisfaction:- The procedural dimension of the quality of the provided services such as the time spent at the waiting reception before getting the required medical attention, the condition of the accommodation provided according to the needs of the patient, and the doctor or physicians anticipated with the patient’s needs and, The personal dimension of the provided service quality-that is, the physical aspect of cleanness, maintenance of the facility, the attitude of the practitioner towards the patients, the demonstration of the body language between the physician and the patient and the voice tone used to address the patients (Agheorghiesei and Copoeru, 2013)

Over the past 10 years, there are many changes that occurred in the Romanian healthcare system.  These changes include the health insurance system, the role of the general practitioner, the position of hospitals and privatization. It is expected that the consumer satisfaction is related to the general healthcare system because of the significance of the role the primary care plays in the new healthcare reform as it has been shown in the transition of other countries(Bara et al., 2002).
The most used instrument in measuring patient satisfaction is a questionnaire survey which usually applied during the discharge moment of patients from hospitals.  Studies have suggested that the method of satisfaction measurement uses a broad and vague term that results in short, superficial, and affirmative answers without any true meaning. Several researchers have brought to attention the notion of “patient satisfaction”. Although this term is commonly used in evaluating and guiding the delivery of healthcare services, it is likely to be related to the quality of services rather than the quality of care provided. “According to Pomerantz, several changes have occurred within the recent years on the perception healthcare service users on quality care, and he suggested that an increase in the focus of patients’ needs and preferences may help better oriented medical care, compared to the adherence of the standard of care”. 

The most frequent aspect of satisfaction and dissatisfaction in the healthcare services is professionalism among the providers. Professionalism is an area that includes various sub-categories such as, advancement in medical knowledge, improved level of development in clinical competence, strong ethical morals and standards, sharing of honesty and respect as values, and showing empathy, courtesy and kind attitude towards the patients. In economically developed countries such as the Western European countries and USA, the medical orientation act changed from a “predominantly doctor-oriented approach to a patient-centred culture”. This cannot be expressed in Eastern Europe, which is influenced by corruption, informal payments and in need of a new reform 5, 20. Since the 1970s, Eastern European countries are slagging behind Western European countries in terms of healthcare quality because of its communist policy throughout the region. Romanian has the lowest level of patient satisfaction in Europe. Romania is faced with other challenges that are related to the lack of access to health services among the less privileged communities.  The general dissatisfaction and cynicism in Romania are owned by the country’s poor economic performance, which limits the freedom of the individual to explain a greater degree in behavioural and environmental factors(Popa et al., 2017).

INNOVATION FOR IMPROVING PATIENT SATISFACTION(Agency for Healthcare Research and Quality, 2014):

Implementing Staff Training:
It has been brought to attention that most hospital staff such as the physician or the healthcare organizers have expressed their concern to ask patients personal questions that include their race, ethnicity and language. They believe that it may offend the patient. In addition, most physicians may be time-sensitive towards the modern nature of clinical practice and want to ensure the effectiveness of asking questions. For data to be accurate and consistent, healthcare organizations are required to invest in clinical training among all staff levels (health professionals, administrative staff, hospitals and health plan leadership), which includes integrating the significance of the data for detecting and addressing health care needs. For instance, those assigned to the task of asking questions directly to the patients, enrollees can receive a front-line training on the importance of collecting the information, how to use the information and the means of collecting the data, and how to address the concerns of the patients, enrollees and other members.

The training exercise should be based on the context and the methods of collecting and utilizing the data. For example, health plan staff who do not have face-to-face communication with the enrollees can obtain the demographic information through telephone encounters. Therefore, there should a training for “telephone means of collecting data” because pre-registration by telephone can occur before hospital admission or ambulatory care appointments.  Before establishing a formal training session with the medical staff, an assessment should be conducted based on the practices and determine what is currently happening and identify the necessary changes. These changes will be clearly communicated among the staff members during the training session.

Sharing and Collecting of Data Across the Healthcare System:
The health system is a diverse set of a public and private entity that contribute to the collection of data including health surveys, administrative enrollment, billing records and medical records used by different medical departments such as the hospitals, CHCs, physicians and health plan management. The data collected on the patient’s race, language and ethnicity are extended to these entities suggesting that each can collaborate to obtain and sustain the patient’s medical record.  No one of the entities can individually gather the necessary information regarding the population of patients, neither can they collect the health data on an individual patient.  Therefore, it is important to increase the integration of data from other sources within and across the healthcare system.

Many observed three main issues with patient-reported measures, the feedback provided by the patients may not be conclusive because they acquire little or no formal medical training. “Critics hold that patient-reported measures that include patient satisfaction signify an aspect of happiness” as they consider the process to be subjective among patients, which can be influenced by other factors that is not related to health care. The patient’s experience measures could be confounded by aspects that may not be linked to the quality process of the health services.  For instance, it could be a case where the patient may rate their experiences that is based on their subjective assessment of their health status instead of the experience of the healthcare services provided to them. Finally, the experiences of patients may be reversed to the fulfilment of the actual desire of the patient. For example, “the receipt of a specific medication regardless of its benefit”. These problems may decrease the validity of the patient’s perception(LaVela and Gallan, 2014).

A significant factor that influences the satisfaction of patients is the medical services bounded by the medical personnel. Firstly, the level of information provided by the medical staff on the schemes of new treatment, the appearances of advanced medical equipment for diagnosis and investigation, and the medical process can generate a better result in customer satisfaction and, the behavior and attitude of the medical personnel is considered important because it can improve the communication between the doctors and the patients (Economics, Domain and Thesis, 2015).


 Agency for Healthcare Research and Quality (2014) Improving Data Collection across the Health Care System | Agency for Healthcare Research & Quality, U.S Department of Health and Human Services. Available at: (Accessed: 27 April 2018).

Agheorghiesei, D.-T. and Copoeru, I. (2013) ‘Evaluating Patient Satisfaction – A Matter of Ethics in the Context of the Accreditation Process of the Romanian Hospitals’, Procedia -Social and Behavioral Sciences World Conference on Psychology and Sociology, 82, pp. 404–410. doi: 10.1016/j.sbspro.2013.06.283.

Ahoobim, O. et al. (2012) ‘Council on Foreign Relations The New Global Health Agenda’. Available at: (Accessed: 20 April 2018).

Azevedo, M. J. and Johnson, B. H. (2011) ‘The Impact of Globalization Determinants and the Health of the World’s Population’, INTECH. Available at: (Accessed: 20 April 2018).

Burcea, M., Toma, S.-G. and Papuc, R.-M. (2014) ‘PATIENTS’ SATISFACTION WITH THE HEALTH CARE SYSTEM IN THE AGE OF GLOBALIZATION: THE CASE OF ROMANIA* Marin BURCEA Sorin-George TOMA Răzvan-Mihail PAPUC’, Transylvanian Review of Administrative Sciences, Special Issue, pp. 5–20. Available at: (Accessed: 18 April 2018).

Coțiu, M. A. and Sabou, A. (2017) ‘Patient Satisfaction with Diabetes Care in Romania – An Importance-performance Analysis’, in. Springer, Cham, pp. 297–302. doi: 10.1007/978-3-319-52875-5_62.

Green, S. et al. (2012) ‘Aligning quality improvement to population health’, International Journal for Quality in Health Care, 24(5), pp. 441–442. doi: 10.1093/intqhc/mzs049.

Ionilã, Ana-Claudia, A C Bara, WJA van den Heuvel, J. M. (200AD) ‘The Romanian health care system in transition from the users’ perspective’, Ionilã, Ana-Claudia. Available at: (Accessed: 27 April 2018).

Williams, S. et al. (1995) ‘Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction?’, Family Practice. Oxford University Press, 12(2), pp. 193–201. doi: 10.1093/fampra/12.2.193.

Bara, A. C. et al. (2002) ‘Users ’ satisfaction with the Romanian health care system : an evaluation of recent health care reforms’, European Journal of Public Health, 12(4), pp. 39–40.

Economics, F. O. F., Domain, M. and Thesis, D. (2015) ‘Doctoral School in Economics and Business Administration Study Regarding the Measurement of Consumer Satisfaction in Healthcare’.

LaVela, S. and Gallan, A. (2014) ‘Evaluation and Measurement of Patient Experience’, Patient Experience Journal, 1(1), pp. 28–36. Available at:

Popa, D. et al. (2017) ‘Patients’ perceptions of healthcare professionalism - A Romanian experience’, BMC Health Services Research, 17(1). doi: 10.1186/s12913-017-2412-z.


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