Tasiopoulos N, Zikopoulos K, Sivetidou S, Kaskanakou V, Georgopoulos Ch.
“ANAPLASI” REHABILITATION CENTER, ATHENS, GREECE
The Rehabilitation Center ANAPLASI commenced its activity in Athens, in 1996. The Center is an independent Rehabilitation Unit, treating patients on an outpatient basis. Since the beginning, it aims to reach high standards in Rehabilitation care. The Center implements and maintains, since 2000, a Quality Management System that fulfills the requirements of the ISO 9001 standard.
Our purpose was to collect data about patients’ opinion, regarding satisfaction and quality of care in a Rehabilitation Center that could be used to improve the quality of the offered rehabilitation services.
MATERIALS – METHOD
All patients completing a rehabilitation program after the ISO 9001 certification of the center were given a questionnaire containing 5 sections (each with 4-6 questions). The replies took the form of a scoring system 1 (unsatisfactory), 2 (satisfactory), 3 (good), 4 (very good), 5 (excellent) for the following categories: a. facilities available at the center b. quality of care given by medical staff and therapists c. safety and hygiene d. perceived level of knowledge and behavior of staff, e. financial.
After at least 6 months, all patients were called by phone and were requested to express their opinion regarding their treatment in ANAPLASI Rehabilitation Center and whether they were satisfied or not with the therapeutic outcome.
After analyzing these replies, the information was used to deal with criticisms and complaints according to the procedures proscribed by the Quality Control System. All answers were studied and some of them were taken into account to implement changes for the improvement of the system.
The participants were the first 882 patients that finished their treatment, after the date of ISO official certification. They aged less than 60 years old in 51, 1% and more than 60 years old in 48,9%. 511 suffered from musculoskeletal diseases and 371 from neurological diseases. We found out that good and very good answers ranged in all variables between 80 and 99%.
The degree of patients’ satisfaction was analyzed. We considered that it represented the result of a combined interaction between the needs and the expectations of each patient, since, before treatment, every patient was carefully informed about the nature of his medical problem and the anticipated therapeutic outcome, as well. In category a the 80% of replies were excellent, in category b 92% were excellent, in category c 99% were v, in category d 97% were excellent and in category e 94% were excellent.
The data is given in more detail as follows.
- A) The statistics were based on the analysis of data according to the 5 basic categories of interest and were as follows:
- Facilities. 80% of patients considered the facilities to be excellent. 20% scored the parking and changing facilities only, as satisfactory to good.
- QUALITY of care by medical staff and therapists. 92% of patients considered the general care to be excellent or very good. Specifically, 96% of patients considered the effectiveness of the treatment to be excellent or very good, 3% good, 1% unsatisfactory; 98% of patients considered the diagnosis and treatment to be excellent or very good and 2% satisfactory; 100% of patients considered the quality of care by medical staff and therapists to be excellent or very good, specifically 99% judged the quality of care given by the therapists as excellent.
- SAFETY AND HYGIENE. 99% of patients were of the opinion that the services were excellent or very good (only 1% judged the safety in the changing rooms as good), while 100% of patients judged the cleanliness to be excellent or very good.
- STAFF. 97% of patients considered the staff generally to be excellent or very good. Only 3% considered some parameters (professional attitude and problem arrangement) satisfactory.
- FINANCE. 94% scored as excellent or very good and 6% ranged from good to unsatisfactory with particular emphasis on the service provided by their insurance scheme, an event caused by the well-known deficiency of cover for rehabilitation therapy by the state insurance schemes.
- OTHER. There were no common remarks. (One patient wrote “Wonderful” another requested a greater choice of coffee.)
All (100%) agreed that the patient was regarded as the most important concern at Anaplasi.
- B) Six months later, all patients were called by phone and were requested to express their opinion regarding their treatment in ANAPLASI Rehabilitation Center and whether they were satisfied or not with the therapeutic outcome. Out of 822 patients who followed rehabilitation programs and participated in the present study it was confirmed that 506 (57.35%) patients stated they were completely satisfied with their therapeutic course, 340 (38.55%) were very satisfied (stating they regretted they had been unable to complete their programs either because of distance from the center, financial reasons or because the had not taken the advice of the doctor in Anaplasi. 36 (4.09%) were satisfied and did not complete their program either because of distance, financial reasons or because they were not convinced of the need for a rehabilitation program and remained on medication alone.
The concept of day-care rehabilitation, something new in Greece, allows a high quality level of treatment with significant social and economic benefits to the community.
The current consensus of scientific opinion considers the ideal rehabilitation program to take place in a rehabilitation center under the auspices of the rehabilitation team. The concept of day-care in the rehabilitation setting is the result of the clinical application of current international opinion on medical services generally, where the target is to allow the patient to enjoy the health services he needs without being dissocialized, that is without unnecessary hospitalization.
The key is organized, consistent communication between therapists, facilitated by regularly scheduled team meetings, a program of continuing education as well as a flexible rehabilitation plan, tailored to the needs of the patients, ensuring individual therapies are of high quality by regular audit, increasing therefore, the potential for quicker resolution of symptoms and restoration of function. The team members not only meet regularly to discuss the patient but also to conduct joint therapy sessions something that is unique to ANAPLASI, having all the necessary equipment available.
The therapeutic protocols and procedures for quality control in ANAPLASI Rehabilitation Center were dictated by a Quality Management System that fulfills the requirements of the ISO 9001 standard.
The results of completed questionnaires and the telephone survey, six months post treatment, are clearly indicative of the high degree of satisfaction of treated patients. However, the Certified Quality Control System of the center does not stop at a high level of satisfaction, but focuses on the patients who were not completely satisfied, through the following procedures:
- Preventive and corrective action, with internal inspection and effective handling of complaints.
- Strict rules regarding the equipment providers and services, with criteria based on quality and cost.
- Fully computerized system to organize therapy sessions to best-fit patient needs and abilities.
- Strict criteria for selecting, training and assessing in-house personnel and associated colleagues, and provision of programs of continuing education.
- A series of specific procedures, which ensure an easy, fast and effective patient management.
- A strict program of service for the equipment and a protocol for hygiene and cleanliness of the building.
An audit has verified that the quality management system fulfills the requirements of the ISO 9001 standard. The remarks of the dissatisfied patients were investigated by the Quality Control Manager to evaluate their justification to initiate the protocols for preventive and corrective measures. For example, extra meetings of the Rehabilitation Team, changes in the continuing education program to accommodate new needs and so on. The remarks made by patients regarding the facilities and equipment were evaluated and extra pieces of equipment were ordered and a general improvement in facilities was undertaken.
The above results are indicative of a high standard of care. They show how audit and continuing assessment of the complete care system can be used to maintain and improve quality. It is our belief that, a well informed patient, as the end-user of rehabilitation services can be the most significant judge and therefore his opinion can be used to instigate improvement.