The research question chosen for the current exploration is the following: “Is there a connection between patient satisfaction and patient outcomes?” The research question was chosen due to the need for hospitals to consider the metric of patient satisfaction when increasing the quality of their care and ensuring positive health outcomes among patients they serve.
Study design to answer the research question
A mixed-methods study presents the most opportunities for researching the identified question. The qualitative perspective is necessary for collecting feedback from both patients and nurses regarding the topic of patient satisfaction and its impact on health outcomes (Patten & Newhart, 2017). The quantitative perspective is needed for analyzing pre- and post-interventional patient outcomes to determine whether they improved over a given period. Therefore, the need for the mixed-methods design is attributed to the need to use one method for informing and supporting another. For instance, the qualitative section of the study can conclude with the finding that patient satisfaction is not a metric needed for quality improvement at facilities. This, the quantitative section, should also find no connection between the two variables.
The “pros” of using the research design
The mixed-methods research provides strengths that are beneficial for offsetting the weaknesses of qualitative and quantitative designs implemented separately (Schoonenboom & Johnson, 2017). For example, a quantitative study is weak in understanding the settings and contexts in which people behave. Qualitative research, on the contrary, is limited by the potential of biased interpretations. Therefore, mixed-method studies can provide a multi-dimensional perspective on a research issue by explaining how causal processes work.
The challenges of using the research design
Despite the range of advantages that mixed-methods design offers, it is essential to mention that it can be very complex in implementation. Scholars require much more time and resources to plan and implement mixed-methods studies. In addition, it can be challenging to plan and execute one part of the study by drawing on the findings of another. Also, it is vital to consider the issue of resolving discrepancies that arise based on interpretations of the different conclusions.
The variables of the study
Educational programs for healthcare providers to boost patient satisfaction rates represent an independent variable in the current study.
Patient outcomes and satisfaction rates are the dependent variables that rely on the quality of care provided to them.
The education of healthcare professionals regarding patient satisfaction is the critical confounding variable in the study. It is expected that practitioners will be challenged by the expectation to consider the metric of patient satisfaction when caring for them. With the high pressure placed on nurses and other hospital personnel, additional training and education on patient satisfaction can become a significant burden.
Type of sampling for the study
Sampling represents a process used in statistical analysis in which a previously determined number of observations is attained from a large population. Depending on the type of analysis being performed, a scholar may choose between random and non-random sampling. The primary purpose of sampling is to select a representative sample that could provide data applicable to a large population. For the highest representativeness of the sample, a scholar should randomly draw participants that will encompass the characteristics of a population to which the study would be applied (van Hoeven, Janssen, Roes, & Koffijberg, 2015). The most unbiased sampling method is a simple random sample, in which each subset of a population has an equal opportunity for being involved in the study. A sample chosen in such a method is intended to be unbiased and represent a group to the highest possible extent.
Given the design of the study, a suitable solution is to implement two different sampling methods for the qualitative and quantitative sections. First, the facility that will be the target of the intervention will be selected using convenience sampling. While this method implies a degree of bias, the complexity of the mixed-methods design allows for some shortcuts. Within the facility, the participants-patients and participants-nurses will be selected randomly to eliminate possible brought by convenience sampling. Data for the quantitative section of the study will be collected from patient report cards and electronic health records to compare pre-and post-intervention outcomes. It is expected to collect qualitative data from 50 patients, 30 nurses, and at least 100 reports on patient outcomes.
The inclusion and exclusion criteria for the study
Establishing both exclusion and inclusion criteria for identifying study participants is a standard, required practice associated with designing high-quality protocols for research. As mentioned by Patino and Ferreira, “inclusion criteria are defined as the key features of the target population that the investigators will use to answer their research question”. Standard criteria for involving potential participants are usually linked to clinical, demographic, and geographic characteristics. Reasons linked to not including some individuals in research imply specific features that may interfere with the success of a project and increase the likelihood of unfavorable outcomes or results. Typical exclusion criteria include the qualities of potential individuals to make them less likely to present during follow-ups, more likely to miss appointments for data collection, offer accurate information, or have additional conditions that could bias study results (Patino & Ferreira, 2018).
The inclusion criteria for the nurses involved in the educational intervention experience in the nursing field of at least two years, experience working at the given facility of at least six months, and no prior education associated with patient satisfaction. The exclusion criteria for the nurses will include the possession of extensive training and experience with patient satisfaction monitoring.
The inclusion criteria for patients involved in the study will include them staying at the given facility as inpatients for at least three days, as well as age 18 and older. The exclusion criteria for the patients will be associated with individuals diagnosed with a severe illness requiring surgery and additional intervention.
Sample size and its effect on the results and their application to practice
The larger the sample chosen for particular research, the higher is the likelihood of data showing high rates of reliability. However, in the current research, the quality of data will matter the most in terms of the qualitative component of the methods. The sample of 50 patients is representative enough for the findings to be applied to hospital practice across the country. Thirty nurses is a relatively representative sample of practitioners because, depending on the size of a facility, it includes almost all nurses working in a specific setting.
Data collection represents a fundamental component of conducting the study. To gather data for the study, it is necessary to assess the data from the interviews. For the social aspect of the study, interviews will represent a critical method for data collection. Interviews are helpful for this research because they offer to attain highly personalized information. While this is not the case for the current study, interviews are viable options when there are limited respondents and a reasonable return rate.
Given that the researcher will interview fifty patients and thirty nurses, structured interviews will be administered. Structured interviews are a form of verbally administered questionnaires, in which a list of predetermined questions are asked, with limited to no scope for additional follow-up regarding these questions (McIntosh & Morse, 2015). Consequently, the interviews are relatively quick and easy to implement. Structured interviews offer a positive contribution to the study because they are easy to replicate in any setting. The questions used are easy to quantify, which provides an easy opportunity to test for reliability. However, it is also essential to consider that structured interviews are not flexible, which implies that a schedule must be followed. Also, answers collected from structured interviews lack detail.
The following is a step-by-step breakdown of the intended data collection procedure:
Step 1: Identifying issues and opportunities for data collection. The critical question to consider in the study is to determine whether patient satisfaction rates influence patient outcomes.
Step 2: Developing a data collections plan. This step will help the scholar structure, plan, and oversee the process of monitoring. Research questions will be identified, indicators used for answering the questions, enter data sources that will provide information necessary for analysis, identify data collection instruments, and determine the individual who will be collecting information.
Step 3: Identifying data sources for the given study. These sources will include information from patient and nurse interviews and electronic health records, thus both internal and external data sources. It is also important to answer whether the sources offer high-quality data, whether it is easily accessible and can be accessed regularly, as well as whether the costs of obtaining data are reasonable.
Step 4: Collecting data for the study. Both existing and new data will be collected during the study. Existing data regarding patient outcomes pre-intervention will be acquired from patient-related reports completed by nurses and doctors upon discharge. New data on patient outcomes will be gathered using the same method after implementing the educational intervention among practitioners.
New information will be gathered from interviews with both nurses and patients who will be asked to contribute to the study at the chosen facility. The format of structured interviews will be easy and quick to implement, which means that not much time is needed for collecting data. Nurses will be asked about the free time they have to dedicate to the interview. Patients will also be contacted directly by the researcher.
Examples of interview questions that nurses will be asked include the following:
- What is your perception of high-quality care?
- Have you considered the role of patient satisfaction in your practice?
- Have your patients ever reported low satisfaction with the care provided to them?
- Has your management ever implemented training to boost patient satisfaction at facilities?
- Have you ever participated in quality improvement initiatives?
Examples of interview questions that patients will be asked include the following:
- Have you ever been dissatisfied with the quality of care provided at healthcare facilities?
- Have you ever been surveyed by healthcare providers as to your feedback on care quality?
- What areas in your care have been overlooked by nurses or doctors?
- Do you think that your satisfaction with care quality can impact health outcomes?
- Do you think that nurses should be better educated regarding patient satisfaction?
For the qualitative section of the study, it is expected to implement a thematic analysis of interviews with patients and nurses. It will be useful for identifying and recording patterns of meaning within the collected data. Since both patient and nurse-related data will be collected, the analysis of the interviews can also yield the identification of common themes found in the answers of both study groups.
In regards to the analysis of the data pre-and post-intervention, the information will be approached separately. Patient outcomes pre-and post-intervention will then be situated side-by-side to implement a t-test. This analysis method represents a type of inferential statistic implemented in research for determining whether there is a difference between two groups that relate to particular features (Patten & Newhart, 2017). Thus, samples taken from the pre-intervention group of patients and a group post-intervention should have a slightly different mean and standard deviation. The main advantage of interviews is associated with the capability to offer a complete description and analysis of research without limiting is the scope and the nature of participants’ responses.
Feasibility of the study
The feasibility of a study refers to the analysis that considers all relevant factors, including technical, economic, legal, and scheduling considerations. All of these are necessary for ensuring that a project will be completed successfully. Notably, some scholars conduct feasibility studies to differentiate between the advantages and disadvantages of undertaking a project. The sample study and the intended procedure are easy to implement and therefore are feasible.
The mixed-methods study represents several challenges, such as the complexity of implementation and the extended timeframe needed to complete both research sections. Although, the researcher has accounted for this fact and chosen structured interviews that will not take much time to implement. The quantitative part of the study is also feasible to implement because no new data will have to be collected from the beginning. Most facilities provide patient outcome reports upon discharge, which means that the necessary information will be easy to find and use in the current research.
Lessons learned regarding the research process
During the research process, the critical takeaway is associated with the need for planning and preliminary design before implementation. A creative approach toward research design is of particular importance. In simple terms, research represents a preliminary investigation of a given topic undertaken for collecting knowledge and understanding of various subject areas within a specific specialization. The generation of ideas and information leading to the revelation of scientific insights within relevance to society is another important takeaway.
Thus, the production of new data that will bring value to society is one of the most essential findings attained as a result of the study process. Also, it is vital to understand that research is both theoretical and empirical, which represents some challenges. The theoretical nature of studies is attributed to the fact that the starting point of such explorations refers to developing a concept developed for a particular research topic. Research is practical (empirical) because it requires the implementation of a series of observations, analyses, and measurements of data that is grounded on the application of proper experimental design (Balajumar, Inamdar, & Jagadeesh, 2013).
Difficulties in answering the questions on the research design
When answering these questions intended for discussing the study’s methodology, it is imperative to mention that considerations of the planning process and steps intended for the smooth implementation of the project must be approached with great detail. It was complicated to develop the methodology for the study hypothetically as no actual facility was visited, nor were any practitioners contacted. In addition, it is challenging to hypothetically discuss the potential perspectives of patients regarding their satisfaction with services as they can differ from one individual to another.
Some concern arises regarding the ability of the researcher to attain clear responses from patients and achieve high response rates. Patient-associated interviews are complicated to implement in a mixed-methods design because of the need for support or supplement the data collected from the quantitative section of the research. If the interviews do not provide the necessary volumes of data to reveal trends in patients’ and nurses’ approaches to patient satisfaction, the data collected from patient reports regarding final health outcomes may not offer a complete look at whether satisfaction with the quality of care has any influence on the health of patients discharged from facilities.
McIntosh, M. J., & Morse, J. M. (2015). Situating and Constructing Diversity in Semi-Structured Interviews. Global Qualitative Nursing Research, 2, 2-12.
Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies: definitions and why they matter. Jornal Brasileiro de Pneumologia: Publicacao Oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 44(2), 84.
Patten, M., & Newhart, M. (2017). Understanding research methods. Abington, UK: Routledge.
Schoonenboom, J., & Johnson, R. B. (2017). How to Construct a Mixed Methods Research Design. Kolner Zeitschrift fur Soziologie und Sozialpsychologie, 69(Suppl 2), 107-131.
van Hoeven, L., Janssen, M., Roes, K., & Koffijberg, H. (2015). Aiming for a representative sample: Simulating random versus purposive strategies for hospital selection. BMC Medical Research Methodology, 15(90), 1-9.