"Word of mouth" - Unterschiede im Kommunikationsverhalten von Patienten in Abhängigkeit vom Zufriedenheitsgrad unter besonderer Berücksichtigung des PPP33-Fragebogens

Patients often use experience-based sources when choosing a hospital, frequently in form of word-of-mouth (WOM) propaganda which is perceived to be independent of direct information from providers. There is scarce data on the prevalence and intensity of WOM in the medical context. This exploratory cohort study recruited patients for elective surgery at two maximum care facilities. In addition to demographic data, information sources used and determinant factors for decisive hospital choice were determined. After hospital discharge, a telephone interview was used to inquire about the state of health, complications, overall satisfaction, the extent of satisfaction, the extent and intensity of positive and negative communication and the estimated number of people reached. Satisfaction with a standard deviation of 1.9 and a median of 8 (mean 7.9) 94 (40.6%) were considered merely to highly satisfied (score >8), 30 dissatisfied (score ≤6, 13%) and 107 neutral (score >6 to <8, 46.4%). Postoperative factors like persisting pain (p=0.012) and a slow recovery to normal function (p=0.008) were associated with lower satisfaction scores. 348 questionnaires were evaluated and 231 patients were reached by telephone. 120 patients had had contact with their GP/specialist doctors, 226 to family and friends, 129 to others which included 105 responses to the hospital staff. Satisfied patients had given more positive, neutral predominantly positive and dissatisfied rather negative information to others. As per patient positive aspects were passed on to 12, negative to 5 persons. All satisfied and 46,7% of dissatisfied patients would recommend the hospital. WOM was found to correlate to satisfaction, with different proportions of positive and negative communication along the satisfaction continuum. Overall, the communication of positive aspects dominates, only dissatisfied patients communicated more negative aspects than positive. The theory on asymmetrical effects suggests that negative events produce a stronger effect by signalling that action needs to be taken and proportionally more dissatisfied people are expected to engage in WOM. Our findings suggest otherwise and most patients stated that they had passed on positive aspects of their stay and treatment, and satisfied patients reported a higher contact frequency. Several factors may be responsible: First, most patients are thankful when surgery and anesthesia are over. In addition, it is unusual address negative or unpleasant factors directly, as long as the patients are not extremely dissatisfied. Here, the so-called social desirability may influence behavior, while there are further studies that support our findings: In the “Polyanna principle” pleasantness predominates and positive aspects are more accessible after exposition to pleasant events (“positivity bias”). Individuals strive for interpretation in positive terms to minimize negative aspects, in extreme cases leading to denial. There might a negative association in the lower and a positive in the higher part of the satisfaction continuum as in our study. In this concept, the relationship changes at a point located within a “zone of indifference”, were expectations and experiences match and no particular reaction is to be expected, an effect that was observable in our study. Hence, WOM communication itself cannot be considered as an indicator of the degree of satisfaction.