Assessing dissatisfaction with an out of hours service: reasons and remedies.

Objective: To identify characteristics associated with dissatisfaction following contact with an out of hours co-operative in Glasgow, and to identify reasons for this dissatisfaction. To make recommendations for good practice in the light of these findings.

Design: Survey of attenders during one week of operation of an out of hours co-operative. Analysis of factors associated with dissatisfaction.

Setting: The Glasgow Emergency Medical Service, October 1996.

Subjects: Questionnaires were received from 1115 patients or their carers, representing a 69.3% response rate.

Results: Dissatisfaction was associated with unmet expectations, particularly among those expecting home visits. Parents of young children, more affluent patients, and those experiencing problems with daytime services also tended to be dissatisfied. Seventy four (7%) respondents indicated that they were very dissatisfied with aspects of the service. A high proportion of this dissatisfaction was related to telephone contact. Transport to out of hours centres caused problems for some patients, particularly for those with young children. Perceptions of dismissive attitudes by medical staff, and of incorrect diagnoses and treatment were causes of strong dissatisfaction. Patients with adverse medical outcomes were also likely to be very dissatisfied.

Conclusion: Clear reasons for dissatisfaction were found among our sample. In most cases, remedial management action could be taken to reduce the likelihood of major dissatisfaction with the service.