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The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery


  • Conner-Spady, Barbara L.
  • Sanmartin, Claudia
  • Johnston, Geoffrey H.
  • McGurran, John J.
  • Kehler, Melissa
  • Noseworthy, Tom W.


Objectives The disconfirmation model hypothesizes that satisfaction is a function of a perceived discrepancy from an initial expectation. Our objectives were: (1) to test the disconfirmation model as it applies to patient satisfaction with waiting time (WT) and (2) to build an explanatory model of the determinants of satisfaction with WT for hip and knee replacement.Methods We mailed 1000 questionnaires to 2 random samples: patients waiting or those who had received a joint replacement within the preceding 3-12 months. We used ordinal logistic regression analysis to build an explanatory model of the determinants of satisfaction.Results Of the 1330 returned surveys, 1240 contained patient satisfaction data. The sample was 57% female; mean age was 70 years (SD 11). Consistent with the disconfirmation model, when their WTs were longer than expected, both waiting (OR 5.77, 95% CI 3.57-9.32) and post-surgery patients (OR 6.57, 95% CI 4.21-10.26) had greater odds of dissatisfaction, adjusting for the other variables in the model. Compared to those who waited 3 months or less, post-surgery patients who waited 6 to 12 months (OR 2.59, 95% CI 1.27-5.27) and over 12 months (OR 3.30, 95% CI 1.65-6.58) had greater odds of being dissatisfied with their waiting time. Patients who felt they were treated unfairly had greater odds of being dissatisfied (OR 4.74, 95% CI 2.60-8.62).Conclusions In patients on waiting lists and post-surgery for hip and knee replacement, satisfaction with waiting times is related to fulfillment of expectations about waiting, as well as a perception of fairness. Measures to modify expectations and increase perceived fairness, such as informing patients of a realistic WT and communication during the waiting period, may increase satisfaction with WTs.

Suggested Citation

  • Conner-Spady, Barbara L. & Sanmartin, Claudia & Johnston, Geoffrey H. & McGurran, John J. & Kehler, Melissa & Noseworthy, Tom W., 2011. "The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery," Health Policy, Elsevier, vol. 101(3), pages 245-252, August.
  • Handle: RePEc:eee:hepoli:v:101:y:2011:i:3:p:245-252

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    References listed on IDEAS

    1. Brooks, Richard AU -, 1996. "EuroQol: the current state of play," Health Policy, Elsevier, vol. 37(1), pages 53-72, July.
    2. Oliver, Richard L & Swan, John E, 1989. " Equity and Disconfirmation Perceptions as Influences on Merchant and Product Satisfaction," Journal of Consumer Research, Oxford University Press, vol. 16(3), pages 372-383, December.
    3. Linder-Pelz, Susie, 1982. "Toward a theory of patient satisfaction," Social Science & Medicine, Elsevier, vol. 16(5), pages 577-582, January.
    4. Siciliani, Luigi & Hurst, Jeremy, 2005. "Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries," Health Policy, Elsevier, vol. 72(2), pages 201-215, May.
    5. Edwards, Rhiannon Tudor & Boland, Angela & Wilkinson, Clare & Cohen, David & Williams, John, 2003. "Clinical and lay preferences for the explicit prioritisation of elective waiting lists: survey evidence from Wales," Health Policy, Elsevier, vol. 63(3), pages 229-237, March.
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    Cited by:

    1. Brown, Paul & Panattoni, Laura & Cameron, Linda & Knox, Stephanie & Ashton, Toni & Tenbensel, Tim & Windsor, John, 2015. "Hospital sector choice and support for public hospital care in New Zealand: Results from a labeled discrete choice survey," Journal of Health Economics, Elsevier, vol. 43(C), pages 118-127.
    2. Fanwen Meng & Kiok Teow & Chee Ooi & Bee Heng & Seow Tay, 2015. "Analysis of patient waiting time governed by a generic maximum waiting time policy with general phase-type approximations," Health Care Management Science, Springer, vol. 18(3), pages 267-278, September.
    3. repec:eee:hepoli:v:122:y:2018:i:3:p:269-278 is not listed on IDEAS


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