ACQ Vol 12 No 3 2010

Quality assurance

Quality assurance A private practice perspective Katherine Osborne

This paper reports an attempt at conducting a quality assurance survey in a private practice pathology practice. The mothers of 33 children receiving speech pathology services were surveyed. The purpose of the survey was to improve the service provided. A 44-item survey covering 11 topics was given to parents, who returned the surveys anonymously. Results indicated high levels of satisfaction in relation to the quality of service provided and validated parent involvement in assessment and treatment. Findings also revealed the need for explicit discussion regarding anticipated length of time in therapy, for increased teacher consultation and for cancellation policies to be made explicit. Finally, some of the difficulties implementing this quality assurance project are presented. Q uality assurance could be defined as the steps taken to evaluate a service to ensure the service is of a sufficiently high quality to meet industry standards. Quality assurance can be achieved through interaction between the consumer and the supplier. Involving consumers in evaluating the service promotes empowerment, ownership, and accountability (Nilson, Myrhaug, Johansen, Oliver, & Oxman, 2006). Parents, as consumers, can be used as a significant resource for change (Andrew, Andrews, & Shearer, 1989) Is there a need to engage in quality assurance in private practice? After all, it is reasonable to assume that when consumers pay for a private service, they are satisfied with it. Is satisfaction a sufficient goal? Determining whether a service is satisfactory is important but determining how satisfactory a service is, is quite different. Conducting quality assurance checks could improve a service from mediocre or merely satisfactory to excellent (Grela & Illerbrun, 1998; Hammond, 2008). Client and clinician service evaluation data are necessary for the provision of satisfying and appealing services (Hammond, 2008; Nelson & Steele, 2006). Without feedback from consumers, a mismatch between therapists’ intentions and actual service may exist (Donaldson,

McDermott, Hollands, Copley, & Davidson 2004). For example, Donaldson and colleagues conducted interviews with parents and their child’s therapists (including speech pathologists and occupational therapists) regarding their report writing. They found that while the clinicians felt they were writing reports that met the parents’ needs, a mismatch existed between the clinicians’ intentions and actual practice. There are few studies concerning parent satisfaction with speech therapy services in the private sector. However, one such study was conducted by Mirabito and Armstrong (2005). They interviewed seven Australian mothers attending private therapy with their children aged 3 to 7 years. These researchers found overall responses were positive though participants had all volunteered to participate in the study. They suggested that the involvement and motivation of these mothers may have been exceptional, possibly leading to results that could not be considered representative. Nevertheless, all parents reported feeling the experience was collaborative though they regarded themselves as observers in the sessions and coaches beyond the clinic setting. Time limitations and child behaviour were identified as barriers to involvement. Hammond (2008) conducted an extensive review of both quantitative and qualitative studies of client satisfaction with speech and language services. These studies concerned both specific services such as aphasia therapy and general satisfaction with speech and language services. Hammond’s review of the qualitative research suggested some client dissatisfaction with regard to the length of therapy, discharge protocols, client–clinician interaction, activity choice, task appropriateness, clinician behaviours, functionality of tasks, explanation of therapy, likely outcomes, and goal choices. The current quality assurance study sought the opinions of mothers regarding many of the aspects of service identified as sources of client dissatisfaction in Hammond’s study as well as satisfaction with assessment process, reporting, fee schedule and health rebates. Quantitative and qualitative data collection in the form of open-ended questions was used. Open-ended questions allow more detailed information to be collected and used to improve a practice (Liamputtong & Ezzy, 2005). Method Survey items and format were developed following perusal of the ASHA Consumer Satisfaction Survey (ASHA, 1989), Frattali’s 1991 paper discussing the merits of both

Keywords CHILD

ASSESSMENT AND THERAPY PARENT SURVEY PRIVATE SPEECH PATHOLOGY QUALITY ASSURANCE

Katherine Osborne

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ACQ Volume 12, Number 3 2010

ACQ uiring knowledge in speech, language and hearing