世界银行-利用满意度调查改进向哥斯达黎加人民提供卫生服务的情况（英）-2023-7页_364kb

Costa Rica's Health Service Satisfaction Survey Program: Summary

Overview
Costa Rica's Social Security Fund (CCSS) has successfully implemented and analyzed satisfaction surveys for five consecutive years, even during the COVID-19 pandemic, to evaluate and improve outpatient and inpatient health services based on user feedback. This initiative began in 2015 and was revitalized in 2016 with support from the World Bank's Program for Results (PforR), which focused on modernizing and strengthening healthcare, improving service quality, and enhancing user experience.

Key Objectives

• To measure user satisfaction through the SERVQUAL model, which assesses five dimensions: tangibility, reliability, responsiveness, assurance, and empathy.
• To develop focused improvement plans based on survey results, ensuring that services align with user priorities and institutional goals.
• To increase the visibility of user feedback across all CCSS units and address specific needs, including those of indigenous populations.

Methodology and Implementation

• Surveys were redesigned in 2016–2017 to reflect user priorities identified through focus groups and household surveys. Key dimensions included reliability (e.g., wait times and appointment ease), with added Net Promoter Score for overall loyalty measurement.
• Surveys, conducted by CID Gallup since 2018, are deployed annually via telephone due to pandemic-related disruptions. They cover hospitalization and outpatient services, aiming for full population representativeness.
• Results are disseminated internally, and each service unit develops improvement plans prioritizing low-scoring indicators. The CCSS tracks these plans in a centralized matrix.

Results and Successes

• Despite challenges like the COVID-19 pandemic and cyberattacks, surveys have maintained high response rates (e.g., over 2,963 hospitalization interviews in 2022).
• The program has increased user voice visibility, leading to focused service enhancements, particularly for indigenous populations.
• Evidence shows user satisfaction peaks during crisis periods, such as active pandemic communication, underscoring the positive impact of user-centered approaches.

Challenges and Solutions

• Initial resistance from healthcare units and bureaucratic delays were mitigated through early stakeholder engagement, legal framework support, and external hiring of surveyors for transparency.
• Non-response rates in telephone surveys were addressed by refining samples, extending interview windows, and interviewer training.
• Limitations in sample size for indigenous data were handled by standardizing to national-level reporting and improving data collection.

Lessons Learned

• Engagement with users at the design phase ensures surveys align with local priorities and linguistic sensitivities.
• Pilots and clear work plans are essential for tool adaptation and annual compliance.
• Strengthening improvement plan follow-up mechanisms increases the likelihood of positive outcomes.

Way Forward

• The CCSS plan to redesign surveys to include new services (e.g., teleconsultation) and enhance follow-up on improvement plans.
• Future efforts will focus more on responsiveness and reliability dimensions to address key dissatisfaction points.
• The program serves as a blueprint for other health systems, emphasizing political will and resource allocation for sustained user satisfaction improvements.

Key Takeaways

• User satisfaction is influenced more by interpersonal care than resources.
• Continuous adaptation and improvement plans are crucial for long-term success.
• Collaboration with users and external partners ensures effective implementation.