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[Subjective requirements for psychosomatic rehabilitation and their influence on patient satisfaction - "basic, performance and excitement factors" according to Kano].

OBJECTIVE
The main goal of this study was to identify different types of requirements which patients have during rehabilitation and their influence on patient satisfaction.


METHODS
276 patients in psychosomatic rehabilitation were investigated by an anonymous cross-sectional survey at the end of their inpatient stay. Patient satisfaction (instruments FPZ and ZUF-8), psychological distress (BSI) and health status (SF-12) were assessed by the questionnaire. In addition, personal minimal standards as well as positive and negative events during the rehabilitation were assessed and evaluated by a content analysis.


RESULTS
Patient satisfaction showed significant correlations with depression (neg.), life satisfaction and health status. In the penalty-reward-contrast analysis, the rehabilitation outcome came out as a "performance factor", that means disappointed expectations led to dissatisfaction, exceeded expectations to satisfaction. The skills of the doctors seemed to be regarded as a "basic factor" by the patients, while psychosocial competence of the doctors appeared as an "excitement factor". Accordingly the patients in their free answers stressed the meaning of the kindness of the staff, but also parameters of accommodation (especially the single room was regarded as minimal standard). The comparison of the two methods of analysis (validated scales and content analysis of free answers) showed common as well as complimentary results.


CONCLUSION
The three factors typology of satisfaction according to Kano were confirmed also in a clinical setting as an interesting approach. Obviously influencing factors to some degree have non-linear relationships with patient satisfaction. The finding that interpersonal aspects seem to be important for patient satisfaction speaks for social training of the staff as a central task of quality management.