Every organization and individual claims to have superior customer service. Indeed, virtually all urban medical centers claim to be in the top 10 in one category or another. While measuring clinical outcomes is a common way of judging quality, patient satisfaction and loyalty are much more dependent on their perceptions of treatment as a person (Lee, 2004). During these challenging economic times, it is even more important to know what it takes to deliver real patient satisfaction. This editorial will briefly explore the single most critical ingredient: patient communication.

The opportunity to effect patient satisfaction exists with every human interaction along the surgical continuum. The opportunities for these interactions occur at defined events along the continuum (Figure 1).

Figure 1. Linear surgical continuum.

1. Initial physician visit

2. Diagnostic testing

3. Physician review

4. Pre-Op

5. Surgery

6. Post-OP

7. Follow-up postdischarge.

By bending the continuum line into a circle, the opportunity to ensure patient satisfaction becomes never ending (Figure 2).

Figure 2. Continuous surgical continuum.

At each of these points the patient comes into contact with a service provider. A service provider is anyone who encounters a patient face-to-face. It is then that an individual has the opportunity to enhance the patient's overall experience. This human interface is the piece individuals have the most control over. Remember that patients want to know what you know. They will look to their care providers at that moment for answers. For this scenario, the patients want to know when they will be discharged. The physician is responsible for making that decision, but the patients only want to know "when." This is where an opportunity to effect patient satisfaction exists.

According to Hersey and Brown (2000), the readiness of customers-or in this case, patients-plays an important role in influencing the relationship between the patient and the service provider. For the purposes of this discussion, there are four possible readiness states of patient perception and knowledge level (Figure 3).

Figure 3. Patient perception relationships to knowledge level.

Communication is the key to ensuring that patients are informed (Allenbaugh, 1992). Communication can be viewed as one-way or two-way. One-way communication is directive in nature. That is, the service provider does most of the talking and is explaining policies, procedures, expectations, and so forth.

Two-way communication is truly interactive or conversational. The greater the amount of both one-way and two-way communication the more likely the patient will be both informed and happy.

More than 75 major studies found that you cannot identify a single most effective style (Hersey & Brown, 2000). Influence effectiveness has to do with the environment, or the situation, in which the influence takes place.

Service effectiveness, patient satisfaction, depends on the situation. Any situation can encompass many variables:

* Yourself as a caregiver

* Your patient

* Your manager

* Organizational structure

* Policies and procedures

* Time constraints

Knowledge level and satisfaction are the two key variables that play a role in a patient's readiness:

* Knowledge level

* Does the patient know the what, when, where, and how of the care being provided?

* Is their knowledge level sufficient?

* Are their expectations realistic?

* Level of satisfaction

* How strongly does the patient perceive that the care provided satisfies his or her needs as a person?

* How secure is the patient with the care provider currently?

* Is the patient happy or unhappy?

Both one-way and two-way styles of communication are invaluable in the pursuit of patient satisfaction. It is unrealistic to believe that every patient will be happy. Sometimes the best a care provider can do is to simply provide information.

The opportunity to effect patient satisfaction exists with each and every face-to-face encounter. The extent that your influence is possible depends on many variables and the situation in which the encounter occurs. Most importantly, how well the nurse communicates with the patient will have the greatest impact on patient loyalty. Keeping in mind the patient's perspective of quality care as well as clinical outcomes will help achieve true patient satisfaction.

Communication among plastic surgical nursing is also important for ensuring quality care of patients. As a tool for communication among professionals, Plastic Surgical Nursing brings you the latest information. In this issue, you will find research in the area of nerve injuries of the upper extremities, a companion Chapter of the Core Curriculum covering the nursing considerations for reconstruction of the hand, nursing research basics, and external Lefort III midface distraction recollections of families. In addition, the departments include articles on safety, wound assessment, medical identity theft, blepharoplasty practice guidelines, and a new department, New Trends in Aesthetics.

Please feel free to forward your comments to me and the editorial board, by writing us at Plastic Surgical Nursing, American Society of Plastic Surgical Nurses, 7794 Grow Drive, Pensacola, FL 32514-, or send an e-mail to Candise Flippin at [email protected].

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