Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Many popular client satisfaction measures are not contextually-specific and therefore, data collected through these measures may not be specific enough to reflect all aspects in various social service settings. In order to collect data with direct relevance, it is not uncommon for researchers, evaluators or service providers to construct new measures. They often construct a set of (usually Likert-type) satisfaction rating response items for each of the service elements relevant to their settings. Typically, scores from these multiple items are either summed or averaged to produce global satisfaction scores. By summing or averaging satisfaction scores across all items, one implicitly assumes that all survey items which represent various service elements carry equal weight. This assumption of equal weight is somewhat counter-intuitive because individual clients may perceive certain survey items or service elements to be more important, or carry more weight, than others. This study empirically examined this equal weight assumption in an elderly case management service setting.

Methods: This paper will report results from a survey conducted with 112 clients of the Chicago Central West Case Management Unit, a service Unit under the Jane Addams College of Social Work at the University of Illinois at Chicago. Five major service elements, which were assessment of clients' needs, plan of care development, case manager's knowledge regarding available services, case manager's ability to get services for clients, and the availability of the case manager, were identified based on the literature and discussions with clients and service providers. Survey participants were asked to rate the importance of each of these service elements on a five-point scale from “Extremely important” to “Not at all important.” Participants were then asked to place these service elements into a rank hierarchy, based on importance. Using ranking is advantageous because ranking not only shows the importance of each service element but also provides direct comparisons of importance across service elements. Elements of equal importance received the same ranks. Data were analyzed using the generalized estimating equations (GEE) and exploded logit regression models.

Results: Importance ratings of individual service elements did not differ significantly, which seemed to support the equal weight assumption. However, not all service elements were equally important when ranking, a more precise method than individual rating, was used. There were significant differences in importance ranking and the most important service element was case manager's ability to get services, followed by case manager's knowledge regarding available services, assessment of clients' needs, the availability of the case manager, and plan of care development.

Implications for practice: Not all service elements were equally important, which called into question the practice of simply summing satisfaction scores across various service elements to indicate a client's global satisfaction. In addition, these findings suggest that service providers should identify and pay special attention to any dissatisfaction with service elements that are considered more important by the clients. Furthermore, these findings can help service providers set priorities for service improvement based on clients' perceived importance and ultimately benefit their clients.