Communication and relationships: how patients’ perceived informational and interactional justice can improve patient-centered care

Abstract

Abstract Background: After analyzing the three tenants of patient-centered care (i.e., communication, relationships and health promotion), we tested the role of patients’ perceived interactional and informational organizational justice in health service performance with respect to patients’ behaviors of adhering to professional advice and loyalty to the service. Literature shows that organizational variables as perceived organizational justice can influence patients’ behaviors. We have the ultimate goal of better understanding patients’ experiences with health care organizations, so health care service management can adjust to provide a better-quality patient-centered care considering patients’ inputs. Methods: We conducted a cross-sectional study using two data samples from Spain and the U.S. The sample comprised 473 (male 59.2%) health care users from Spain and 450 (male 52.0%) from the U.S. over 18 years old. We measured the interactional and informational dimensions of perceived organizational justice, participants’ trust in the health care provider, their satisfaction with health care services, their adherence to professional advice and their loyalty to the service through a self-administered survey. Results: Significant correlations were found in both samples for each justice dimension with both behaviors: adherence to advise (interactional, r=.15/.18, p<.01; informational, r=.19/.19, p<.01) and loyalty to the service (interactional, r=.45/.79, p<.01; informational, r=.45/.70, p<.01). When we tested the model that included mediating patients' attitudes of trust and satisfaction, we found that the direct relationship between informational justice and adherence still held (standardized trajectory coefficient =.13, p <.01) showing their consolidated relationship. For interactional fairness, trust and satisfaction significantly mediated the relationship with adherence. On the other hand, the relationships between both justices and patient loyalty to the service were always partially mediated by patient trust and satisfaction (model fit for interactional justice perceptions RMSEA=.101, CFI=.959, GFI=.959; model fit for informational justice perceptions RMSEA=.136, CFI=.937, GFI=.946). Conclusions: Patients’ perceptions of interactional and informational justice play an essential role in their adherence to professional advice, their loyalty to the service, and their ability to foster trust and satisfaction in health services. When discussing communication and relationships in patient-centered care, we should also consider fostering patients’ perceptions of fairness to improve health services results. Policies, programmes and procedures for patient-centered care should consider these patients’ perceptions. Article classification: Empirical research paper