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Surprisingly little direct information from patients is available in the medical literature. Focus groups, which came into use in the 1940s, provide a simple, cost effective way of exploring attitudes and values within market segments or targeted groups. In healthcare, focus groups are being used to track patients' experiences, expectations and satisfaction in order to optimize quality and cost effectiveness. This study reports on a collaboration of three upstate New York Health Maintenance Organizations (HMOs) that used the same focus group format and questions to identify' best practices' and opportunities for improvement. Participants across groups reported similar experiences despite differences in geography and plan organization. Members' most positive comments were about costs, preventive services, ease of paper work and access to sick care, all administrative functions of the health plans. The most negative focused on retaining one's physician, telephone access, providers' medical skills, provider behavior and notification of results, all related to interpersonal/communication issues. We conclude that focus groups are useful for understanding and responding to the 'voice of the customer'. They also have some distinct advantages over forced-choice questionnaires, especially in trying to discover the range of patients' experiences and expectations, though they are not without their challenges.

Thirty-five voices in search of an author: What focus groups reveal about patients experiences in managed care settings