Should St. Merciful Hospital Become CorpHealth,Inc.?: Ownership and Quality in U.S. Health Care Organizations

In this article, a review of empirical research on ownership and quality of care suggests the existence of a quality gap between for‐profit and nonprofit firms in some health sectors, depending on the prevailing type of financial payment for health care. Results of a theoretical model incorporating quality of care suggest that the nondistribution constraint is a simple and powerful explanation for a higher level of patient care quality at nonprofit health care facilities when reimbursement for health services is fixed prospectively. Analysis suggests that review of future conversions of health care facilities from nonprofit to for‐profit status should take into consideration the implied effects of the conversion on patient outcomes.     

Strengthening implementation success using large-scale consensus decision-making - A new approach to creating medical practice guidelines

A study involving over 2000 stoma care nurses in the development of best practice guidelines for the assessment of peristomal body profiles, patient engagement and patient follow-up was conducted in 2018. The study was designed to develop guidelines for stoma care treatment and product selection and to decrease the evidence to implementation gap. The project built on research evidence from a literature review of 77 articles. The results of the literature review were then used to inform a series of Delphi surveys sent out to stoma care nurses through Association and industry list-serves in 11 languages. The Delphi surveys were followed by a face2face professionally facilitated discussions among nurse-research experts. The project concluded with a facilitated consensus dialogue among 960 stoma care nurses from 25 countries, resulting in an implementation plan to ensure the guidelines become a normal part of routine patient care. The study resulted in a set of medical practice guidelines for stoma care nurses, designed to improve patient outcomes and patient quality of life, that were accepted and adopted into routine medical practice across 25 countries. This article describes the study and how the process used, coined the ‘Modified Delphi Process’ by the process designer, led to faster implementation than is generally experienced in the medical community.     

NEW TRENDS IN THE DOCTOR-PATIENT RELATIONSHIP: IMPACTS OF MANAGED CARE ON THE GROWTH OF A CONSUMER PROTECTIONS MODEL

Managed care is prompting a large revision not only in the ways doctors are employed and paid but also in the essence of the relationship between doctors and patients. In medical sociology, a discipline with a long-standing focus on scrutinizing the role of both the physician and the patient, there has already been discussion of a shift from the doctor as more all knowing to a less dominant position vis-a-vis both the patient and delivery of care. Patients are aware of shifts that place physicians in an environment characterized by new roles and responsibilities, such as acting as a gatekeeper. Limitations on health care coverage and the rethinking of roles have led to a depiction of the patient as the consumer of care and the managed care plan's becoming the commercial enterprise from which a service is obtained. The model of the patient as consumer of medically related goods and services appears to be growing, as does a model of the physician as one who contracts for a specified range of services for specific patients. In this article, trends in and problems with contemporary managed care are raised. Calls for patients' rights legislation may be among the health trends of the new millennium.     

Designing centralized waiting lists for attachment to a primary care provider: Considerations from a logic analysis

Access to a regular primary care provider is essential to quality care. In Canada, where 15 % of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus mostly on CWLs for specialized health care. We aim to better understand how to design CWLs for unattached patients in primary care.In this study, a logic analysis compares empirical evidence from a qualitative case study of CWLs for unattached patients in seven Canadian provinces to programme theory derived from a realist review on CWLs. Data is analyzed using context-intervention-mechanism-outcome configurations.Results identify mechanisms involved in three components of CWL design: patient registration, patient prioritization, and patient assignment to a provider for attachment. CWL programme theory is revised to integrate mechanisms specific to primary care, where patients, rather than referring providers, are responsible for registering on the CWL, where prioritization must consider a broad range of conditions and characteristics, and where long-term acceptability of attachment is important. The study provides new insight into mechanisms that enable CWLs for unattached patients to work.     

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. Conclusions: (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.     

The meaning of patient satisfaction with prepaid primary health care in Israel

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.     

Telemedicine,rural elderly,and policy issues

Historically, rural America has had a difficult time providing health care to its residents, particularly its frail elderly population. Rural health care is often faced with a shortage of health care specialists, facilities with inferior equipment, and insufficient resources compared to health care in more urban areas. It is anticipated that the use of telemedicine will help address many of the problems facing the delivery of health care services to rural elderly. This paper reviews some innovative projects delivering services to the elderly. Also, the paper discusses several issues that need to be addressed before telemedicine can reach its full potential in improving access to health care, including reimbursement policies, patient and provider liability and confidentiality, and the infrastructure supporting telemedicine. Although telecommunications has tremendous potential to address the care needs of frail isolated elderly, without comprehensive reimbursement policies, guidelines for ethical conduct of a teleconsultation, acceptable security measures of patient records, and adequate as well as compatible infrastructure, that potential cannot be completely realized.     

Quality of medical care by central government health scheme--a study

This study reports findings on the time spent by CGHS medical officers per patient in different medical care activities for 2,115 patients, as obtained by time study technique. This study was conducted during the year 1976-77. The average observed time spent by the medical officer per patient was found to be 117.15 seconds per patient. The medical officers elicited only main complaints without asking past and family history in 84.44 per cent of patients and the average time spent on history taking was 42 seconds per patient which also included examination of identify card, recording of name, age and sex of the patients. Physical examinations were conducted in only 23.88 per cent of patients and the time spent per patient was 45.93 seconds. The advice for investigations was imparted in 2.60 per cent of patients, though the facilities for routine laboratory examinations were available in the dispensaries. Advice to the patient regarding dietary instructions and general advice was exclusively given in only 5.20 per cent of cases whereas the family planning/health education advice to the patients was given only in 0.76 per cent of patients. The medical officers are aware of the inadequate quality of medical care provided to the beneficiaries and they felt they should at least spend 6.83 minutes for an old patient and 12.42 minutes for the new patient. Probably they are not able to do so because of long queues in the dispensaries during peak hours. Hence, to improve the overall medical care and provide comprehensive care to the beneficiaries it is suggested that the medical officers can be given certain beneficiary population and made responsible to them.     

Bridging the gap between primary care and mental health

Major depression is a leading cause of disability in the United States and is frequently diagnosed and managed within a primary care setting, with less-than-optimal results. Studies have shown that adequate follow up significantly affects patient outcomes, including mortality; however, primary care providers face many challenges in providing this care within the constraints of a primary care setting. Collaborative care models have been shown to be effective in managing depression, and accordingly, the Translating Initiatives for Depression into Effective Solutions (TIDES) model was selected by the Bay Pines Veterans Affairs Healthcare System to help primary care providers manage depressed patients within the primary care setting. This article describes the implementation of TIDES and identifies a new role for mental health nurses outside of the traditional mental health setting.     

Standardizing the care of detox patients to achieve quality outcomes

Providing appropriate treatment for detoxification patients is both challenging and difficult because alcohol abuse and dependence are largely underestimated in the acute hospital setting. Alcohol withdrawal syndrome is treated not only by addictionologists on chemical dependency units, but also by primary care physicians in acute inpatient settings. The need for consistent inpatient treatment through the use of identified protocols can help provide safe and effective care. The need for consistent, inpatient medical-surgical detoxification treatment in our organization became apparent with the staff's identification of patient care concerns. Using an organizational approach, a multidisciplinary team was created to standardize the care of detoxification patients, beginning with patient admission and ending with discharge and referral for outpatient management. Standardization would ensure consistent assessment and intervention, and improve communication among the clinical team members. A protocol was developed for both the emergency department and the inpatient units. The goals of the team were to decrease the adverse events related to detoxification, such as seizures and aggression, and provide a consistent method of treatment for staff to follow.     

Phenomenology in End-of-Life Care: Implications for Philosophy and Clinical Practice

Care of the terminally ill and dying in the hospice setting is a growing practice field for social workers. Support to family, as well as the patient, is implicit in hospice care, adding to the reach and impact of the hospice social worker’s role. As people age and approach the end of life, they may encounter changes in their experience of time, space and of the material world. They often have to redefine the role of hope in their day to day lives. Based on these changing experiences and perceptions, phenomenology, with its focus on a patient’s subjective, lived experience, has implications for end-of-life care. The role of empathy and compassion are also explored in relation to existential experiences of the terminally ill through the lens of phenomenology and Eastern philosophy. To complement the Western biomedical model of care for the dying, insight from Eastern philosophical traditions, which view living and dying on the same continuum, and provide an expanded view of suffering bring comfort and understanding to how living and dying are processed within the phenomenology of patient experience and the hospice model of care. Case vignettes demonstrate social work theory and practice at the intersection of various interrelated phenomena when caring for those facing the end of life.     

JUST A MINUTE: THE EFFECT OF EMERGENCY DEPARTMENT WAIT TIME ON THE COST OF CARE

Wait times are rising in U.S. emergency departments (EDs). The longer a patient waits to be seen, the more their condition may worsen. Notably, patients in worse condition can cost more to care for. This study estimates the effect of ED wait time on the cost of care by exploiting the quasi-random assignment of patients to triage nurses in an instrumental variables framework. The results suggest that prolonging the wait of a patient who arrives with a serious condition by 10 minutes will increase the hospital's cost to care for the patient by an average of 6%. The magnitude of this effect dissipates (fading to zero) among patients who arrive with less serious conditions.(JEL D24, H41, I10)     

Inpatient practice. An integrated framework.

A framework for practice that integrates nursing concepts and processes with system concepts has distinct advantages. Nursing concepts provide direction for nursing care; the nursing process provides the structure in which nursing care is delivered and evaluated. Application of system concepts enables the CNS to navigate and negotiate the larger institutional context. Inpatient practice is not just the delivery of quality patient care; it also involves managing the system so it is possible to deliver care. An integrated framework has been offered as a guide to inpatient practice. Although further use and testing are indicated, so far it has proved useful in the practice of a CNS.     

Care giving and nursing, work conditions and Humanitude®

Increased lifespan in western societies causes the increase of hospitalization in the old age, notably for patient showing forms of dementia including Altzheimer disease. These patients relate poorly to care givers and nurses, and cases of maltreatment have repeatedly been reported. To prevent abuse and increase patient's quality of life, Gineste and Pelissier (2007) proposed a philosophy of care based on the Humanitude? concept. Acknowledging that being human is being vertical and related to other humans, the pillars of Humanitude? are gaze, touch, talk, and standing. These modes of relation are systematically developed in care giving techniques derived from the concept. After several studies in geriatric hospitals, to assess psychosocial and ergonomic aspects of work, we present an analysis of the gap between the logic of human care and the logic of hospital organization, impacting employees work conditions and psychological welfare. Care giving is not only a "one to one" relation with the patient but needs to be integrated in the whole organization. Psychologists and ergonomists should be instrumental in defining the project and the organization linking human care giving towards the patients and better work conditions for healthcare employees.     

Queues and care: how medical residents organize their work in a busy clinic

How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings.     

Internet Technology in Service of Personal Health Care Management: Patient Perspective

Internet technology has become an informational resource for most health care consumers. Online information, discussion, and support groups, in the form of message boards, listservs, and chat rooms are emerging as parts of virtual self-health-care network. This paper examines the extent to which participation in online health discussion groups was reported to be helpful in increasing medical knowledge and in enhancing the participatory patient role of health care consumers in interaction with health care service professionals. Data for this study was collected from 350 patients who participated in Internet discussion groups for cancer patients. The findings of the study indicated the important impact of Internet health discussion groups on health care management practices as perceived by health care consumers, including empowerment through knowledge and proactive participation in cancer care management. This research contributes to understanding the patient perspective and assesses the perceived importance of Internet groups by health care consumers.     

Study on workloads of human care worker with the introduction of IT system - the characteristics of work loads by observational research and the suggestions for KAIZEN

The purpose of this study was to clarify the characteristic of workloads on human care worker with the introduction of IT system, and suggested the support measures for KAIZEN in Japan. The investigation method is workflow line and hearing with a focus on work observation. The objects were 8 human care workers of the acute hospital that introduced an electronic system. By the introduction of the electronic chart, the nurse station sojourn time decreased, sickroom sojourn time increased, and time about direct nursing care to a patient increased. In addition, access to patient information became easy, and the offer of the health care service based on correct information came to be possible in real time. By The point of workflow line, it was effect that moving lengths decreased in order to install the electronic chart in patients' rooms. Though, it was a problem that it hasn't formed where to place the instruments such as sphygmomanometer, clinical thermometer and others.