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Validating the primary provider theory in emergency medicine

Joseph S. Guarisco (Department of Emergency Medicine, Ochsner Medical Center, New Orleans, Louisiana, USA)
Stefoni A. Bavin (Press Ganey Associates, Inc., South Bend, Indiana, USA)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 2 May 2008




The purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.


The case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.


The findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.

Practical implications

These findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.


There are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.



Guarisco, J.S. and Bavin, S.A. (2008), "Validating the primary provider theory in emergency medicine", Leadership in Health Services, Vol. 21 No. 2, pp. 120-130.



Emerald Group Publishing Limited

Copyright © 2008, Emerald Group Publishing Limited

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