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The purpose of this paper is to explore the existing literature on the relationship between different service attributes and patient satisfaction at outpatient nutrition clinics to propose and test a culture-specific conceptual model interlinking the drivers of patient satisfaction.

Over a 7-week period in Fall 2019 (November 2–December 19), 600 patients from a Lebanese-Middle Eastern hospital (396 females and 204 males) completed an anonymous-designed survey with closed questions (n = 30). Statements were considered to represent specific attributes of nutrition services. In order to measure the existence and degree of significant relationships between different research variables, Pearson correlation coefficients and Fisher's Z test were employed to analyze the collected data, before and while joining the clinic, during and after the appointment. Means of scores and frequencies were calculated.

The results show that the nutrition service attributes with reference to “after the appointment” may improve the patients' satisfaction level more than attributes with reference to “while joining the clinic” and “during the appointment”. Most patients were satisfied with their overall outpatient clinic experience. The patient experience is a direct result of positive interactions with the entire services offered.

The conceptual model sets the foundations for testing and for further research to develop. Moreover, the findings of this study are important for assessing the quality of nutrition service attributes and for reporting on the ability of this service to meet the needs and preferences of patients in the health care sector.

This study attempts to fill the gap in knowledge on nutrition service quality as indicators for overall patient satisfaction, while opening clear research avenues for further studies to follow. It is the basis for the development of clinical practice guidelines and other quality enhancement tools.

For health services researchers and health services management educators, chronicling the unfolding of a country's implementation of national health insurance (NHI) is once in a lifetime opportunity. Rarely, do researchers have the opportunity to observe the macro and micro changes associated with turning a country's health care delivery system 180 degrees. Accordingly, we report on the first decade of Taiwan's changing delivery system and selected adaptations of health care management, providers and patients.

We study research designs where a binary treatment changes discontinuously at the border between administrative units such as states, counties, or municipalities, creating a treated and a control area. This type of geographically discontinuous treatment assignment can be analyzed in a standard regression discontinuity (RD) framework if the exact geographic location of each unit in the dataset is known. Such data, however, is often unavailable due to privacy considerations or measurement limitations. In the absence of geo-referenced individual-level data, two scenarios can arise depending on what kind of geographic information is available. If researchers have information about each observation’s location within aggregate but small geographic units, a modified RD framework can be applied, where the running variable is treated as discrete instead of continuous. If researchers lack this type of information and instead only have access to the location of units within coarse aggregate geographic units that are too large to be considered in an RD framework, the available coarse geographic information can be used to create a band or buffer around the border, only including in the analysis observations that fall within this band. We characterize each scenario, and also discuss several methodological challenges that are common to all research designs based on geographically discontinuous treatment assignments. We illustrate these issues with an original geographic application that studies the effect of introducing copayments for the use of the Children’s Health Insurance Program in the United States, focusing on the border between Illinois and Wisconsin.

As hospitals are now being designed with an increasing number of single rooms or cubicles, the individual preference of patients with respect to social contact is of great interest. The purpose of this study is to gain a better understanding of the experience of patients in an outpatient infusion center.

A total of 29 semi-structured interviews were conducted, transcribed and analyzed by using direct content analysis.

Findings showed that patients perceived a lack of acoustic privacy and therefore tried to emotionally isolate themselves or withheld information from staff. In addition, patients complained about the sounds of infusion pumps, but they were neutral about the interior features. Patients who preferred non-talking desired enclosed private rooms and perceived negative distraction because of spatial crowding. In contrast, patients who preferred talking, or had no preference, desired shared rooms and perceived positive distraction because of spatial crowding.

In conclusion, results showed a relation between physical aspects (i.e. physical enclosure) and the social environment.

The findings allow facility managers to better understand the patients’ experiences in an outpatient infusion facility and to make better-informed decisions. Patients with different preferences desired different physical aspects. Therefore, nursing staff of outpatient infusion centers should assess the preferences of patients. Moreover, architects should integrate different types of treatment places (i.e. enclosed private rooms and shared rooms) in new outpatient infusion centers to fulfill different preferences and patients should have the opportunity to discuss issues in private with nursing staff.

This study emphasizes the importance of a mix of treatment rooms, while new hospital designs mainly include single rooms or cubicles.

There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals.

The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility.

The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants.

Limitations of the study include the lack of control group.

This program is easy to disseminate and could improve the quality of care and costs.

This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.

Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic bypass costs, complication rates, readmission rates, and post-operative care.

Objective. To examine the 6-month costs and outcomes of laparoscopic vs. open bariatric bypass surgery using a national population-based sample.

Design. We use the 1998–2003 Nationwide Inpatient Sample to examine national trends in the rate of laparoscopic bypass. To examine post-operative outcomes, we examine insurance claims for 2,384 bariatric bypass surgeries, at 308 hospitals, among a population of 5.6 million non-elderly people covered by large employers across 49 states in 2001 and 2002. Multivariate logit regression analysis is performed to risk-adjust outcomes.

Main Outcome Measures. 180-day outcomes: 12 complications specific to bariatric surgery and 44 general post-operative conditions, readmission rates, ER rates, and expenditures following bariatric surgery.

Results. Between 1998 and 2003, the national percentage of bariatric bypass surgeries that were laparoscopic grew from 1.5 to 17.1%. There was no significant difference in in-hospital mortality between laparoscopy and open surgery. With the 2001–2002 claims data, we find that of the patients having bypass surgery, men had 48% lower odds of having laparoscopy and that high bariatric volume hospitals were close to four times more likely to use laparoscopy. Laparoscopic bypass, compared with open bypass, had 34% lower odds of a complication during the initial surgical stay, 27% lower odds of a 30-day complication, but no statistically significant difference in 180-day complications. Laparoscopy had 49% higher odds of having the general 44 post-operative conditions, with 45% higher odds of a readmission and 54% higher odds of an ER visit. However, overall, laparoscopy resulted in a 23% lower number of hospital days and 9% lower 180-day expenditures.

Conclusion. The laparoscopic cost-savings during the less invasive initial surgery stay outweigh the increase in post-discharge utilization. Further cost-savings will only emerge from laparoscopy only if its late post-operative complications are reduced. More cost-savings will also emerge as more physicians switch to the use of laparoscopy for bypass surgery.

The last few years have seen a stronger emphasis on patient-centred care within the international healthcare setting. Patient-centred care is clearly perceived to be important to optimise the satisfaction and well-being of patients. The purpose of this paper is to review current patient-centred practices for outpatients in both private clinics and public hospitals in Dubai. Such a comparison contributes to the identification of best management practices as a means of enhancing healthcare delivery.

This study is based on an independent survey consisting of self-administered questionnaires, in which patients were asked to rate several aspects of private clinics or government hospitals in Dubai. The questionnaire used has been drawn from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey, Version 3.0. Responses from 420 patients form a data set that is analysed quantitatively.

In total, 420 respondents took part in this survey. The results of the survey show that there is a considerable difference between the expectation levels of patients from government hospitals and patients from private clinics. Patients from government hospitals consistently show that time is a critical aspect of the service received, with 68 per cent of the respondents reporting this issue. Additionally, poor customer care, as reported by 14 per cent of the respondents, is also a critical issue. Timely service and appointments are among the main factors that contribute to patient satisfaction. Patients in private clinics, instead, particularly value clear explanations from doctors and nurses – this is corroborated by the fact that 11 per cent of the respondents reported appreciation of this type of service.

This paper draws attention to a patient-centric perspective of healthcare, and highlights the importance of educating patients through clear explanations.

Little evidence exists on the standards of healthcare in Dubai. The authors explore this area and present direct evidence on quality standard implementation, identify implementation shortcomings and make recommendations for future research and practice.

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

This chapter demonstrates (1) divergence between spending based upon a budget ratcheting model and a benchmark spending model, (2) that this divergence affects organizational performance, and (3) that internal benchmarking enables unit-to-unit performance comparisons, despite claims of organizational or unit uniqueness. We contrast two spending models to examine whether the divergence, or cost estimation gap, affects operating performance across inpatient (n=4,536) and outpatient departments (n=8,438) in 23 U.S. Army hospitals. Using a fixed-effects panel data methodology for fiscal years 2004–2006, we find that unit managers’ spending in this setting is more closely approximated by budget ratcheting. Using multiple performance metrics measured via a DuPont-like decomposition, we find that, within a specified range, operating performance generally improves as resources become constrained. Outside that range, however, we find nonlinear performance effects that approximate a quadratic loss function. Our benchmark model enables clinical department comparisons while controlling for facility, clinical specialty, and case mix severity. The resulting departmental comparability facilitates identification and communication of best practices across the entire Army hospital system. These results should be of interest to corporate executives, government officials, and agency managers who have responsibility for establishing funding mechanisms that include performance-based components.

The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting‐times.

Cases were selected according to successful and sustained queue reduction. The approach in this study is action research.

Accessibility improved as out‐patient waiting lists for two clinics were reduced. The main success was working towards matching demand and capacity. It has been possible to sustain the improvements.

Results should be viewed cautiously. Transferring and generalizing outcomes from this study is for readers to consider. However, accessible healthcare may be possible by paying more attention to existing solutions.

The study indicates that queue reduction activities should include acquiring knowledge about theories and methods to improve accessibility, finding ways to monitor varying demand and capacity, and to improve patient processing by reducing variations.

Accessibility is considered an important dimension when measuring service quality. However, there are few articles on how clinic staff sustain reduces waiting lists. This paper contributes accessible knowledge to the field.