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This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It provides physician-centered tools, models, concepts, and the language to implement transformational patient-centered medical care.

To improve care delivery, quality, and patient engagement, a systems approach to care is required. This paper examines a systems approach to patient care where all inputs that influence patient interactions and participation are considered in the design of health care delivery and follow-up treatment plans. Applying systems thinking, organizational change models, and team-building, we have examined the continuum of this change process from ideation through the diffusion of new methods and behaviors.

PCMHs make compelling business sense. Studies have shown that the PCMH improves patient satisfaction, clinical outcomes and reduces underuse and overuse of medical services. Patient-centered care necessitates transitioning from an adversarial to a collaborative culture. It is a transformation process predicated on strong leadership able to align an organization toward a vision of patient-centered care, creating a collaborative culture committed to health-goal achievement.

This paper proposes that the PCMH is a rigorous team-building transformational organizational change, a radical departure from the current hierarchical, silo-oriented, medical practice model. It requires that participants within and across health care organizations learn new skills and behaviors to achieve the anticipated quality and efficiency improvements. It is an innovative health care organization model of the future whose success is premised on teams supplanting the individual as the building block and unit of health care performance.

This paper aims to review the patient satisfaction literature, specifically meta‐analyses, which critically analyses its theory and use; then to present evidence for perceived service quality as a separate and more advanced construct.

Papers that judiciously review the development and application of patient satisfaction were identified; along with studies addressing the conceptual and methodological deficiencies associated with the concept; and the current perceived service quality theory.

Patient satisfaction has been extensively studied and considerable effort has gone into developing survey instruments to measure it. However, most reviews have been critical of its use, since there is rarely any theoretical or conceptual development of the patient satisfaction concept. The construct has little standardisation, low reliability and uncertain validity. It continues to be used interchangeably with, and as a proxy for, perceived service quality, which is a conceptually different and superior construct.

The persistent use of patient satisfaction to evaluate the client's perception of the quality of a health service is seriously flawed. The key to solving this dilemma may be for the healthcare sector to focus on perceived health service quality by considering the specific concepts and models that can be found in the services marketing literature. This literature offers more advanced consumer theories which are better differentiated and tested than existing healthcare satisfaction models.

The paper points out that there is an urgent need for differentiation and standardisation of satisfaction and service quality definitions and constructs, and argues for research to focus on measuring perceived health service quality.

The increase in demand for health services requires companies in the segment to seek management tools and techniques that focus on reducing waste such as waiting, unnecessary displacement and low people productivity. The purpose of this paper is to present the value stream mapping (VSM) of patients at an occupational medicine clinic, proposing a new scenario with the aid of the simulation of discrete events to reduce the total waiting time during the patient's journey.

The methodology consisted of a case study developed in an occupational health clinic, involving the analysis of the patients' arrival times, time of attendance, number of employees and their functions. Data collection considered 100 random samples from the patients' arrival interval and 40 random samples for each of the operational processes performed by the clinic in a work shift. The collected data served as input for the simulation of scenarios and prioritization of the times for the proposal of the future VSM.

With the study it was possible to propose the reduction of time wasted in the patient's journey, mainly the waiting times (37.92%) and the lead time (29.86%), making it possible for the patient to go through the entire process without waiting for queues. In addition, the increase in employee productivity and efficiency in patient care during the work shift is considered.

Despite the considerable gains obtained with the realization of this study in relation to the processing times, total waiting time and lead time, the analysis was not considered, the mode of execution of the processes performed by the professionals and the influence of the layout to improve the flow of patients, being some of the challenges for future studies to consolidate lean culture in the health segment.

The simulation of discrete events indicated that it is possible to attend a larger number of patients with the same professional structure, in case the delay in the arrival time of doctors and speech therapists is resolved. There was a reduction in the average total waiting time of 37.92%, a reduction in lead time to 29.86% and identification of the steps that most contributed to the increase in queues for patients in a 05:30 min work shift.

The work proposed the constitution of a VSM based on a discrete simulation with data from the entire health unit system, considering everything from the reception for patient registration, collection of laboratory and image exams to medical assistance. The work differs from the others in that it considers the patient's entire journey in the occupational medicine clinic, instead of prioritizing only one service department. The analysis of the results considered the scenario that presented the maximum efficiency of the available resources, respecting the patient's individualized care times, which is one of the complaints of the therapeutic teams to the use of standardization by the VSM.

The purpose of this paper is to describe accomplishments and conundrums in a midcareer program of research with roots in the Strauss and Corbin seminars at UCSF in the early 1990s. My use of grounded theory methods in a succession of studies, all focused on family caregiving during cancer treatment, has generated theory on family caregiving skill, a phenomenon that was underconceptualized in the early 1990s. However, my successive grounded theory studies have raised a number of methodological conundrums pertaining to researcher perspective. I describe two here. First, how can a researcher develop grounded theory through successive studies without becoming so analytically enmeshed with previous study results that what gets noticed in new data is limited? Second, how strong a presence can a researcher's clinical perspective have in an analysis without violating the tenets of grounded theory? I argue that recent scholarship in grounded theory provides new ways of thinking about these conundrums.

Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context.

The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included.

The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce.

The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care.

The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

In 2005, the Qualitative Methods in Psychosocial Health Research Group (QMiPHR) at the University of Nottingham was established as a forum to bring together academics, researchers and practitioners with an interest in qualitative methods. The group has provided colleagues in nutrition, psychiatry, psychology, social work and sociology with a forum for discussion around the question of how qualitative research is able to contribute to understanding mental health and the development of evidence‐based treatment. As a group, we asked ourselves where we stood in relation to the use of qualitative methods in mental health. While we are unified in our view that qualitative research is important and under‐utilised in mental health research, our discussions uncovered a range of views on the underlying philosophical stance of what it means to be a qualitative researcher in mental health. The aim of this paper is to provide an overview of our discussions and our view that as qualitative approaches have become more widely accepted they have largely been assimilated within the mainstream ‘medical model’ of research. In this paper, we call for researchers to re‐engage with the philosophical discussion on the role and purpose of qualitative enquiry as it applies to mental health, and for practitioners and decision‐makers to be aware of the implicit values underpinning research.

Health Information Exchange (HIE) is essential for the efficient and cost-effective delivery of health-care services. The provider’s administrative structure and external environment can substantially influence adopting technologies involving inter-organizational linkages, such as HIE. Using the theoretical lens of institutional theory, this study aims to compare how public and private hospitals' engagement in HIE is influenced by corruption and government online services or e-government usage.

The study uses the positivist research design of secondary data analysis to test the six hypotheses proposed. Data from multiple third-party reliable sources, including the European Commission and World Bank, are combined into the final dataset consisting of observations from 1,442 hospitals across 30 countries in Europe. A multilevel modeling approach is used to associate country and hospital-level variables and test the hypothesis.

The study finds that, on average, a 10% increase in corruption leads to a 6.3% decrease, while a 10% increase in e-government leads to a 7% increase in the probability of HIE engagement for a hospital. The negative impact of corruption on average is 18% more in public than private hospitals, while the positive impact of e-government is 75% stronger in public in comparison to private hospitals. The study also finds that HIE engagements in health systems with predominantly public hospitals are more sensitive to corruption and e-government.

To the best of the authors’ knowledge, the study is one of the first to use the institutional view to test the influence of government actions and public providers' concentration on HIE engagement. The comparison of public and private institutions enriches our understanding of promoters and inhibitors of HIE.

This paper synthesises the literature on the issues related to the older patient, health service quality and its measurement. It discusses the need to consider these perspectives in the definition and assessment of quality of a community‐focused aged healthcare programme, and critically examines the existing evaluation of quality in healthcare, contrasting the patient's role and impact on the quality of the service and its outcome. The paper then reviews the documented problems associated with using satisfaction as an indicator of the patient's view of quality. An alternate validated approach to measuring the patient's perception of the quality of the service is identified in the services literature; this multidimensional hierarchical tool and scale, which specifically measures the patient's view of quality, is presented. The tool covers nine sub‐dimensions, four dimensions and the global perspective of quality as perceived by the patient. An adaptation of this tool is presented to measure the patient's view of quality using the relatively new Transition Aged Care programme as an example, and make the argument for the holistic measurement of transitional aged care quality, using a validated and reliable patient‐specific tool. Importantly, the paper proposes that the identification of the patient view of service quality will offer information that could specifically assist with service improvement.

The purpose of this paper is to find determinants of the effectiveness of the business improvement processes that create value for services offered to patients in healthcare industries. The words patients and customers are used interchangeably throughout without any distinction. The features that distinguish medical services of different types and their inter-related factors are examined. The aim is to come up with a model of value vs cost that can help healthcare managers examine and use this exercise as an example of improvement micro-projects to help reduce cost and eliminate the patient’s dissatisfaction gaps.

The list of factors or attributes influencing the creation of value of a given medical process or a single procedure is described. The factors in the value creation are examined that will help in the categories for the risk analysis to determine the value-added benefits for the patient outcome. The cost analysis is approached from two angles to include: the cost of the service, and the costs of poor quality of service.

The model describes the value for the patient satisfaction depending on the quality level or grade of the treatment or procedures used and the cost factor. The analysis is done at several levels with special reference to case examples. A search for various analogous models in similar service providing situation used in business process management of other process types is highlighted and discussed.

The model is an interesting generic illustration for considering value vs cost in all patient care strategies. It enables the position of various medical procedures that can be applied to the same disease in order to keep the variations as minimum as possible within the quality control specification limits. The importance in different aspects of check-points or hold points for inspection is also discussed.

The purpose of this paper is to gauge the health-care services from a patient’s perspective in five private hospitals in the Syrian capital Damascus.

The five dimensions-SERVQUAL model (tangibility, empathy, assurance, reliability and responsiveness) was implemented to measure the gap between patient’s perception and expectation in health-care service quality.

The SERVQUAL tool proved to be reliable and valid in assessing service quality in Syrian health-care setting. The assessment of the service quality from a patient’s perspective shows that all SERVQUAL dimensions were negative except for tangible element that scored (+0.57) gap. Based on patient’s expectation, empathy scored the highest score with (4.37), followed by responsiveness (4.17), reliability (3.90), tangibility (3.82) and assurance (3.45). The widest negative gaps among the 22 SERVQUAL items were related to listening skills of hospital staffs (−1.52) and for spending enough time with patient (−1.81). This study indicated that tangible dimension plays a significant role in balancing the deficiency in other service quality dimensions. In addition, communication skills of medical and paramedical staff should be improved to ameliorate patient’s perception about health-care services.

This study provides valuable insights into the patient’s perception, but the feedback from hospital staffs (doctor, nurses) and hospital’s senior managers also considered potential rich information sources. This survey is conducted in the capital, and future research should include replication of this study in the other 13 Syrian governorates before generalizing the findings of this research.

Hospital administrator could use SERVQUAL model to improve their operational performance as well as to benchmark their behavior against other competitors in the health-care market in Damascus. This paper provides valuable information to policymakers and top hospital management to understand patient-centered care and to improve health-care system in Syria. Besides, this research provides a marketing insight to realize what patient expects and how she/he assesses the care service.

To the author’s knowledge, this is one of very few studies conducted to assess service quality in private health-care sector in Damascus. The main contribution of this study is providing the empirical evidence that the five dimensions-SERVQUAL scale proved to be reliable and valid instrument for measuring and analyzing health-care service quality in Syria.