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Identifying the factors that contribute or hinder the provision of good quality care within healthcare institutions, from the managers’ perspective, is important for the success of quality improvement initiatives. The purpose of this paper is to test the Integrative Quality Care Assessment Tool (INQUAT) that was previously developed with a sample of healthcare managers in the USA.

Written narratives of 69 good and poor quality care episodes were collected from 37 managers in Italy. A quantitative content analysis was conducted using the INQUAT coding scheme, to compare the results of the US-based study to the new Italian sample.

The core frame of the INQUAT was replicated and the meta-categories showed similar distributions compared to the US data. Structure (i.e. organizational, staff and facility resources) covered 8 percent of all the coded units related to quality aspects; context (i.e. clinical factors and patient factors) 10 percent; process (i.e. communication, professional diligence, timeliness, errors and continuity of care) 49 percent; and outcome (i.e. process- and short-term outcomes) 32 percent. However, compared to the US results, Italian managers attributed more importance to different categories’ subcomponents, possibly due to the specificity of each sample. For example, professional diligence, errors and continuity of care acquired more weight, to the detriment of communication. Furthermore, the data showed that process subcomponents were associated to perceived quality more than outcomes.

The major limitation of this investigation was the small sample size. Further studies are needed to test the reliability and validity of the INQUAT.

The INQUAT is proposed as a tool to systematically conduct in depth analyses of successful and unsuccessful healthcare events, allowing to better understand the factors that contribute to good quality and to identify specific areas that may need to be targeted in quality improvement initiatives.

The scientific literature evidences that the quality of care must be improved. However, little research has focused on investigating how health care managers – who are responsible for the implementation of quality interventions – define good and poor quality. The purpose of this paper is to develop an empirically informed taxonomy of quality care as perceived by US managers – named the Integrative Quality Care Assessment Tool (INQUAT) – that is grounded in Donabedian’s structure, process and outcome model.

A revised version of the critical incident technique was used to collect 135 written narratives of good and poor quality care from 74 health care managers in the USA. The episodes were thematically analyzed.

In total, 804 units were coded under the 135 written narratives of care. They were grouped under structure (9 percent, n=69), including organizational, staff and facility resources; process (52 percent, n=419), entailing communication, professional diligence, timeliness, errors, and continuity of care; outcomes (32 percent, n=257), embedding process- and short-term outcomes; and context (7 percent, n=59), involving clinical and patient factors. Process-related categories tended to be described in relation to good quality (65 percent), while structure-related categories tended to be associated with poor quality (67 percent). Furthermore, the data suggested that managers did not consider their actions as important factors influencing quality, but rather tended to attribute the responsibility for quality care to front-line practitioners.

The INQUAT provides a theoretically grounded, evidence-based framework to guide health care managers in the assessment of all the components involved with the quality of care within their institutions.

The purpose of this paper is to determine the association between patients who talked to their doctor about their risk of falling, or occurrence of balance problem. This study analyzed a secondary data set based on the Medicare Health Outcomes Survey (HOS) for the Medicare Advantage patients of 65 years and older. This study guided by two hypotheses that: patients who talked to their doctor about falling or balance problem are more likely to have fallen in the past than those who did not talk to their doctor about their fall risk; and patients talking to their doctor about a fall or balance problem are more likely to receive an early intervention such as patient education to prevent a future fall.

This study utilized a secondary data set to test its hypotheses. The Centers for Medicare and Medicaid Services (CMS) is dedicated to monitoring the quality of care provided to Medicare population in a managed care setting. Inter-University Consortium for Political and Social Research conducts the HOS to measure outcomes of quality improvement interventions developed by CMS in collaboration with the National Committee for Quality Assurance for Medicare Advantage Organizations (MAOs). The measures are focused on assessing the physical functioning and mental health being of Medicare beneficiaries and are aligned with reporting evidence of standards of care. Medicare HOS is administered in each Spring surveying a random sample of Medicare beneficiaries from MAOs that have a minimum of 500 enrollees; the cohort is surveyed again two years later as a follow-up measurement.

Reporting of a fall or balance problem is a critical component in fall prevention strategies. This study analyzed the distribution of beneficiaries who talked with their doctor about a fall or balance problem to understand if personal disposition (i.e. social class – educational level, gender, and race) would have been a factor in patients communicating with their doctor about their risk factors. The study found that 67.77 percent of patients who talked with their doctor about a fall or balance problem have at least a high school education compared with 32.23 percent who have less than a high school education or GED.

All patients who responded to the survey and fulfilled the inclusion criteria were included in the study. Therefore, the data presented a limitation due to a self-report of no doctor visits, which could indicate inopportunity for provider-patient communication to take place. Additionally, such an information on fall or balance problem, including actual fall occurrence in the past 12 months, was based on self-report that could present inaccuracy since the elderly population tend to have diminished or poor memory, which may also be problematic.

Although this specific interaction starts with patient reporting of a health problem such as a fall or balance problem, provider must take a proactive approach in deploying prevention strategies, such as to conduct a comprehensive fall-risk assessment regardless of a report of a fall history by the patient. Further investigation of this study is recommended to ascertain pre-dispositional factors that affect patient communication, in order to address any barriers that could impede patient-provider collaboration. Nonetheless, enhancing patient-provider communication is fundamental to any quality intervention strategies such as fall prevention.

Another key finding in this study is that patient communication facilitates fall prevention. Patients who talked to their doctor about their fall or gait problem were provided with patient education on how to prevent falls by their doctor. The provider is informed on patient’s balance problem, which leads to further evaluation of patient health status in order to identify other related factors since a comprehensive fall-risk assessment would have been likely conducted providing adequate information beyond the fall occurrence. This affirms the need for provider-patient communication to serve as catapult for effective care coordination, which is effectual in any intervention strategies.

Fall prevention is increasingly drawing attention and gaining momentum among healthcare organizations (including non-managed care) since falls and fall-related injuries are easily preventable (Lach et al., 2011). Efforts that can identify and accurately analyze patient health status, including intrinsic and extrinsic risk factors, promote effective interaction between patient and provider. This study has shown the positive effect of patient communication in order to allow doctors to effectively intervene (i.e. prevent a future fall) through the provision of patient education.

Health care organizational research should pay greater attention to the specific settings where health is practiced. An ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center. A thick description of the setting and interaction among center staff and patients is offered in an attempt to establish why qualitative research of health care settings is so important. Findings are compared to Ellingson’s work on health care setting. Humor, ritual and defiance have therapeutic value and deserve greater attention in cancer treatment centers and health care organizations more broadly. The paper aims to discuss these issues.

An ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center through thick description.

This study reinforces the literature on the value of institutionalizing humor and ritual to improve patients’ experience in cancer care given the dominance of large public institutions, most easily accessed by academic researchers. Suncoast Coast Radiation Center’s “institutionalized humor” is an important finding that should be examine further. Scholarship can also illuminate the use of ritual in settings where health care is practiced.

This study is limited to a particular research setting which is a private, concierge care radiation oncology treatment center in the Southeastern USA.

Cancer care centers should consider carefully institutionalizing humor and ritual into their daily practices. Further, patient defiance should be reinterpreted not as a patient deficiency but as a therapeutic coping mechanism by patients.

While nearly half of cancer care in the USA is offered in private, for-profit institutions, the vast majority of the understanding of cancer care comes only from non-profit and government-run institutions. Shining a light of these neglected cancer care settings will add to the understanding and the ability to improve the care offered to patients.

This is the first health ethnography in a concierge care, cancer care treatment setting. It tests the proposition that humor, ritual and defiance play an important role in a private concierge cancer care organization.

The purpose of this paper is to investigate the clinical communication using Tamale Teaching Hospital as a case.

The paper is based on the Reassure, Explain, Listen, Answer, Take Action and Express Appreciation (RELATE) model and the Four Habits models of Clinical Communication.

The results of the study indicate that leadership conducted staff meetings with some of the components of the RELATE model. These include staff meetings, employee rounding and communication/notice boards. The results of the study also suggest that much as some parts of the Four Habits model was used in provider–patient communication, certain aspects of the model were absent. The study identified some communication challenges including poor dissemination, lack of unity among some health workers, poor attendance in meetings and, with respect to patients, language barrier, patients’ reluctance to disclose their actual health problems to health providers, lack of privacy and lack of a friendly environment.

Providers, especially physicians, should be given training on the local languages in areas where they perform their services. Health service providers should receive as part of their learning in-depth training on the Four Habits model of Clinical Communication, especially the Medical Officers.

It is imperative to embrace evidence-based practices/models aimed at securing proper communication in all hospitals but most especially teaching hospitals.

The purpose of this paper is to evaluate the impact of extended waiting time on patients’ perceptions of provider communication skills and in-clinic satisfaction, in three major cities in India.

In total, 625 patients were interviewed. The multivariate general linear model was used to determine the causality and relationship between the independent and the dependent variable. A moderation analysis was also conducted to assess waiting time role as a potential moderator in doctor-patient communication.

Results show that patients with higher waiting time were less satisfied with health care quality. Male patients and patients of male providers were more affected by extended waiting time than female patients and patients of female providers. The advanced regression analysis, however, suggests weak support for waiting time and its effect on overall satisfaction with clinic quality. Waiting time did not moderate the relationship between satisfaction with dominant communication style, and overall satisfaction at the outpatient clinic.

A cross-sectional study does not easily lend itself to explaining causality with certainty. Thus, sophisticated techniques, such as structural equation modelling may also be utilized to assess the influence of extended waiting time on satisfaction with healthcare at outpatient clinics.

Findings are relevant for providers as the onus is on them to ensure patient satisfaction. They should initiate a workable waiting time assessment model at the operational level.

There has been a relatively lesser focus on patient waiting time in patient-provider satisfaction studies. In India, this aspect is still vastly unexplored especially in the context of outpatient clinics. Gender wise pattern of patient satisfaction and waiting time is also missing in most studies.

The purpose of this paper is to examine the relationship between patients’ provider communication effectiveness and courteousness with patients’ satisfaction and trust at free clinics.

This cross-sectional survey (n=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics.

Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness.

Investment in patient-centered communication training for providers will improve patient satisfaction and trust.

The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.

Implicit bias is the application of an unconscious attitude or belief; in the clinical setting, a provider’s perception of a patient, based upon perceived race or ethnicity, is hypothesized to affect clinical decisions, provider-patient interactions and patient health. The purpose of this paper is to provide a brief synopsis of and critique the relevant works over the past 15 years while highlighting the strengths of this body of literature.

A MEDLINE search, from 2000 to 2015, using the terms “implicit bias,” “unconscious bias” and “aversive racism” was performed. US-based studies investigating the effect of racial or ethnic implicit bias on the clinical encounter or patient outcomes were assessed. In total, 15 articles were eligible for review.

Despite well-reasoned hypotheses that racial/ethnic bias negatively affects patient care, this review found mixed results. Largely, studies showed that US-providers hold an anti-black implicit bias negatively affecting patient-provider communication and patient satisfaction. But studies have not shown that this bias consistently negatively affects diagnosis and treatment regimens of black patients in comparison to white patients. There is a significant dearth of implicit bias literature addressing the care of other patient groups of color.

This review of the recent literature challenges the black-white dichotomy of most implicit bias research in the USA and highlights the lack of patient-oriented outcome research in this field. Furthermore, it demonstrates that regardless of the effect of implicit bias on patient outcomes, focus on eliminating implicit bias is insufficient to improve the health of people of color.

Effective provider‐patient communication and the relationships that it supports are located at the centre of quality health‐care delivery. The patient‐centred approach is increasingly seen as an effective way to provide effective patient care, being more sensitive and responsive to the needs of the individual. Empathy has been identified as a core component of “patient‐centredness” but definitions often lack conceptual clarity. This paper proposes to clarify the definition of empathy keeping the discussion true to Rogers' original definitions of the concept whilst integrating the work of other writers. A major thrust is the development of an innovative conceptual model of empathy which has the potential to both integrate previous research findings and provide a framework for future research and training. The model is based in social psychological conceptions of attitude.