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The Consultation and Relational Empathy (CARE) Measure is a validated tool for assessing the patients' perception of the doctors' communication in primary care. The present study aims to evaluate the potential usefulness of the CARE Measure in secondary care in a single Hospital Trust in Scotland.

A total of 1,015 out‐patients attending 25 consultants across ten specialities anonymously completed the questionnaire immediately after their appointment. Overall satisfaction, estimated consultation length, satisfaction with consultation length, and demographic and socio‐economic variables were also recorded.

The number of missing values and “not applicable” responses to the ten CARE Measure items was extremely low (3.4 per cent). Almost 90 per cent of patients felt the CARE Measure items were of major importance. The measure had a high internal reliability (Cronbach's alpha 0.94) and reduced to a single factor. Overall CARE Measure score correlated with overall satisfaction (r=0.7, p<0.0001), whether patients would recommend the doctor (r=0.6, p<0.0001), and satisfaction with consultation length (r=0.6, p<0.0001). Multi‐regression analysis showed that personal continuity of care, consultation length, and patient age positively influenced CARE Measure score, but the effect size was small. Patients' gender, marital status, general health, and socio‐economic factors did not influence scores. Reliability analysis indicated that 40 patients were required per doctor in order to achieve an overall reliability co‐efficient of above 0.7.

Secondary care patients across a range of specialities have endorsed the CARE Measure as a relevant tool. It has high face and concurrent validity, internal and structural reliability and is not subject to major influences by demographic or socio‐economic factors. These findings support the feasibility and reliability of the CARE Measure in secondary care.

This pilot study indicates that the CARE Measure is considered by most patients to be of high relevance to everyday out‐patient consultations in secondary care.

The purpose of this paper is to determine the relevance and reliability of the ten‐item Consultation and Relational Empathy (CARE) Measure as a tool for measuring patients' views of anaesthetists during preoperative assessment consultations.

Self‐completed patient questionnaire containing the ten‐item CARE Measure. Consecutive adult patients were asked to complete the ten‐item CARE questionnaire immediately after their pre‐operative assessment consultation with the anaesthetist and return it to a designated local co‐ordinator. Reliability co‐efficient of the overall measure, and relevance of each item to patients' concerns were measured.

Using the Measure, 31 consultant anaesthetists were assessed by 1,582 patients (559 male, 952 female). The total number of “not applicable” responses was 1,086, (6.8 per cent of the total number of possible “not applicable” responses). The overall number of missing values was 0.6 per cent. The measure effectively discriminated between doctors (reliability co‐efficient of the average score per doctor provided by 40 patients was above 0.8) and had high internal consistency (Cronbach's alpha, 0.93).

The present study presents evidence of a tool which may have utility in anaesthetics and other settings.

Detached Concern and its core dimensions – employees’ concern toward and detachment from their clients – are important facets of the emotion-generative process during client interaction in people-oriented work environments. We studied the intra- and interpersonal effects of Detached Concern on professionals’ burnout (N = 1411) and patient-centered care quality (N = 332 patients; 43 physicians). Our findings indicate different Detached Concern types. Balanced employees (scoring high on concern and detachment) yielded lower burnout levels compared to imbalanced professionals. Patients’ perception of care quality was positively related to their physicians’ concern and detachment, and was significantly higher for the balanced than for the imbalanced physicians.

L. Dee Fink proposes that different and more significant kinds of learning should be created in higher education to transition student outcomes from simply “learning” to “significant learning,” and these new types of learning should be situated within significant learning experiences (Fink, 2003). Fink also identified a taxonomy of significant learning that included six components: integration, foundational knowledge, application, human dimension, caring, and learning how to learn. Using Fink’s Taxonomy of Significant Learning as a framework, the authors will share the development of a course on navigating the US Healthcare System that resulted in significant learning outcomes for students completing the first semester of a four-year Doctor of Pharmacy curriculum. Each learning experience will link to a component of the taxonomy and will serve as the mechanism for the authors to share the development and implementation associated with each aspect of the semester-long course. The assessment structure of the course is described in detail. The authors present one or more learning experiences to illustrate each component of Fink’s Taxonomy. Finally, lessons learned from the development and implementation of the course are presented to guide programs considering implementation of a similar significant learning experience.

The medical consultation is one of the requirements in diseases diagnosis and patient treatment. In addition, a high-quality consultation is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to identify factors affecting the high-quality consultation in medical communications.

The following electronic databases were searched: MEDLINE (via PubMed), Web of Science, Cochrane, EMBASE, Scopus and ProQuest until December 2018. In addition, the authors searched Google Scholar. Qualitative and quantitative studies were assessed using the Critical Appraisal Skills Programme, Qualitative Checklist and the Center for Evidence-Based Management appraisal checklist, respectively. A stepwise approach was conducted for data synthesis.

Of 3,826 identified studies, 29 met the full inclusion criteria. Overall, after quality assessment of studies, 25 studies were included. The studies were conducted in the USA (n=6), the UK (n=6), the Netherlands (n=4), Canada (n=2), Belgium (n=2), Poland (n=2), Germany (n=1), Iran (n=1), Finland (n=1), Austria (n=1), Qatar (n=1), Denmark (n=1) and China (n=1), and five studies were excluded. Data synthesis showed that high-quality consultation consisted of three main categories: structural (4 main themes with 26 sub-themes), process (2 main themes with 33 sub-themes) and outcome (3 main themes with 12 sub-themes) quality.

Using the indicators of consultation quality improvement can develop physicians’ clinical competence and skills. Decision makers can use them to monitor and evaluate physicians’ performance. A high-quality consultation can be useful in social prescribing that helps patients to manage their disease.

Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000 and considering the challenges that providers face in their quest to provide a high standard and affordable health service in the near future.

Methodology/Approach: We discuss recent policy developments and published analysis covering innovations within major aspects of health care (primary, secondary and tertiary) and ASC, before considering future challenges faced by providers in England, highlighted by a 2017 UK Parliament Select Committee.

Findings: The NHS and ASC system have experienced tightening budgets and serious financial pressure, with historically low real-terms growth in health funding from central government and local authorities. Policymakers have tried to overcome these challenges with several policy innovations, but many still remain. With large-scale investment and reform, there is potential for the health and social care system to evolve into a modern service capable of dealing with the needs of an ageing population. However, if these challenges are not met, then it is set to continue struggling with a lack of appropriate facilities, an overstretched staff and a system not entirely appropriate for its patients.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has been recognized as a “gold standard” set of “practical standardized measures” for assessing hospital service quality. Beginning with the HCAHPS, the purpose of this paper is to extend efforts to assess patient-centered communication (PCC) and the quality of healthcare and presents a scale for measuring patient perceptions and expectations of service quality in an emerging economy context.

A self-administered survey of patients in private hospitals (N = 171) was conducted to test the proposed framework. Exploratory and confirmatory factor analyses were used to establish the measurement model. Multiple regression analysis was used to explain the scale's predictive ability. ANOVA was used to analyze service quality gaps and rank patients' priorities.

Five components of PCC are identified. Among these, nurse affective communication has a significant positive effect on patient satisfaction. The gap analysis shows that patients have high expectations for doctors' affective communication, while they perceive a low level of service performance in the realm of nurse affective communication. The study highlights a new means of measuring “reliability” in healthcare. Important findings on patients' priorities are evaluated and discussed.

Healthcare organizations and practitioners can improve patient-centered care by stressing the dimensions of PCC, including clinicians' affective and instrumental communication.

The study expands the understanding of HCAHPS instruments in an emerging economy context and opens avenues for more widespread use of the measures. The research contributes to the literature on patient-centered care and healthcare service quality by proposing a scale for managing specific practices and interactions in healthcare.

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions.

A qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework.

Although the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient.

Given that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice.

This research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level.

Given the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.

This chapter addresses inequalities in the United Kingdom through the lens of health inequalities. Driven by inequalities in income and power, health inequalities represent a microcosm of wider debates on inequalities. They also play a role as the more politically unacceptable face of inequalities – where other types of inequality are more blatantly argued as collateral damage of advanced neoliberalism including ‘inevitable’ austerity measures, politicians are more squeamish about discussing health inequalities in these terms.

The chapter starts by depicting health inequalities in Scotland and summarises health policy analyses of the causes of, and solutions to, health inequalities. It then describes the concept of ‘proportionate’ universalism’ and sets this within the context of debates around universal versus targeted welfare provision in times of fiscal austerity.

It then turns to a small empirical case-study which investigates these tensions within the Scottish National Health Service. The study asks those operating at policy and practice levels: how is proportionate universalism understood; and, is it a threat or ballast to universal welfare provision?

Findings are discussed within the political context of welfare retrenchment, and in terms of meso- and micro-practices. We conclude that there are three levels at which proportionate universalism needs to be critiqued as a means of mitigating the impacts of inequalities in the social determinants of health. These are within the political arenas, at a policy and planning level and at the practice level where individual practitioners are enabled or not to practice in ways that might mitigate existing inequalities.