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Purpose: We analyze how medical providers use accountability processes or the regulatory means through which individuals hold themselves or others accountable to social norms, to uphold their medical authority. We use the case of trans medicine because in this medical domain, providers often have little to no expertise and few are trained specifically in delivering trans medicine or working with trans patients. As a result, providers experience uncertainty and are left without the typical tools and expertise on which they depend in most other areas of medical decision-making.

Design/methodology/approach: We conducted in-depth interviews with 23 medical providers and observations of transgender healthcare conferences in the United States between 2012 and 2015.

Findings: Our work offers insight into the provider side of patient-provider encounters and medical decision-making in gender minority health. The first accountability strategy providers employed was to invoke the language of evidence as a method to maintain their authority, in spite of the paucity of scientific evidence that undergirds this emergent medical domain. The second strategy was to mandate compliance by holding trans people accountable to the expectation of acquiescing to medical authority.

Originality/value: We contribute to the scholarship on gender minority health by examining how high power actors use accountability processes to restore order in interactions with trans and nonbinary patients. We demonstrate how enforcement to expectations through accountability processes is a plausible, though oft-overlooked, dimension of health inequalities.

The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices.

This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality.

Primary care physicians’ offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions.

The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings.

The patient’s choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape.

This work contributes to the understanding of how to provide cost effective and efficient UC services.

This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.

The purpose of the study was to empirically validate the linkages between IoT adoption and how it overarched influenced the patient care service engagement. This contributes to the body of knowledge and helps hospital managers to understand the relationship and relevance of IoT adoption; otherwise healthcare sector are late movers towards technology adoption. This gives a nuanced framework towards establishing empirically validated framework which will motivate healthcare services providers to be motivated to adopt and implement IoT enabled care delivery. The physician patient interaction and alignment during decision making will foster positive word of mouth, superior care service and reduce extra overheads for healthcare providers without compromise or rather with increment in service delivery proposition.

The study theoretically and empirically describes that with the adoption of internet of things (IoT) devices in health care, better services can be provided to patients by using partial least square – structure equation modelling-based robust technique and explains the better understanding of the health-care process with the help of information pervasiveness, physician-patient orientation and improved patient and physician involvement in the decision-making process.

This study shows that wearable IoT device adoption in health-care service delivery opens new opportunities and disrupts the conventional and traditional way of health-care service delivery by empowering the patient to take part in decision-making and enhancing their engagement in health-care service delivery.

The study might influence by generalizability. Perception-based cross-examination knowledge from the patient’s perspective. It is likely that patients who use these devices will grow accustomed to using them and become more capable of using them. Thus, time-series tests have not been used to catch enhanced skills. New patients’ experiences will be altered over time. Regardless, non-response bias and traditional process bias received excessive interest.

The study aims at unravelling how the adoption of IoT enabled practices and usage of IoT devices bolsters the available data points in the context of healthcare especially with respect to patient care delivery. The study conceptualizes and empirically validates how the usage of IoT interface enabled technology enables better patient treatment and caregiver participation. The study puts forth a nuanced understanding regarding how pervasively available ubiquitous care information fosters shared decision making. This study further emphasizes that importance of ensuring a reliable computing environment devoid of privacy and security risks. The study attempts at Emphasizing empirically how the enhanced information pervasiveness catapults the patient-provider interactions, through health data exchange. Highlighting the importance of search feature in cloud storage and recovery mechanisms. The study not only fulfills the overarching linkage between enhanced service engagement with IoT adoption, it provides a mental map and ready to refer framework for hospital and healthcare experts to refer to, which prescribes thar care providers must build new methods aimed at empowerment of patients to participate and take more inclusive role. This unique confluence between patients and physicians will unravel the sync; helping not only avoid costly decision errors, but also improve patient care delivery environment. Patients should be permitted to participate in decision-making,inspire patients to be participatory.

The study efforts to empirically investigate and discover the link between how wearable sensor-based IoT enhances health-care service engagement is underway. Using primary data this linkage validation allows the community and readers at large to gain a nuanced understanding of how superior interaction is enabled by a digital-health-care process with the help of IoT-enabled information pervasiveness, physician-patient orientation and empowered involvement.

The purpose of this study is to examine how premium holders of Ghana's Health Insurance Scheme (NHIS) perceive the state of quality healthcare delivery in public hospitals in the country.

Questionnaires were administered to a sample of 250 insured patients receiving care in some selected public hospitals accredited by the National Health Insurance Authority in Ghana. Results are presented using descriptive statistics and Chi‐square analysis.

The results demonstrate that the human dimensions of service quality (interaction with service provider and attitude of healthcare providers) were perceived by the insured patients to be good, and they constitute significant determinants of perceived service quality. Although waiting time was generally perceived to be long, it is not in any way associated with patient perception of quality of care.

The findings of the study provide an important step towards strengthening service quality in public hospitals in the wake of the introduction of the NHIS.

The purpose of this paper is to detail experiences that sickle cell disease (SCD) patients associate with healthcare justice and injustice in pain control.

A content analysis study of open-ended comments written by 31 participants who completed a 20-item healthcare injustice questionnaire-revised twice: once in reference to experiences with doctors and once in reference to experiences with nurses.

Participants’ mean age was 33±10 years; most were African-Americans and women. Themes showed: the four domains of healthcare justice were represented in patients’ comments; examples of justice and injustice were provided; specific incidents and interactions with healthcare providers were memorable to patients; and setting was a factor important to healthcare experiences because expectations about services vary by setting.

Patients were self-selected. Future work will include qualitative interviews and focus groups to uncover more details about how patients experience healthcare injustice.

Additional training is needed for SCD providers and about proper management of sickle cell pain; educational modules are also needed that address areas of healthcare injustice by patients.

The authors are the first to report how patients define healthcare justice and injustice. Specific details about memorable SCD patient-provider interactions and pain control are described.

Native American (NA) women's health needs in general are underresearched, and use of holistic, community-informed, and resilience-based approaches are rare. Despite extensive documentation of the continuing health inequalities between NA women and the general US population, little research examines what healthcare infrastructure and healthcare provider factors most impact, and exacerbate, these health disparities. The purpose of the study was to provide insight into the healthcare experiences of NA women. A qualitative descriptive research methodology with “hues” of an ethnographic life-history approach was used. Data were collected through qualitative semi-structured life-history interviews with 31 NA women from the Gulf Coast region of the United States. All women identified healthcare obstacles and barriers. These barriers were predominately comprised of Healthcare Infrastructure Barriers, which entailed: (1) Cost and Insurance Barriers; (2) Concerns about Western Medication; (3) Language Barriers; (4) Distance to Medical Facilities or Specialists; and (5) Long-wait Times, and Negative Provider Relationships, which included: (1) Rushed or Rude Provider Interactions; (2) Providers not Listening, or Ignoring Patient Concerns; (3) Poor, Inaccurate, or Inadequate Care or Diagnosis; (4) Discrimination in Healthcare; and (5) The need for Personal Relationships with Providers. These findings suggest that healthcare infrastructure issues and poor healthcare provider relationships are important structural issues that contribute to health disparities. The findings from this study have important implications for the type of training those working in healthcare services receive to be more sensitive to the needs of NA women and suggest that NA women may need unique support when accessing healthcare.

Patient-centric exchanges, a major type of Health Information Exchange (HIE), empower patients to aggregate and manage their health information. This exchange model helps patients access, modify and share their medical information with multiple healthcare organizations. Although existing studies examine patient engagement, more research is required to investigate patients' attitudes and willingness to play an active role in patient-centered information exchange. The study's main objective is to develop a model based on the belief-attitude-intention paradigm to empirically examine the effects of patients' attitudes toward engagement in care on their willingness to participate in patient-centric HIE.

The authors conducted an online survey study to identify the antecedents and consequences of patients' attitudes toward engagement in care. To empirically test the research model, the authors collected data from a national sample (n = 357) of individuals in the United States. The data were analyzed using structural equation modeling (SEM).

The proposed model categorizes the antecedents to patients' attitudes toward engagement in patient-related and healthcare system factors. The results show that patient-related factors (perceived health literacy and perceived coping ability) and health system factors (perceived experience with the healthcare organization and perceived patient-provider interaction) significantly shape patient attitude toward care management engagement. The results indicate that patients' attitudes toward engaging in their healthcare significantly contribute to their willingness to participate in medical information sharing through patient-centric HIE initiatives. Moreover, the authors’ findings also demonstrate that the link between patient engagement and willingness to participate in HIE is stronger for individuals who perceive lower levels of privacy and security concerns.

The authors validate the proposed model explaining patients' perceptions about their characteristics and the healthcare system significantly influence their attitude toward engaging in their care. This study also suggests that patients' favorable attitude toward engagement can bring patient-centric HIE efforts onto a path to success. The authors’ research attempts to shed light on the importance of patients' roles in adopting patient-centric HIE initiatives. Theoretical and practical contributions of this study are noticeable since they could result in a deeper understanding of the concept of patient engagement and how it may affect healthcare services in an evolving digital world. The authors’ findings can help healthcare organizations provide public citizen-centric services by introducing user-oriented approaches in healthcare delivery systems.

The increasing diversity among workforces – as well as the increasing diversity among patient populations served – offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration.

This conceptual paper develops a framework that combines three organizational behavior theories – emotional labor theory, similarity-attraction theory and climate theory – with evidence from the broader healthcare literature.

Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier.

The authors offer a conceptual model to unlock positive outcomes – including reduced absenteeism, better morale and improved patient satisfaction – regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.

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.

Existing descriptions of trust in health care largely assume a straightforward association between a patient’s relationship with a regular provider and his or her trust in health care. I extend status characteristics theory (SCT) and social identity theory (SIT) to suggest greater variability in this association by investigating the role of social differences between patients and their regular providers. Whereas the SIT extension predicts lower trust in dissimilar than similar dyads, the predictions from the SCT extension depend on status in dissimilar dyads. Further, research examining how social differences in patient–provider dyads shape trust largely emphasizes racial differences, but the theories implicate gender differences too.

I analyze a longitudinal dataset of patient–provider dyads offering a conservative test of the extensions.

Results generally support predictions from the SCT extension. Specifically, patients’ status based on differences in either race or gender: (1) is inversely related to their trust in health care and (2) influences the resiliency of their trust, whereby the degree health care met prior expectations matters less (more) for the trust of low (high) status patients than equal status patients.

When patients and providers differ on both race and gender, findings sometimes depart from predictions. This indicates differences in two social categories is a unique situation where the contributions of each category are distinct from that of the other.

This research extends SCT to explain greater variability in the connection between patient–provider dyads and trust in health care, while also showing how gender compares to race.