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Volume 56, Number 2
March/April 2011

  • INTERVIEW
    Interview with Anthony A. Armada, FACHE, President, Advocate Lutheran General Hospital and Advocate Lutheran General Children's Hospital
    Stephen J. O'Connor
  • TRENDS
    What Will It Take? Exploiting Trends in Strategic Planning to Prepare for Reform
    Ian R. Lazarus
  • REFORM
    It's Time to Get On With the Work at Hand
    William D. Petasnick
  • ARTICLES
    Selecting a Provider: What Factors Influence Patients' Decision Making?
    Jean Abraham, Brian Sick, Joseph Anderson, Andrea Berg, Chad Dehmer, and Amanda Tufano
    Does Missed Nursing Care Predict Job Satisfaction?
    Bea Kalisch, Dana Tschanen, and Hyunhwa Lee
    Designed to Fail: How Computer Simulation Can Detect Fundamental Flaws in Clinic Flow
    Jennifer Kaye Parks, Patricia Engblom, Eric Hamrock, Siriporn Satjapot, and Scott Levin

Executive Summary

Selecting a Provider: What Factors Influence Patients' Decision Making?, Jean Abraham, Brian Sick, Joseph Anderson, Andrea Berg, Chad Dehmer, and Amanda Tufano

Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers' awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation.            

Executive Summary
Does Missed Nursing Care Predict Job Satisfaction?, Bea Kalisch, Dana Tschanen, and Hyunhwa Lee

This study explores the impact of missed nursing care (required patient care that is omitted) on job satisfaction of nursing personnel. Data from 3,135 registered nurses (RNs) and 939 nursing assistants (NAs) on 110 patient care units in ten midwestern hospitals revealed that nursing staff who perceived less missed nursing care on the patient care unit where they work are more satisfied in their current position and occupation. Perceptions of staffing adequacy also significantly predicted both satisfaction variables. Focused interventions aimed at decreasing missed care and ensuring staffing adequacy are needed to improve job satisfaction and patient care.

Executive Summary
Designed to Fail: How Computer Simulation Can Detect Fundamental Flaws in Clinic Flow, Jennifer Kaye Parks, Patricia Engblom, Eric Hamrock, Siriporn Satjapot, and Scott Levin

Discrete-event simulation can be used as an effective tool for healthcare administrators to "test" various operational decisions. The recent growth in hospital outpatient volumes and a constrained financial environment make discrete-event simulation a cost-effective way to diagnose inefficiency and create and test strategies for improvement. This study shows how discrete-event simulation was used in an adult medicine clinic within a large, tertiary care, academic medical center. Simulation creation steps are discussed, including information gathering, process mapping, data collection, model creation, and results. Results of the simulation indicated that system bottlenecks were present in the medication administration and check-out steps of the clinic process. The simulation predicted that matching resources to excessive demand at appropriate times for these bottleneck steps would reduce patients' mean time in the system (i.e., visit time) from 124.3 (s.d. ± 65.7) minutes to 87.0 (s.d. ± 36.4) minutes. Although other factors may affect real-world operations of a clinic, discrete-event simulation allows healthcare administrators and clinic operational decision makers to observe the effects of changing staffing and resource allocations on patient wait and throughput time. Discrete-event simulation is not a cure-all for clinic throughput problems, but can be a strong tool to provide evidentiary guidance for clinic operational redesign.