Books & Journals

Buy HAP Books
Online Now!
  Books & Journals Links:
 
 

Volume 49, Number 3
May/June 2004

I. INTERVIEW
Larry Mathis, FACHE, consultant, D. Peterson & Associates, Kyle L. Grazier

II. PHYSICIAN-EXECUTIVE RELATIONS
From Co-opetition to Collaboration, Barbara LeTourneau

III. REPLACEMENT FACILITIES
First the Strategy, then the Bricks, Douglas R. Rich and James E. Hosking

IV. ARTICLES

  • A Practice Change Model for Quality Improvement in Primary Care Practice, Deborah Cohen, Reuben R. McDaniel, Jr., Benjamin F. Crabtree, Mary C. Ruhe, Sharon M. Weyer, Alfred Tallia, William L. Miller, Meredith A. Goodwin, Paul Nutting, Leif I. Solberg, Stephen J. Zyzanski, Carlos R. Jaén, Valerie Gilchrist, and Kurt C. Stange
  • Keeping Patients Safe: An Analysis of Organizational Culture and Caregiver Training, Kathie Johnson
  • The Impact of Nursing Care and Other Healthcare Attributes on Hospitalized Patient Satisfaction and Behavioral Intentions, Koichiro Otani and Richard S. Kurz

V. FELLOW PROJECT
Getting a Return on Investment from Spending Capital Dollars on New Beds,
Patsy A. Hardy

Executive Summary
A Practice Change Model for Quality Improvement in Primary Care Practice, Deborah Cohen, Reuben R. McDaniel, Jr., Benjamin F. Crabtree, Mary C. Ruhe, Sharon M. Weyer, Alfred Tallia, William L. Miller, Meredith A. Goodwin, Paul Nutting, Leif I. Solberg, Stephen J. Zyzanski, Carlos R. Jaén, Valerie Gilchrist, and Kurt C. Stange

Faced with a rapidly changing healthcare environment, primary care practices often have to change how they provide medicine. Yet change is difficult, and the process by which practice improvement can be understood and facilitated has not been well elucidated. Therefore, we developed a model of practice change using data from a quality improvement intervention that was successful in creating a sustainable practice improvement. A multidisciplinary team evaluated data from the Study To Enhance Prevention by Understanding Practice (STEP-UP), a randomized clinical trial conducted to improve the delivery of evidence-based preventive services in 79 northeastern Ohio practices. The team conducted comparative case-study analyses of high- and low-improvement practices to identify variables that are critical to the change process and to create a conceptual model for the change.

The model depicts the critical elements for understanding and guiding practice change and emphasizes the importance of these elements' evolving interrelationships. These elements are (1) motivation of key stakeholders to achieve the target for change; (2) instrumental, personal, and interactive resources for change; (3) motivators outside the practice, including the larger healthcare environment and community; and (4) opportunities for change-that is, how key stakeholders understand the change options. Practice change is influenced by the complex interaction of factors inside and outside the practice. Interventions that are based on understanding the four key elements and their interrelationships can yield sustainable quality improvements in primary care practice.


Executive Summary
Keeping Patients Safe: An Analysis of Organizational Culture and Caregiver Training, Kathie Johnson

News headlines and professional publications, such as the Institute of Medicine reports, have brought to the attention of both healthcare providers and consumers the importance of the issue of patient safety. In this article, we describe the study conducted by one hospital to improve patient safety within its culture. The study included the development and use of a culture survey tool. Key learnings from this survey are presented here as well. The article also states the limitations of the study and offers recommendations for further research.

The work of improving both the culture and processes of healthcare institutions to reduce error and promote safety is ongoing. The findings from this study add to the growing body of knowledge on successful patient-safety strategies and tools.


Executive Summary
The Impact of Nursing Care and Other Healthcare Attributes on Hospitalized Patient Satisfaction and Behavioral Intentions, Koichiro Otani and Richard S. Kurz

Healthcare organizations in the United States are struggling to find ways to survive in their uncertain and competitive environments. One of the survival strategies used by those organizations is to increase patient satisfaction. This article presents research on factors that influence hospitalized patients' satisfaction and their intention to return to and recommend the hospital.

The first objective of this study was to find out, using a comprehensive set of healthcare attributes, which attributes play a more important role in increasing patient satisfaction and behavioral intentions. The second objective was to analyze the relative importance of those attributes and the nature of the relationships across the values of the attributes. More specifically, this study attempted to identify any existing curvilinear relationships among these variables. If any curvilinear relationships exist, do they show an increasing or a decreasing marginal-utility function? Included in this article is an example, featuring a hospital-discharged patient, that explains the importance and uniqueness of this curvilinear relationship.

This study found that among six attributes, nursing care showed the largest parameter estimate for the patient satisfaction and behavioral intentions models. Thus, simply improving the nursing care attribute seems to be the most effective manner to enhancing patient satisfaction and behavioral intentions. However, nursing care also showed a diminishing marginal-utility function for both models. To assess the effect of this diminishing marginal-utility function, the impact of nursing care was computed for each unit of improvement together with other attributes. The finding from this study provides information needed to increase patient satisfaction and behavioral intentions and should result in more effective and efficient healthcare management.