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Volume 50, Number 5
September/October 2005

  • INTERVIEW
    Interview with Dianne Mandernach, FACHE, Commissioner, Minnesota Department of Health, Kyle L. Grazier
  • FUNDING
    Philanthropy: The Last Frontier for Capital Funding, William O. Cleverley and
    James O. Cleverley
  • COMMUNICATION
    Persuasion: What to Say, How to Be, Paul Preston
  • ARTICLES
    Opportunities for Administrators to Promote Disease Management, Bita A. Kash, Larry D. Gamm, Jane Nelson Bolin, and B. Mitchell Peck
  • Managing Primary Care Using Patient Satisfaction Measures, Koichiro Otani, Richard S. Kurz, and Lisa E. Harris
  • Emergency Department Overcrowding: The Impact of Resource Scarcity on Physician Job Satisfaction, Kent V. Rondeau and Louis H. Francescutti
  • Fellow Project
    Seeding Community Partnerships in Providing Medical Care that Lowers Cost of
    Care, Robert A. Colvin

Executive Summary
Opportunities for Administrators to Promote Disease Management, Bita A. Kash, Larry D. Gamm, Jane Nelson Bolin, and B. Mitchell Peck

Studies of disease management (DM) have shown that patients who participate in such programs achieve better health status and make fewer emergency room visits. Private and government payers have recently increased their efforts to promote DM initiatives through financial incentives to healthcare providers. This article explores opportunities for administrators of health services organizations (HSO) to promote DM in the current political and economic environment.

Our survey of professionals (DM leaders, physicians, and DM nurses) in six DM programs reveals these professionals’ assessments of the key players and resources that they deem important to their respective DM programs. They view DM programs as heavily dependent on the support of physicians, nurses, and health plan leaders but relatively less so on the support of HSO administrators—a situation that may suggest opportunities for administrators to take on greater leadership in moving the HSO toward developing DM programs. Survey results also indicate a strong need for the integration of resources such as communication systems, electronic medical records, and DM reporting. Taken collectively, these needs suggest a number of strategies for the administrator to play a larger role in supporting the adoption and effective implementation of DM.

In the article, we propose that DM programs can benefit substantially from an administrator who can demonstrate a thorough knowledge of DM-related government and private-payer initiatives and who has the ability to provide leadership to develop and implement viable DM programs. Valued contributions that the administrator should bring to the table include support of standardized DM processes, use of practice guidelines, and provision of pertinent information systems.

Executive Summary
Managing Primary Care Using Patient Satisfaction Measures, Koichiro Otani, Richard S. Kurz, and Lisa E. Harris

Our study aimed to identify which attributes of a primary healthcare experience have the most impact on patient satisfaction as well as which aspects of each attribute are most significant in patients’ response to the services they receive. The three attributes examined in this study were access, staff care, and physician care. Analyses of the aspects of each attribute controlled for age, , gender, and race. Data used in this study were obtained through a survey questionnaire with random sampling, resulting in the sample size of 8,465. The psychometric properties of the questionnaire were also examined and showed appropriate reliability and validity. The multiple regression analysis showed that among the three attributes, physician care was most influential, closely followed by staff care, with access having much less influence.

Further analyses revealed that specific aspects of each attribute were more influential on patient satisfaction. Within the physician care attribute, patients were found to be rational consumers who were looking for surrogate indicators of correct diagnosis and treatment options among the measures available to them. They were much less likely to be influenced by so-called bedside manner. Within the staff care attribute, willingness and compassionate behaviors of staff and prompt service were most important. Within the access attribute, patients sought caring interaction with appointment personnel. After considering the findings, we discuss possible actions for healthcare managers.

Executive Summary
Emergency Department Overcrowding: The Impact of Resource Scarcity on Physician Job Satisfaction, Kent V. Rondeau and Louis H. Francescutti

Emergency departments in most developed countries have been experiencing significant overcrowding under a regime of severe resource constraints. Physicians in emergency departments increasingly find themselves toiling in workplaces that are characterized by diminished availability of, limited access to, and decreased stability of critical resources. Severe resource constraints have the potential to greatly weaken the overall job satisfaction of emergency physicians.

This article examines the impact of hospital resource constraints on the job satisfaction of a large sample of emergency physicians in Canada. After controlling for workflow and patient characteristics and for various institutional and physician characteristics, institutional resource constraints are found to be major contributors to emergency physician job dissatisfaction. Resource factors that have the greatest impact on job satisfaction include availability of emergency room physicians, access to hospital technology and emergency beds, and stability of financial (investment) resources.