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Volume 54, Number 2
March/April 2009

  • INTERVIEW
    Interview with Samuel Levey, PhD, LFACHE, Gerhard Hartman Professor of Health Management and Policy, College of Public Health, The University of Iowa, Kyle L. Grazier

  • PHYSICIAN RELATIONS
    Changing Physician Behavior Through Involvement and Collaboration, Kenneth H. Cohn
  • TRENDS

    Workplace Medical Clinics: The Employer-Redesigned "Company Doctor" , A. Michael LaPenna

  • ARTICLES
    Patient Satisfaction: Focusing on "Excellent", Koichiro Otani, Brian Waterman, Kelly M. Faulkner, Sarah Boslaugh, Thomas E. Burroughs, and W. Claiborne Dunagan
    A Model for Improving Uninsured Children's Access to Health Insurance via the Emergency Department, Colleen Acosta, Charles Dibble, Mary Giammona, and N. Ewen Wang
  • Measuring the Opportunity Loss of Time Spent Boarding Admitted Patients in the Emergency Department: A Multihospital Analysis, Raymond Lucas, Heather Farley, Jospeh Twanmoh, Andrej Urumov, Bruce Evans and Nils Olsen
    The Impact of Participative Management Perceptions on Customer Service, Medical Errors, Burnout, and Turnover Intentions, Ingo Angermeier, Benjamin B. Dunford
    Abstract from the Academy of Management

     

Executive Summary

Patient Satisfaction: Focusing on “Excellent”, Koichiro Otani, Brian Waterman, Kelly M. Faulkner, Sarah Boslaugh, Thomas E. Burroughs, and W. Claiborne Dunagan

In an emerging competitive market such as healthcare, managers should focus on achieving excellent ratings to distinguish their organization from others. When it comes to customer loyalty, “excellent” has a different meaning. Customers who are merely satisfied often do not come back. The purpose of this study was to find out what influences adult patients (≥20) to rate their overall experience as “excellent.” The study used patient satisfaction data collected from one major academic hospital and four community hospitals.

After conducting a multiple logistic regression analysis, certain attributes were shown to be more likely than others to influence patients to rate their experiences as excellent. The study revealed that staff care is the most influential attribute, followed by nursing care. These two attributes are distinctively stronger drivers of overall satisfaction than are the other attributes studied (i.e., physician care, admission process, room, and food). Staff care and nursing care are under the control of healthcare managers. If improvements are needed, they can be accomplished through training programs such as TQM/CQI, through which staff employees and nurses learn to be sensitive to patients’ needs. Satisfying patients’ needs is the first step toward having loyal patients, so hospitals that strive to ensure their patients are completely satisfied are more likely to prosper.

Executive Summary

A Model for Improving Uninsured Children’s Access to Health Insurance via the Emergency Department, Colleen Acosta, Charles Dibble, Mary Giammona, and N. Ewen Wang

A shift in commercially insured patients to publicly insured or uninsured status has caused an increase in emergency department (ED) visits for routine and nonemergent care. Meanwhile, hospitals struggle to compensate for decreasing reimbursements across all payer groups and increasing underwritten costs of care for the uninsured. Children represent a particularly vulnerable population and a substantial proportion of uninsured patients.

In this study we assessed the efficacy and financial benefit of an insurance-referral program that is integrated into the routine pediatric ED admitting protocol of an academic hospital for the period 2004 to 2007. In this model, the ED of Stanford Hospital and Clinics acted as a referral agency to the San Mateo County Children’s Health Initiative, a county coalition that carries out screening and enrollment assistance for public insurance. Referral from the ED was available 24 hours a day, and partnership with the county coalition negated the use of a hospital insurance-enrollment worker.

Over the four-year study period, the referral program attained a successful linkage rate of 54.5 percent, which represents nearly 800 newly insured children. The vast majority (88.6 percent) of these pediatric patients were linked to Medicaid, which can reimburse retroactively for services rendered. For the academic hospital, this linkage rate resulted in $105,829.25 in insurance reimbursements and $658,559.97 deflected from bad-debt conversion.

This pilot program is a sustainable, medically responsible model for linking uninsured children who need medical services with healthcare insurance. In addition, the program has the potential to yield financial return for the hospital. Similar models may be implemented in EDs across the United States. Healthcare managers who are seeking to alleviate the financial impact of care for the uninsured may find this model to be useful.

Executive Summary

Measuring the Opportunity Loss of Time Spent Boarding Admitted Patients in the Emergency Department: A Multihospital Analysis , Raymond Lucas, Heather Farley, Joseph Twanmoh, Andrej Urumov, Bruce Evans, and Nils Olsen

Emergency department (ED) crowding is an international crisis affecting the timeliness and quality of patient care. Boarding of admitted patients in the ED is recognized as a major contributor to ED crowding. The opportunity loss of this time is the benefit or value it could produce if it were used for something else. In crowded EDs, the typical alternative use of this time is to treat patients waiting to be seen. Various ED performance benchmarks related to inpatient boarding have been proposed, but they are not commonly reported and have yet to be evaluated to determine whether they correlate to the opportunity loss of time used for boarding.

This study quantified several measures of ED boarding in a variety of hospital settings and looked for correlations between them and the opportunity loss of the time spent on boarding. In particular, average boarding time per admission was found to be easy to measure. Results revealed that it had a near-perfect linear correlation to opportunity loss. The opportunity loss of every 30 minutes of average boarding time equaled the time required to see 3.5 percent of the ED’s daily census. For busy hospitals, the opportunity loss allowed sufficient time for staff to be able to see up to 36 additional patients per day. This even correlation suggests that average boarding time per admission may be useful in evaluating efforts to reduce ED crowding and improve patient care.

Executive Summary

The Impact of Participative Management Perceptions on Customer Service, Medical Errors, Burnout, and Turnover Intentions, Ingo Angermeier, Benjamin B. Dunford, Alan D. Boss, and R. Wayne Boss

Numerous challenges confront managers in the healthcare industry, making it increasingly difficult for healthcare organizations to gain and sustain a competitive advantage. Contemporary management challenges in the industry have many different origins (e.g., economic, financial, clinical, and legal) , but there is growing recognition that some of management’s greatest problems have organizational roots. Thus, healthcare organizations must examine their personnel management strategies to ensure that they are optimized for fostering a highly committed and productive workforce. Drawing on a sample of 2,522 employees spread across 312 departments within a large U.S. healthcare organization, this article examines the impact of a participative management climate on four employee-level outcomes that represent some of the greatest challenges in the healthcare industry: customer satisfaction, medical errors, burnout, and turnover intentions.

This study provides clear evidence that employee perceptions of the extent to which their work climate is participative rather than authoritarian have important implications for critical work attitudes and behavior. Specifically, employees in highly participative work climates provided 14 percent better customer service, committed 26 percent fewer clinical errors, demonstrated 79 percent lower burnout, and felt 61 percent lower likelihood of leaving the organization than employees in more authoritarian work climates. These findings suggest that participative management initiatives have a significant impact on the commitment and productivity of individual employees, likely improving the patient care and effectiveness of healthcare organizations as a whole.