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.
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.
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