Patient Satisfaction, Quality Attributes, and Organizational Characteristics: A Hierarchical Linear Model Approach.

Patient satisfaction studies have gained more and more attention, and there are many patient satisfaction studies. These studies assume that patients were selected randomly and independently, but patient satisfaction surveys are described as a multistage or hierarchically structured sample. Thus, there is a need to conduct a hierarchical linear model (HLM) analysis with a large number of hospitals. This study utilized an HLM to investigate both the individual patient-level effect on the overall satisfaction rating and the effect of hospital characteristics on the combining process of patient's overall satisfaction rating. This study used patient satisfaction data collected from 100 hospitals with the sample size of 85 766. The hospital-level characteristics include total expense per personnel, payroll expense per personnel, number of staffed beds per personnel, and number of admission per personnel. This study found that hospital characteristics influence overall rating of the hospital through the doctor, staff, and room attributes. When considering the complex nature of the overall patient rating process of hospitals, it makes more sense to analyze hospital characteristics that are interacting with attributes rather than treat hospital characteristics as independent of these factors.

Advancing the Certified in Public Health Examination: A Job Task Analysis.

OBJECTIVES: In 2014, the National Board of Public Health Examiners performed a job task analysis (JTA) to revise the Certified in Public Health (CPH) examination. The objectives of this study were to describe the development, administration, and results of the JTA survey; to present an analysis of the survey results; and to review the implications of this first-ever public health JTA. METHODS: An advisory committee of public health professionals developed a list of 200 public health job tasks categorized into 10 work domains. The list of tasks was incorporated into a web-based survey, and a snowball sample of public health professionals provided 4850 usable responses. Respondents rated job tasks as essential (4), very important (3), important (2), not very important (1), and never performed (0). RESULTS: The mean task importance ratings ranged from 2.61 to 3.01 (important to very important). The highest mean ratings were for tasks in the ethics domain (mean rating, 3.01). Respondents ranked 10 of the 200 tasks as the most important, with mean task rankings ranging from 2.98 to 3.39. We found subtle differences between male and female respondents and between master of public health and doctor of public health respondents in their rankings. CONCLUSION: The JTA established a set of job tasks in 10 public health work domains, and the results provided a foundation for refining the CPH examination. Additional steps are needed to further modify the content outline of the examination. An empirical assessment of public health job tasks, using methods such as principal components analysis, may provide additional insight.

The Impact of Self-Rated Health Status on Patient Satisfaction Integration Process.

The purpose of this study was to investigate how patients' self-rated health status (SRHS) is associated with their attribute reaction integration process and, in turn, their overall ratings of hospitals. We collected patient satisfaction data from 70 hospitals by means of a patient satisfaction questionnaire. The sample included patients who were 18 years or older and discharged from the hospital from July 1, 2011, through June 30, 2012. Data for 36,528 patients were available for analysis. We conducted multiple linear regression analysis with patients' SRHS and interaction effects with nursing care, physician care, staff care, and room, while controlling for age, gender, race, and education. Study findings showed an association between SRHS levels and the patient's overall rating of the hospital; they also revealed interaction effects with nursing care, physician care, and staff care variables in the model. The statistically significant interaction effects indicate that for patients whose SRHS was less than excellent, physician care became more important and nursing care and staff care became less important compared with patients whose SRHS was excellent. When we consider the nature of medical care, this transition seems reasonable. We also found that it is reasonable to categorize patients into two groups: those whose SRHS is excellent and those whose SRHS is less than excellent (i.e., very good, good, fair, or poor). As the study findings show, these two groups of patients combined their attribute reactions differently.

Impact of Pain on Patient Satisfaction Integration Process: How Patients With Pain Combine Their Health Care Attribute Reactions.

CONTEXT: Health care environments have been changing rapidly, and one of the changes is to emphasize patient satisfaction. However, most studies assume that all patients integrate their health care attribute reactions in the same way to arrive at their satisfaction. OBJECTIVE: The objective of this study is to investigate how patients' experience of pain influences their attribute reaction integration process and their overall rating of the hospital. DESIGN: Patient satisfaction data were collected using a mailed questionnaire. Multiple linear regression analyses with a dichotomous (yes/no) pain variable and its interaction effects with nursing care, physician care, staff care, and hospital room were conducted with control variables. MAIN OUTCOME MEASURES: The pain variable was statistically significant and also revealed interaction effects with the physician care and the staff care variables in the model. Patients who needed medicine for pain showed lower overall rating of the hospitals than patients who did not need medicine. RESULTS: The statistically significant interaction effects indicate that for patients who needed medicine for pain, staff care becomes more important and physician care becomes less important compared to patients who do not need medicine for pain. All 4 attributes (nursing care, physician care, staff care, and hospital room) are not equally influential. CONCLUSION: Implementing policies and procedures related to these interaction effects would lead to the most efficient and effective improvement outcomes. These findings suggest that future policies should be modified to enhance nursing and staff care to provide more direct care for patients with pain.

Improving patient satisfaction in hospital care settings.

Health-care managers have to address many aspects of the organization, and patient satisfaction is clearly one of the critical aspects for managers. To respond to the need of health-care managers, there have been many patient satisfaction studies. However, these studies focus on which attributes (factors such as nursing care and physician care) are more influential; they do not provide specific aspects for each attribute. In order to develop an effective intervention programme to improve patient satisfaction, more specific research outcomes are needed. This study utilized data collected between January 2007 and June 2008 from 32 hospitals representing a large, national private not-for-profit hospital system. The patient satisfaction survey included the Consumer Assessment of Healthcare Providers and Systems, Hospital version questionnaire items, and there are 31,471 cases. Two-stage multiple linear regression analyses were conducted with control variables (age, gender, perceived health, education and race). It was found that patients' highest priority is to be treated with courtesy and respect by nurses and physicians. An effective intervention programme to improve patient satisfaction would include a training programme, where care providers understand that patients want them to show courtesy and respect. Then, well-trained and empathetic nurses and staff members can comfort patients, and consequently improve patient satisfaction.

A model-driven approach to qualitatively assessing the added value of community coalitions.

Community-based coalitions are commonly formed to plan and to carry out public health interventions. The literature includes evaluations of coalition structure, composition, and functioning; evaluations of community-level changes achieved through coalition activities; and the association between coalition characteristics and various indicators of success. Little information is available on the comparative advantage or "added value" of conducting public health interventions through coalitions as opposed to less structured collaborative mechanisms. This paper describes a qualitative, iterative process carried out with site representatives of the Controlling Asthma in American Cities Project (CAACP) to identify outcomes directly attributable to coalitions. The process yielded 2 complementary sets of results. The first were criteria that articulated and limited the concept of "added value of coalitions". The criteria included consensus definitions, an organizing figure, a logic model, and inclusion/exclusion criteria. The second set of results identified site-specific activities that met the definitional criteria and were, by agreement, examples of CAACP coalitions' added value. Beyond the specific findings relevant to the added value of coalitions in this project, the use of a social ecological model to identify the components of added value and the placement of those components within a logic model specific to coalitions should provide useful tools for those planning and assessing coalition-based projects.

Improving patient evaluation of hospital care and increasing their intention to recommend: are they the same or different constructs?

Many patient satisfaction studies consider patient satisfaction and intention to recommend as the same constructs. However, we propose to investigate the two constructs separately. This study has utilized patient satisfaction data with 32 hospitals in different locations to investigate how hospital discharged patients combine their attribute reactions to arrive at their evaluation of hospital care and their intention to recommend to others. A multiple linear regression analysis with a scatter term was conducted while controlling for age, gender, perceived health, educational attainment and race. The interpretation of the scatter term is presented with a story. There were 31,471 cases for the analysis, and the results show some similarities and critical differences between the two models. In conclusion, hospital managers are well advised to focus on improving nursing care first, and then staff care and environment in order to increase patient evaluation of hospital care and intention to recommend.

Patient satisfaction integration process: are there any racial differences?

BACKGROUND: Patient satisfaction studies have received strong attention from both health care managers and researchers. Many of them investigate how patients combine their health care attribute reactions to arrive at their overall satisfaction. These studies, however, did not specifically investigate a possible different combining process among different racial groups. Thus, these minority populations were statistically marginalized in the outcomes of the analyses. It means that parameter estimates of the attributes were assumed to be the same for all racial groups. PURPOSE: This study investigated a possible different combining process between Caucasian and African American patients. The objective of this study was to discover how differently Caucasian and African American patients combine their attribute reactions to arrive at their overall satisfaction. METHODOLOGY/APPROACH: Data used for this analysis were collected from 32 hospitals by using a patient satisfaction questionnaire, the Consumer Assessment of Healthcare Providers and Systems, Hospital version. There were 29,684 cases. A multiple linear regression analysis with a scatter term was conducted while controlling for age, gender, perceived health, and educational attainment. FINDINGS: Caucasian and African American patients recognize the same four attribute reactions (nursing care, staff care, physician care, and environment). However, when paying attention to the sizes of the parameter estimates (weights), these two groups show a clear difference. It is also found that Caucasian patients are risk averse. On the other hand, African American patients are likely to average out their attributes reactions proportionately. PRACTICE IMPLICATIONS: The critical differences found in this study provide a very important implication for health care managers developing an intervention program to improve patient satisfaction. A one-size-fits-all strategy would not work for all patients. Caucasian and African American patients are different, and each requires a different intervention program to improve their overall evaluation of their hospital stay.

Examining the consulting physician model to enhance the school nurse role for children with asthma.

BACKGROUND: The Centers for Disease Control and Prevention's Strategies for Addressing Asthma Within a Coordinated School Health Program recommends a consulting physician for schools to help manage asthma. The literature examines the effects when a school nurse is present, but the addition of a consulting physician is not well understood. The purpose of this study is to assess the effect of having a consulting physician on school absenteeism and children sent home due to health reasons for children with asthma and all children pooled together. METHODS: A 2-year preimplementation group cohort and 1-year implementation group cohort of grades K-6 in an urban school district were used to determine the impact of a consulting physician on school absenteeism for children with asthma and all children pooled together. RESULTS: A consulting physician was significantly associated with reduced missed school days for children with asthma and all children as a group. All children pooled together were 44% more likely (OR = 1.44, 95% CI = 1.31-1.58) to be sent home without the consulting physician. There was a reduction from 13.8% to 12.6% of sent home events in children with asthma. CONCLUSIONS: Having consulting physicians in school districts appears to be associated with fewer days of school absence. The results provide additional evidence and suggest that more research is required to determine if this association is valid and to better understand the cause of such an association.

Bridging implementation and institutionalization within organizations: proposed employment of continuous quality improvement to further dissemination.

OBJECTIVE: Although organizations may initially adopt and implement interventions, the institutionalization of these interventions does not always occur. The purpose of this article is to provide an example describing the breakdown in the dissemination process using an accepted conceptualization and measurement of institutionalization. We also suggest an approach for understanding the movement of the intervention through the dissemination process to improve the likelihood of institutionalization. METHODS: Through the Controlling Asthma in American Cities Project in St. Louis, the institutionalization of evidence-based interventions was measured in multiple settings. Specifically, data from three school districts were measured and presented. External implementation and financial support for the intervention were phased out and internal support by the districts was phased in after 2 years of implementation. Representatives for the districts and the schools were asked to complete the Levels of Institutionalization (LoIn) scales instrument measuring the institutionalization of these interventions. RESULTS: The LoIn scale data demonstrate increasing Routinization and saturation mean scores for all school districts in the first 2 years, with decreasing scores in district A in year 3. District A did not have external facilitation of implementation and support in year 3, which is Reflected in the decreasing scores. Institutionalization did not occur in the conduct of formal evaluation, the presence of job descriptions, and the presence of similar and permanent funding in all three districts. CONCLUSION: We propose an approach to help identify and measure processes of dissemination through continuous quality improvement, increasing the likelihood that interventions are institutionalized.

Factors influencing organ donation decisions by African Americans: a review of the literature.

The purpose of this article is to review the literature from 1980 to 2005 regarding organ donation decision making by African Americans for themselves and their loved ones and recommend improvements in subsequent studies. Using the behavioral model of health services utilization as an organizing framework, the review procedure consists of a (1) search of health and medical literature using several key words and eight indexes, (2) selection of articles based on specific criteria, and (3) review of each article with regard to the population and sample used, study design, dependent variables addressed, and its findings. The review indicates that predisposing, enabling, and need factors each influence African Americans' organ donation decision making. Retrospective chart reviews provide a good design for future multivariate analyses of the many factors influencing African American decision making. Interventions to influence decision making should emphasize both community education and the process of organ procurement.

Managing primary care using patient satisfaction measures.

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.

Competencies for public health finance: an initial assessment and recommendations.

The purpose of the study in this article was to identify The needs of public health managers with regard to public health finance. A survey of public health practitioners regarding competencies was conducted and a review of course offerings in finance among schools of public health was performed. Most public health practitioners surveyed believe that a broad array of management competencies are required to administer the finances of a public health facility or department. Respondents added 35 competencies to those initially given to them for review. Most added competencies that were more specific than the original competencies or could be viewed as subpoints of the original competencies. Many schools offered no courses specifically addressing public health care finance, with a few offering at most only one public health finance course. All schools offered at least one corporate finance course, and the majority offered two or more courses. We conclude with a number of recommendations for education and competency development, suggesting several next steps that can advance the field of public health's understanding of what managers need to master in public health finance to effectively function as public health managers.

The impact of nursing care and other healthcare attributes on hospitalized patient satisfaction and behavioral intentions.

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.

Reconsidering models of patient satisfaction and behavioral intentions.

This article considers several models of how patients integrate their reactions to hospital attributes and how these reactions impact their overall satisfaction and behavioral intentions. It finds that patients combine their reactions to the attributes by means of noncompensatory and nonlinear models to form their overall satisfaction or behavioral intentions.