Measuring patient satisfaction in complex continuing care/rehabilitation care.

Purpose - The purpose of this paper is to develop a psychometrically validated survey to assess satisfaction in complex continuing care (CCC)/rehabilitation patients. Design/methodology/approach - A paper or computer-based survey was administered to 252 CCC/rehabilitation patients (i.e. post-acute hospital care setting for people who require ongoing care before returning home) across two hospitals in Toronto, Ontario, Canada. Findings - Using factor analysis, five domains were identified with loadings above 0.4 for all but one item. Behavioral intention and information/communication showed the lowest patient satisfaction, while patient centredness the highest. Each domain correlated positively and significantly predicted overall satisfaction, with quality and safety showing the strongest predictive power and the healing environment the weakest. Gender made a significant contribution to predicting overall satisfaction, but age did not. Research limitations/implications - Results provide evidence of the survey's psychometric properties. Owing to a small sample, supplemental testing with a larger patient group is required to confirm the five-factor structure and to assess test-retest reliability. Originality/value - Improving the health system requires integrating patient perspectives. The patient experience, however, will vary depending on the population being served. This is the first psychometrically validated survey specific to a smaller specialty patient group receiving care at a CCC/rehabilitation facility in Canada.

Evaluating Intention and Effect: The Impact of Healthcare Facility Design on Patient and Staff Well-Being.

OBJECTIVE: This post occupancy evaluation (POE) assessed the impact of architectural design on psychosocial well-being among patients and staff in the context of a new complex continuing care and rehabilitation facility. BACKGROUND: Departing from typical POEs, the hospital design intentions formed the theoretical basis to assess outcomes. Intentions included creating an environment of wellness; enhancing connection to the community, the city, and nature; enhancing opportunities for social interaction; and inspiring activity. METHODS: A pretest-posttest quasi experiment, including quantitative surveys, assessed the impact of the building design on well-being outcomes across three facilities-the new hospital, the former hospital, and a comparison facility with a similar population. RESULTS: With the exception of connection to neighborhood (for patients) and opportunities to visit with others (for staff) and wayfinding (for patients and staff), impressions of the new hospital mirrored the design intentions relative to the former hospital and the comparison facility among patients and staff. Perceptions of improvement in mental health, self-efficacy in mobility, satisfaction, and interprofessional interactions were enhanced at the new hospital relative to the former hospital, whereas optimism, depressive symptoms, general well-being, burnout, and intention to quit did not vary. Interestingly, patients and staff with favorable impressions of the building design fared better on most well-being-related outcomes relative to those with less favorable impressions. CONCLUSIONS: Beyond the value of assessing the impact of the design intentions on outcomes, the approach used in this study would benefit evaluation strategies across a diversity of health and other public and large-scale buildings.

Building Resilience and Organizational Readiness During Healthcare Facility Redevelopment Transitions: Is It Possible to Thrive?

OBJECTIVE: Hospital redevelopment constitutes a revolutionary change that can face strong resistance from employees. Few studies have examined how employee readiness for change relates to adjustment outcomes typically captured in post-occupancy evaluation (POE). The relationship between organizational readiness and employee adjustment is examined in the context of a POE conducted during a hospital redevelopment. BACKGROUND: Our study focuses on the redevelopment of a complex continuing care and rehabilitation hospital that underwent complete physical redevelopment and major shifts in operational and organizational processes. METHODS: Using a pretest-posttest quasi-experimental research design, staff organizational readiness was assessed using surveys at four time periods: 6 months prior to the move (n = 125), 2 months prior to the move (n = 84), 3 months after the move (n = 187), and 6 months after the move (n = 194). Measures included organizational readiness, workplace satisfaction, psychological factors (well-being and optimism), and sociodemographic information. RESULTS: Findings suggest readiness changes from pre- to post-move, with notable drops just prior (2 months) and just post (3 months) hospital move. Employees demonstrated significant increases in workplace satisfaction and interprofessional relationships from 6 months prior to the move to 6 months after. Results suggest that higher readiness is related to improved employee adjustment. CONCLUSIONS: A supportive change environment was found to encourage positive employee outcomes in the face of revolutionary change. It is recommended that change management activities be tailored not only to employee need but also to the timing of the change process.

The care delivery experience of hospitalized patients with complex chronic disease.

OBJECTIVE: This study investigated what is important in care delivery from the perspective of hospital inpatients with complex chronic disease, a currently understudied population. PARTICIPANTS AND SETTING: One-on-one semi-structured interviews were conducted with inpatients at a continuing care/rehabilitation hospital (n = 116) in Canada between February and July 2011. DESIGN: The study design was mixed methods and reports on patient characteristics and care delivery experiences. Basic descriptive statistics were run using SPSS version 17, and thematic analysis on the transcripts was conducted using NVivo9 software. RESULTS: Patients had an average of 5 morbidities and several illness symptoms including activity of daily living impairments, physical pain and emotional disturbance. Three broad themes (each with one or more subthemes) were generated from the data representing important components of care delivery: components of the care plan (a comprehensive assessment, supported transitions and a bio-psycho-social care package); care capacity and quality (optimal staff to patient ratios, quicker response times, better patient-provider communication and consistency between providers) and the patient-provider relationships (characterized by respect and dignity). CONCLUSIONS: As health systems throughout the industrialized world move to sustain health budgets while optimizing quality of care, it is critical to better understand this population, so that appropriate metrics, services and policies can be developed. The study has generated a body of evidence on the important components of care delivery from the perspectives of a diverse group of chronically ill individuals who have spent a considerable amount of time in the health-care system. Moving forward, exploration around the appropriate funding models and skill mix is needed to move the evidence into changed practice.

Conservation of resources theory and research use in health systems.

BACKGROUND: Health systems face challenges in using research evidence to improve policy and practice. These challenges are particularly evident in small and poorly resourced health systems, which are often in locations (in Canada and globally) with poorer health status. Although organizational resources have been acknowledged as important in understanding research use resource theories have not been a focus of knowledge translation (KT) research. What resources, broadly defined, are required for KT and how does their presence or absence influence research use?In this paper, we consider conservation of resources (COR) theory as a theoretical basis for understanding the capacity to use research evidence in health systems. Three components of COR theory are examined in the context of KT. First, resources are required for research uptake. Second, threat of resource loss fosters resistance to research use. Third, resources can be optimized, even in resource-challenged environments, to build capacity for KT. METHODS: A scan of the KT literature examined organizational resources needed for research use. A multiple case study approach examined the three components of COR theory outlined above. The multiple case study consisted of a document review and key informant interviews with research team members, including government decision-makers and health practitioners through a retrospective analysis of four previously conducted applied health research studies in a resource-challenged region. RESULTS: The literature scan identified organizational resources that influence research use. The multiple case study supported these findings, contributed to the development of a taxonomy of organizational resources, and revealed how fears concerning resource loss can affect research use. Some resources were found to compensate for other resource deficits. Resource needs differed at various stages in the research use process. CONCLUSIONS: COR theory contributes to understanding the role of resources in research use, resistance to research use, and potential strategies to enhance research use. Resources (and a lack of them) may account for the observed disparities in research uptake across health systems. This paper offers a theoretical foundation to guide further examination of the COR-KT ideas and necessary supports for research use in resource-challenged environments.

The impact of negative moods on self-enhancing cognitions: the role of reflective versus ruminative mood orientations.

This research program examined how self-focused attention to feelings affects the relation between mood negativity and self-enhancing thought. The primary hypothesis was that the particular manner in which people focus on their moods (reflective vs. ruminative) determines whether they reveal positive (i.e., mood-incongruent) or negative (i.e., mood-congruent) self-relevant thoughts in response to negative moods. Studies 1-4 revealed that social comparisons, temporal comparisons, and other self-enhancing cognitions (i.e., attributions, disidentification, relationship evaluations) are more likely to be mood incongruent when people adopt a reflective orientation to their negative feelings and more likely to be mood congruent when they adopt a ruminative orientation. Additionally, moods and mood orientations affected self-enhancing thoughts through the mediating influence of mood regulation goals and intentions (Studies 5 and 6).