The Effect of Nursing Care on Overall Patient Satisfaction and Its Predictive Value on Return-to-provider Behavior

Patient Satisfaction and Barriers to Nursing Care Quality in Oncology Units

Background: Every patient expects safe and quality patient care. A satisfying journey during hospitalization indicates quality care. Nurses provide a significant component of patient care over a long period, compared to any other healthcare professional. This study aims to find patient satisfaction in oncology units and identify the barriers to nursing care quality.

Materials and Methods: A cross-sectional correlation design was used with 100 cancer patients admitted to oncology units of tertiary care hospital selected by convenience sampling. The Nursing Care Quality Questionnaire was used to assess patient satisfaction, and an investigator-prepared and validated checklist was used to identify barriers to nursing care quality.

Results: The study revealed that 50% of patients were satisfied with the overall nursing care quality received during the hospital stay, and the overall barrier score to patient satisfaction for quality nursing care was 33.5%. Overall, 37% of patients were extremely satisfied with the quality of care and services they received during their hospital stay. The findings revealed a statistically significant association between patient satisfaction and the patients' employment status, type of treatment, and duration of stay in the hospital. This study also revealed that workload, lack of time, and inability to speak the local language were the major barriers to patient satisfaction.

Conclusions: Patients are the hospital's consumers or customers. For the best results, hospitals should train nurses to communicate in the local language, provide adequate staffing, and adequate training.

Antecedents, Consequences, and the Role of Third Parties in the Trust Repair Process: Evidence Taken from Orthodontics

Orthodontic treatment has popularized in Taiwan. Healthcare institutions can be responsive in their coping strategies and determine whether third-party intervention should take place involving medical disputes related to orthodontics in order to repair patient trust. This study draws on orthodontic treatment to explore the effect of various trust repair strategies employed by healthcare institutions and third-party involvement positively affecting outcomes related to trust repair. Patients were recruited among those who have undergone orthodontic treatments, and 353 valid scenario-based questionnaires were collected through an online survey. Results revealed that: (1) the affective and informational repair strategies positively impacted trust repair while the functional repair strategy did not; (2) trust repair positively impacted patient satisfaction/word-of-mouth and mediated between repair strategies and satisfaction/word-of-mouth; and (3) third-party involvement moderated the relationship between trust repair and word-of-mouth. The findings suggest that rather than receiving monetary compensation, patients usually prefer that healthcare institutions acknowledge their fault, offer apologies, and engage in active communications to clarify the causes of medical dispute. Further, an objective third party should be involved to mediate the medical disputes to afford satisfaction all around.

Organizational support and perceived environment impact on quality of care and job satisfaction: a study with Pakistani nurses

Purpose

Referring to the theory of organizational empowerment, the purpose of this study is to examine the relationship of organizational support and perceived environment on quality of care and job satisfaction, with organizational commitment as a mediator for the first variable.

Design/methodology/approach

This study employed a cross-sectional research design and data was collected from seven private and public sector hospitals in Pakistan, involving 352 nurses on a voluntary basis through a self-administered survey.

Findings

The results showed that organizational commitment mediates the relationship between organizational support and job satisfaction with the quality of care. Moreover, the perceived environment has an impact on job satisfaction and quality of care.

Originality/value

Healthcare service quality seems strictly dependent on the perceived quality of care and job satisfaction among healthcare workers. Theoretical and practical implications for policymakers and HR management are discussed.

Influence of word of mouth (WOM) in physician selection by the patients in Bangladesh

Purpose

This study aims to examine how word of mouth (WOM) from the patients influences the building of trust in the physician.

Design/methodology/approach

Based on the review and synthesis of the previous relevant literature, 03 constructs of WOM and their 19 items were derived. The items were confirmed as well as their reliability and validity were measured through confirmatory factor analysis. The structural relationship between WOM factors and trust in physicians was analyzed with data from 330 personal interviews in Bangladesh. Structural equation modeling (SEM) was performed with the application of AMOS.

Findings

This study demonstrates that the trustworthiness of the source, information about medical care facilities and expertise and information about service experience have a significant direct effect on the level of trust in the physicians. This study delivers an understanding of how individualized social and informal communication, WOM, plays a role in the aspects of health-care-related decisions in developing countries.

Research limitations/implications

Findings of this study shed light on the importance of health-care-related communication strategy development and management, which is yet to be emphasized in research and practice in the developing countries contexts. Based on the findings of this study health-care service providers and key touchpoints in health-care delivery and management can develop client's experience-focused service marketing strategies and practices.

Originality/value

The level of trust in physicians regulates the choice of physician decision and the magnitude of service satisfaction and patients' good feeling issues. In health-care service marketing, research is an under-explored area, while the gap is more when developing countries' contexts are concerned. As a customized model and primary data-based study, this paper contributes to addressing the gap mentioned in the previous statement. The sample size could not be extended as no institutional funding was available for this study.

Lean and its impact on sustainability performance in service companies: results from a pilot study

Purpose

The purpose of this empirical research is to understand the application of Lean practices (technical and social) and tools in the service sector, whose implementation is less studied, despite its economic relevance. The study aims to extend previous studies that focused on the relationship between Lean and operational and financial performance, and analyzing the impact on sustainability, encompassing economic, social and environmental perspectives.

Design/methodology/approach

A pilot survey was conducted with Lean experts in European service companies. The authors have utilized various professional contacts on LinkedIn and a satisfactory response rate was obtained for analysis.

Findings

The results of the study showed that there are several motivating factors for the implementation of Lean, the highlights being improving customer satisfaction, efficiency, delivery and cost reduction. The most frequently used Lean tools are related to the identification of improvement opportunities and causes of problems. The pilot survey also made it possible to identify the greater use of technical practices than social practices. The sustainability performance analysis showed that the better performance of service companies is in the economic dimension.

Originality/value

The authors have identified no empirical studies linking Lean and sustainable performance in the service sector. This study bridges this cognitive gap through a pilot study and therefore makes an original contribution to the current literature.

Study of Complexity Systems in Public Health for Evaluating the Correlation between Mental Health and Age-Related Demographic Characteristics: A General Health Study

The main objective of this study is to evaluate the quality of nurses' work lives and mental health during outbreaks. We also use the General Health Questionnaire–28 and Walton's QWL technique to assess the association between these two and their dimensions with demographic variables and each other. First, 165 nurses from COVID-19 medical centers in Iran filled surveys for this research. In an SPSS program, the data were examined. There was a strong link between mental health and age-related demographic factors. There was no evidence of a link between the quality of nurses' work life and their psychological health. However, there was a strong link between somatic symptoms and fair and appropriate compensation, as well as constitutionalism. The worst situations for work life quality were linked to the whole living area dimension. In contrast, the worst conditions for mental health were linked to the somatic symptoms dimension.

The Impact of Nursing on Trauma Patient Satisfaction: An Analysis of HCAHPS From 112,283 Patients

BACKGROUND

Assessment of patient satisfaction is central to understanding and improving system performance with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) national standard survey. However, no large, multi-institutional study exists, which examines the role of nurses in trauma patient satisfaction.

OBJECTIVE

To assess the impact of nurses on trauma patient satisfaction.

METHODS

This retrospective, descriptive study of Level I-IV trauma centers in a multistate hospital system evaluated patients 18 years and older admitted with at least an overnight stay. Data were obtained electronically for patients discharged in 2018-2019 who returned an HCAHPS survey. Surveys were linked by an honest broker to demographic and injury data from the trauma registry, and then anonymized prior to analysis. Patients were categorized as "trauma" per the National Trauma Data Standard (NTDS) definition or as "medical" or "surgical" per the HCAHPS definition.

RESULTS

Of 112,283 surveys from 89 trauma centers, "trauma" patients (n = 5,126) comprised 4.6%, "surgical" 39.0% (n = 43,763), and "medical" 56.5% (n = 63,394). Nurses had an overwhelming impact on "trauma" patient satisfaction, accounting for 63.9% (p < .001) of the variation (adjusted R2) in the overall score awarded the institution-larger than for "surgery" (59.6%; p < .001) or "medical" (58.4%; p < .001) patients. The most important individual domain contributor to the overall rating of a facility was "nursing communication."

CONCLUSIONS

The magnitude of the effect of trauma nurses was noteworthy, with their communication ability being the single biggest driver of institutional ratings. These data provide insight for future performance benchmark development and emphasize the critical impact of trauma nurses on the trauma patient experience.

Transformational Leadership in Health Care Today

Management in nursing is in a state of revolution based on positive transformational changes. Effective leadership on individual nursing units directly affects nursing staff satisfaction. Employees are interested in managers who can lead in a positive and encouraging manner. Nurses who are content in their positions correlate to a reduction in staff turnover and improve retention. When the nursing staff are satisfied with their employment, patient satisfaction rises. Health care organizations can see this trickle-down effect through increases in patient satisfaction scores over time. The promotion of effective communication and positive attitudes enhances a healthy environment for all employees and staff. Health care organizations should evaluate individual nurse managers on units to promote transformational leadership qualities; this will directly result in staff satisfaction, staff retention, and patient satisfaction.

Critical Role of Trauma and Emergency Surgery Physicians in Patient Satisfaction: An Analysis of Consumer Assessment of Healthcare Providers and Systems, Hospital Version Data from 186,779 Patients and 168 Hospitals in a National Healthcare System

BACKGROUND

Trauma and emergency surgery patients are unique with regard to the sudden and unexpected nature of their hospitalization and this can adversely affect patient satisfaction, but, to our knowledge, no large study exists examining this issue. The purpose of this study was to investigate the major factors that affect satisfaction scores in trauma and emergency surgery patients.

STUDY DESIGN

Consumer Assessment of Healthcare Providers and Systems, Hospital Version survey data from patients discharged in 2018-2019 from facilities in a national hospital system were obtained. Patients were categorized as trauma, emergency surgery, or direct admit surgery (elective surgery). Individual Consumer Assessment of Healthcare Providers and Systems, Hospital Version question scores were regressed on the score for "overall rating" to determine the primary, secondary, and tertiary satisfaction drivers.

RESULTS

There were 186,779 patients from 168 hospitals included. As expected, the primary determinant of patient satisfaction was nursing communication for all groups. However, trauma and emergency surgery patients differed from elective surgery patients in that physician communication was the second most important factor in patient satisfaction, accounting for 12.0% (trauma) and 8.6% (emergency surgery) of the total variability in the overall rating beyond the variability explained by the primary driver. If physician communication received low ratings, it was unlikely that high scores in other metrics could compensate to bring the overall score above the 50th percentile.

CONCLUSIONS

Acute care surgeons appear to play a uniquely important role in support of Consumer Assessment of Healthcare Providers and Systems, Hospital Version scores. These data emphasize the importance of physician communication, particularly when a prehospital physician-patient relationship does not exist. Future research should explore specific mechanisms by which physicians effectively communicate with patients.

Association of Demographics and Hospital Stay Characteristics With Patient Experience in Hospitalized Pediatric Patients

There is limited research on patient experience in hospitalized pediatric patients. Our aim was to investigate the association of patient demographics and hospital stay characteristics with experience in a tertiary-care, freestanding children's hospital. We conducted a retrospective cross-sectional study of patient experience surveys. We designated the highest rating as "top-box" and examined data across 8 domains, including overall assessment (OA). A total of 4602 surveys were analyzed. Top-box percentages were lower for younger patients in 6 domains, including OA (0-<1 year old: 57.6%; 1-<4 years old: 61.3%; 4-<12 years old: 68.4%; ≥12 years old: 70.2%; P < .001), and were lower for patients with private insurance in 5 domains, including OA (private 63.2%, public 68.9%; P < .001). There was no association between other demographics (gender, race/ethnicity, primary language) and OA. Overall assessment was also not associated with length of stay (P = .071) and number of consulting services (P = .703). The most important domain predictor of OA was personal issues (odds ratio = 4.79), which assessed concern, sensitivity, and communication from staff. In conclusion, patient experience was associated with age and insurance status but not hospital stay characteristics.

Patient satisfaction with nursing care in Ethiopia: a systematic review and meta-analysis

Background

Patient satisfaction with nursing care has been considered as the most important predictor of the overall patient satisfaction with hospital service and quality of health care service at large. However, the national level of patient satisfaction with nursing care remains unknown in Ethiopia. Hence, the objective of this systematic review and meta-analysis was to estimate the level of patient satisfaction with nursing care and its associated factors in Ethiopia.

Methods

Studies were accessed through an electronic web-based search strategy from PubMed, Cochrane Library, Google Scholar, Embase, PsycINFO, and CINAHL by using a combination of search terms. The quality of each included article was assessed using a modified version of the Newcastle-Ottawa Scale for cross-sectional studies. All statistical analyses were done using STATA version 14 software for windows, and meta-analysis was carried out using a random-effects method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for reporting results.

Results

Of 1166 records screened, 15 studies with 6091 patients fulfilled the inclusion criteria and were included in the meta-analysis. The estimated pooled level of patient satisfaction with nursing care in Ethiopia was 55.15% (95% CI (47.35, 62.95)). Patients who have one nurse in charge (OR: 1.08, 95% CI: 0.45–2.62, I²: 77.7%), with no history of previous hospitalization (OR: 1.37, 95% CI: 0.82–2.31, I²: 91.3%), living in the urban area (OR: 1.07, 95% CI: 0.70–1.65, I²: 62.2%), and those who have no comorbid disease (OR: 1.08, 95% CI: 0.48–2.39, I²: 91.9%) were more likely to be satisfied with nursing care compared with their counterparts although it was not statistically significant.

Conclusion

About one in two patients were not satisfied with the nursing care provided in Ethiopia and may be attributed to several factors. Therefore, the Ministry of Health should give more emphasis to the quality of nursing care in order to increase patient satisfaction and improve the overall quality of healthcare service in Ethiopia.

The lived experience: Nurses' experience of caring for patients with a traumatic spinal cord injury

BACKGROUND

Nurses are involved in delivering care for patients following acute traumatic spinal cord injury throughout the entire care journey. An injury of this type is significant for the individual and their family and can be challenging for nurses delivering care for patients with life changing injuries, especially for nurses new to this setting. There is a lack of research that examines the experience of nurses caring for these patients in the acute setting.

METHOD

A hermeneutic phenomenological approach was used to understand the experience of nurses caring for patients in the acute setting who had sustained a traumatic spinal injury with associated neurological deficit. Using the phenomenological approach guided by the insight of Gadamer and Max Van Manen, participants with a broad range of experience were recruited and interviewed. The responses were transcribed into a text and subjected to hermeneutic analysis. Burnard's (1991) 14-step process and the hermeneutic approach were used to interpret and understand the phenomenon of interest.

CONCLUSION

The study highlights the experience and challenges of providing care to these individuals. Although patients had significant physical disabilities and were often dependent physically, the nurses' concerns were directed more towards fulfilling their psychological needs. Nurses identified grieving patients and felt their role was to provide realistic hope to motivate them. They felt an internal tension regarding desensitisation towards their patients, but this was often an internal protective mechanism to deal with the significance of the events surrounding these patients. Nurses new to this setting took time to learn the routines and manage the unique challenges effectively. Caring for these patients gave the nurses the opportunity to understand their patients and their families, and appreciate that both groups will fluctuate in their behavior throughout the acute process, as they adjust to grief and loss.

The impact of emotional intelligence in health care professionals on caring behaviour towards patients in clinical and long-term care settings: Findings from an integrative review

BACKGROUND

Over recent years there has been criticism within the United Kingdom's health service regarding a lack of care and compassion, resulting in adverse outcomes for patients. The impact of emotional intelligence in staff on patient health care outcomes has been recently highlighted. Many recruiters now assess emotional intelligence as part of their selection process for health care staff. However, it has been argued that the importance of emotional intelligence in health care has been overestimated.

OBJECTIVES

To explore relationships between emotional intelligence in health care professionals, and caring behaviour. To further explore any additional factors related to emotional intelligence that may impact upon caring behaviour.

DESIGN

An integrative review design was used.

DATA SOURCES

Psychinfo, Medline, CINAHL Plus, Social Sciences Citation Index, Science Citation Index, and Scopus were searched for studies from 1995 to April 2017.

REVIEW METHODS

Studies providing quantitative or qualitative exploration of how any healthcare professionals' emotional intelligence is linked to caring in healthcare settings were selected.

RESULTS

Twenty two studies fulfilled the inclusion criteria. Three main types of health care professional were identified: nurses, nurse leaders, and physicians. Results indicated that the emotional intelligence of nurses was related to both physical and emotional caring, but emotional intelligence may be less relevant for nurse leaders and physicians. Age, experience, burnout, and job satisfaction may also be relevant factors for both caring and emotional intelligence.

CONCLUSIONS

This review provides evidence that developing emotional intelligence in nurses may positively impact upon certain caring behaviours, and that there may be differences within groups that warrant further investigation. Understanding more about which aspects of emotional intelligence are most relevant for intervention is important, and directions for further large scale research have been identified.

European hospital managers' perceptions of patient-centred care

PURPOSE

The spotlight has recently been placed on managers' responsibility for patient-centred care as a result of Mid Staffordshire NHS Foundation Trust failings. In previous research, clinicians reported that managers do not have an adequate structured plan for implementing patient-centred care. The purpose of this paper is to assess the perceptions of European hospital management with respect to factors affecting the implementation of a patient-centred approach.

DESIGN/METHODOLOGY/APPROACH

In total, 15 semi-structured interviews were conducted with hospital managers (n=10), expert country informants (n=2), patient organisations (n=2) and a user representative (n=1) from around Europe. Participants were purposively and snowball sampled. Interviews were analysed using framework analysis.

FINDINGS

Most participants felt that current levels of patient-centred care are inadequate, but accounted that there were a number of macro, meso and micro challenges they faced in implementing this approach. These included budget constraints, political and historical factors, the resistance of clinicians and other frontline staff. Organisational culture emerged as a central theme, shaped by these multi-level factors and influencing the way in which patient-centred care was borne out in the hospital. Participants proposed that the needs of patients might be better met through increasing advocacy by patient organisations and greater staff contact with patients.

ORIGINALITY/VALUE

This study is the first of its kind to obtain management views from around Europe. It offers an insight into different models of how patient-centred care is realised by management. It indicates that managers see the value of a patient-centred approach but that they feel restricted by a number of factors at multiple levels.

Evaluation of emergency department nursing services and patient satisfaction of services

AIMS AND OBJECTIVES

To identify nursing services and assess patient satisfaction in patients who present to the emergency department.

BACKGROUND

Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department.

DESIGN

This is a descriptive study.

METHODS

Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form.

RESULTS

Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%).

CONCLUSIONS

The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department.

RELEVANCE TO CLINICAL PRACTICE

We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues.

The employee's productivity in the health care sector in Poland and their impact on the treatment process of patients undergoing elective laparoscopic cholecystectomy

BACKGROUND

Increasing the engagement of employees in the treatment process of patients may benefit a hospital and employee productivity and may result in better patient care and satisfaction with medical services. Given this, the first step in improving the quality of patient care is better availability of doctors for patients in a hospital ward.

METHODS

The research for this paper was conducted in six health care units in the Kuyavian-Pomeranian province in Poland. The research assessed how the elements relating to employees' behavior and things characteristic to medical service influence patients' willingness to recommend a hospital.

RESULTS

Patients' perception of services is linked with the behavior of medical employees and their engagement in the treatment process.

CONCLUSION

Our research indicates that individual employee recognition and collective recognition of hospital employees as a whole were identified as the most important factors in employee engagement in the treatment process (employee productivity) and patients' satisfaction with medical service.

Women's Satisfaction of Maternity Care in Nepal and Its Correlation with Intended Future Utilization

The impact of rapid increase in institutional birth rate in Nepal on women's satisfaction and planned future utilization of services is less well known. This study aimed to measure women's satisfaction with maternity care and its correlation with intended future utilisation. Data came from a nationally representative facility-based survey conducted across 13 districts in Nepal and included client exit interviews with 447 women who had either recently delivered or had experienced complications. An eight-item quality of care instrument was used to measure client satisfaction. Multivariate probit model was used to assess the attribution of different elements of client satisfaction with intended future utilization of services. Respondents were most likely to suggest maintaining clean/hygienic health facilities (42%), increased bed provision (26%), free services (24%), more helpful behaviour by health workers (18%), and better privacy (9%). Satisfaction with the information received showed a strong correlation with the politeness of staff, involvement in decision making, and overall satisfaction with the care received. Satisfaction with waiting time (p = 0.035), information received (p = 0.02), and overall care in the maternity care (<0.001) showed strong associations with willingness to return to facility. The findings suggest improving physical environment and interpersonal communication skills of service providers and reducing waiting time for improving client satisfaction and intention to return to the health facility.

Quality and price--impact on patient satisfaction

PURPOSE

The purpose of this paper is to synthesize existing quality-measurement models and applies them to healthcare by combining a Nordic service-quality with an American service performance model.

DESIGN/METHODOLOGY/APPROACH

Results are based on a questionnaire survey of 1,298 respondents. Service quality dimensions were derived and related to satisfaction by employing a multinomial logistic model, which allows prediction and service improvement.

FINDINGS

Qualitative and empirical evidence indicates that customer satisfaction and service quality are multi-dimensional constructs, whose quality components, together with convenience and cost, influence the customer's overall satisfaction.

ORIGINALITY/VALUE

The proposed model identifies important quality and satisfaction issues. It also enables transitions between different responses in different studies to be compared.

Satisfaction with nursing care in the emergency department of an urban hospital in the developing world: A pilot study

INTRODUCTION

Nurses form the largest group of the workforce in hospitals and as such the quality of nursing care is a critical indicator of patient satisfaction.

OBJECTIVE

To determine the level of patient satisfaction with nursing care in the emergency department of an urban teaching hospital in Jamaica.

METHODS

This descriptive cross-sectional study used a convenience sampling technique to recruit 142 adult patients who accessed nursing care in the emergency and intermediate areas of the emergency department. Data were collected using a 22- item questionnaire adapted from the Patient Satisfaction with Nursing Care Quality Questionnaire and managed using SPSS® version 19.0 for Windows®.

RESULTS

The response rate was 77.6%; most respondents (62%) were female, and educated at the secondary level (42.3%). The mean satisfaction score was 32.60 (± 7.11) out of a possible 42. Most (59.9%) patients reported that they were very satisfied with nursing care in the emergency department. Satisfaction with nursing care was associated with clients' education. Perceived health status and empathy of nursing care offered were associated with patient's satisfaction with care (p = 0.05).

CONCLUSIONS

Patients were highly satisfied with nursing care in the emergency department studied. Client's education, perceived health status and empathy of care were predictors of satisfaction.

Lean practices for quality results: a case illustration

Purpose

– Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations.

Design/methodology/approach

– The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital.

Findings

– Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals.

Practical implications

– An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices.

Social implications

– Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific organisations and inter-organisational networks.

Originality/value

– Healthcare managers are adopting business practices that improve efficiency and productivity while ensuring their healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g. reducing waste and enhancing customer value) at the front-end is crucial for implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice.

Measuring the evidence: reviewing the literature of the measurement of therapeutic engagement in acute mental health inpatient wards

Quality nursing plays a central role in the delivery of contemporary health and social care, with a positive correlation being demonstrated between patient satisfaction and the quality of nursing care received. One way to ensure such quality is to develop metrics that measure the effectiveness of various aspects of care across a variety of settings. Effective mental health nursing is predicated on understanding the lived experiences of service users in order to provide sensitively-attuned nursing care. To achieve this, mental health nurses need to establish the all-important therapeutic relationship, showing compassion and creating a dialogue whereby service users feel comfortable to share their experiences that help contextualize their distress. Indeed, service users value positive attitudes, being listened to, and being able to trust those who provide care, while mental health nurses value their ability to relate through talking, listening, and expressing empathy. However, the literature suggests that within mental health practice, a disproportionate amount of time is taken up by other activities, with little time being spent listening and talking to service users. The present study discusses the evidence relating to the therapeutic relationship in acute mental health wards and explores why, after five decades, it is not recognized as a fundamental metric of mental health nursing.

Effect of spiritual intelligence, emotional intelligence, psychological ownership and burnout on caring behaviour of nurses: a cross-sectional study

AIMS AND OBJECTIVES

To propose a model of prediction of caring behaviour among nurses that includes spiritual intelligence, emotional intelligence, psychological ownership and burnout.

BACKGROUND

Caring behaviour of nurses contributes to the patients' satisfaction, well-being and subsequently to the performance of the healthcare organisations. This behaviour is influenced by physiological, psychological, sociocultural, developmental and spiritual factors.

DESIGN

A cross-sectional survey was used, and data were analysed using descriptive statistics and structural equation modelling.

METHODS

Data were collected between July-August 2011. A sample of 550 nurses in practice from seven public hospitals in and around Kuala Lumpur (Malaysia) completed the questionnaire that captured five constructs. Besides nurses, 348 patients from seven hospitals participated in the study and recorded their overall satisfaction with the hospital and the services provided by the nurses. Data were analysed using structural equation modelling (SEM).

RESULTS

The key findings are: (1) spiritual intelligence influences emotional intelligence and psychological ownership, (2) emotional intelligence influences psychological ownership, burnout and caring behaviour of nurses, (3) psychological ownership influences burnout and caring behaviour of nurses, (4) burnout influences caring behaviour of nurses, (5) psychological ownership mediates the relationship between spiritual intelligence and caring behaviour and between emotional intelligence and caring behaviour of nurses and (6) burnout mediates the relationship between spiritual intelligence and caring behaviour and between psychological ownership and caring behaviour of nurses.

CONCLUSIONS

Identifying the factors that affect caring behaviour of nurses is critical to improving the quality of patient care. Spiritual intelligence, emotional intelligence, psychological ownership and burnout of nurses play a significant role in effecting caring behaviour of nurses.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers must consider the relationships between these factors in their continuing care and incorporation of these in the nursing curricula and training.

The quality in psychiatric care-forensic in-patient instrument: psychometric properties and patient views of the quality of forensic psychiatric services in Sweden

The aim of this study was to evaluate the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Forensic In-Patient and to describe the quality of psychiatric care among forensic in-patients. The study group consisted of patients all receiving care during 2 weeks in September 2009 and meeting the inclusion criteria. A sample of 134 in-patients from 34 forensic wards in Sweden participated. Confirmatory factor analysis revealed a seven-factor structure, and 69% of the patients reported the quality of care as high. The highest rating was for the secluded environment dimension, and the lowest was for the participation dimension. The Quality in Psychiatric Care-Forensic In-Patient is a reliable and valid measurement instrument recommended for use in evaluating quality in forensic in-patient care.

The patient's view of quality in psychiatric outpatient care

The influence of demographic characteristics on patients' ratings of the quality of psychiatric outpatient care has been given little attention in research. The aim of the present study is to elucidate the quality of psychiatric care among outpatients and investigate demographic and clinical factors associated with the way in which this quality is perceived. A sample of 1340 outpatients from 15 general adult psychiatric clinics in Sweden completed the quality in psychiatric care-out-patient (QPC-OP), with a response rate of 71%. The patients' highest ratings were for Encounter; the lowest were for discharge. Most notably, quality of care was rated higher by women, older people, those with a partner, those with a lower educational level and those who were gainfully employed. In regard to visits to the clinic, higher quality of care was associated with shorter waiting time, better information and fewer professions encounters. Older people and those gainfully employed reported better mental health. Thus the QPC-OP was associated with both demographic and clinical factors. In particular, 'wanting to come back to the clinic' was the single strongest predictor of quality.

Inpatients' willingness to recommend: a multilevel analysis

BACKGROUND

Satisfaction with health care is one of the most widely assessed measures of hospital care quality, yet studies that account for clustering effects are uncommon. We constructed a multilevel model to identify predictors of willingness to recommend while controlling for clustering effects due to hospital and care unit. We also examined differences in predictors by care unit.

PURPOSE

The aim of this study was to identify factors that both influence patient perceptions of care and are potentially modifiable by the hospital delivering care.

METHODOLOGY

Our sample includes Hospital Consumer Assessment of Healthcare Providers and Systems survey data collected between July 1, 2007, and June 30, 2008, for 131 hospitals and 33,445 patients. The primary outcome was willingness to recommend the hospital to family and friends. Variables were collected at three levels: patient (Hospital Consumer Assessment of Healthcare Providers and Systems survey item responses and demographics), care unit, and hospital. Data were analyzed using multilevel modeling. We also ran a series of two-level models to explore differences in predictors by care type.

FINDINGS

The strongest predictors of willingness to recommend, controlling for clustering effects, were items that generally reflected interpersonal aspects of care such as nursing and physician behaviors. In the two-level models, predictors of willingness to recommend overlapped across care units, but important differences were noted.

PRACTICE IMPLICATIONS

Our results suggest that hospitals that wish to improve their performance would benefit most from focusing on interpersonal aspects of care. Hospitals that focus resources on improving in these areas, that assess care units separately, and that investigate the meaning and context of survey responses will be most likely to see improvements in satisfaction scores.

Patient satisfaction with birthing center nursing care and factors associated with likelihood to recommend institution

This study analyzed data from an existing hospital birthing center patient satisfaction survey to determine which care factors were most important to patients and correlated with the likelihood to recommend the facility to others. Three dimensions of care emerged--wait time, communication, and service. Patients gave lower scores for satisfaction if they waited longer than expected for a call light response: 40% of patients expected to wait 4 minutes or less for a response. Discussing with patients realistic wait times for call light responses may be a way to improve patient satisfaction.

Patient information and participation still in need of improvement: evaluation of patients' perceptions of quality of care

AIMS

To identify areas in need of quality improvement by investigating inpatients' perceptions of quality of care, and to identify differences in perceptions of care related to patient gender, age and type of admission.

BACKGROUND

Nursing managers play an important role in the development of high-quality care.

METHODS

Quality of care was assessed using the Quality from the Patients' Perspective (QPP). In all, 2734 inpatients at a Swedish university hospital completed the QPP.

RESULTS

Inadequate quality was identified for 15 out of 24 items, e.g. information given on treatment and examination results, opportunities to participate in decisions related to care and information on self-care. Patients with emergency admissions reported lower scores for quality of information and doctors' care than did patients with planned admissions.

CONCLUSION

Results from the present survey identified areas in need of quality improvement and differences in perceived care quality between patients. Quality of care must be developed in close collaboration with other healthcare professionals; in this respect, nursing managers could play an important role.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers could play a more active part in measuring quality of care, and in using results from such measurements to develop and improve quality of care.

Nurse-perceived time pressure and patient-perceived care quality

AIMS

To examine how time pressure among nurses influences patient-perceived care quality.

BACKGROUND

Although nurses worldwide face increased time pressure in the workplace, no studies have addressed how workplace time pressure influences patient-perceived care quality. Patient-perceived care quality predicts patient intent to revisit the hospital if care is required, warranting investigation as to whether nurse-perceived time pressure decreases patient-perceived care quality.

METHODS

A cross-sectional design and survey method were adopted. The data analysis was based on 229 nurse-patient sets drawn from a medical centre in northern Taiwan. Each set comprised one nurse and three patients.

RESULTS

The study results demonstrate that time pressure among nurses reduces patient-perceived reliability/accountability, responsiveness and assurance. The test results, however, did not indicate a significant negative association between time pressure and patient-perceived empathy and tangibles.

CONCLUSION

Time pressure among nurses may reduce patient perception of care quality in terms of reliability/accountability, responsiveness and assurance.

IMPLICATIONS FOR NURSING MANAGEMENT

To enhance patient perception of care quality, nursing managers need to devise means to reduce nurse-perceived time pressure.

Measuring and improving ambulatory surgery patients' satisfaction

The pressure on perioperative services to improve quality for health care consumers creates both challenges and opportunities. To make positive changes, many health care organizations contract with Press Ganey (PG), which processes an extensive database of more than 9.5 million surveys annually and provides benchmark reports to same-type organizations. To measure and improve ambulatory surgery patient satisfaction at one health care network in northeastern Pennsylvania, the nursing leaders in the ambulatory surgery center and OR undertook a quality improvement project focused on educating perioperative nurses on the use of PG reports. After we reviewed the PG reports and implemented changes with nursing staff members in perioperative areas, PG patient satisfaction scores improved regarding information about delays (4.1%) and center attractiveness (0.2%).

Internal marketing and the antecedents of nurse satisfaction and loyalty

Employee satisfaction and retention are critical issues that influence the success of any organization. Yet, one of the most critical problems facing the worldwide health care industry is the shortage of qualified nurses. Recent calls have been made within the traditional nursing literature for research that utilizes marketing and business models to better understand nurse satisfaction and retention. The purpose of this study is to develop scales that can be used to empirically test a model of the proposed antecedents of nurse job satisfaction and loyalty which have been used widely in the internal marketing and the relationship-marketing literature. Specifically, the study will investigate the degree to which structural bonding, social bonding, financial bonding activities, and quality of care impact how well nurses are satisfied with their job and their commitment to the organization. The results show that quality of care most impacted nurse satisfaction and loyalty, followed by structural, social, and financial bonds.

Influence of Personality on Care Quality of Hospital Nurses

This study investigates the relationship between hospital nurse personality and care quality in Taiwan. Hierarchical regression analysis was applied to data for 192 pairs of nurses and patients. Analytical results are as follows: (1) nurse openness was positively correlated with patient perceptions of responsiveness and (2) nurse neuroticism was negatively correlated with patient perceptions of responsiveness, assurance, and empathy.

Patients' Return to Referring Physicians and Its Relation to Their Infertility Duration

OBJECTIVE

To determine if length of patient-reported infertility prior to referral to a specialist is related to the likelihood that the patient will return to the referring physician for obstetrical care.

METHODS

A review of our medical record database identified 430 consecutive pregnant patients, discharged between January 1, 2003, and March 1, 2004. The name of the referring and discharge obstetrician(s), duration of infertility, prior use of clomiphene citrate, and number of previous clomiphene treatment cycles were recorded.

RESULTS

Of the 430 patients, 305 (71%) had information about the referring and discharge obstetrician(s) and complete records regarding prior treatment. Median duration of infertility was 1.3 years (range 0.2-12 years). Fifty-five percent (167 of 305) of patients returned to their referring physician for obstetrical care. If patients were referred prior to 6 months of treatment by the referring obstetrician, 76% (35 of 46) returned. If patients were referred after 6 months to 1 year of treatment, 67% (82 of 122) returned. If after 1-2 years, 35% (33 of 94), and after more than 2 years, 40% (10 of 25) returned to their referring physician. Overall, 25% of patients (77 of 305) patients had preliminary treatment with clomiphene citrate. If the referring physician did not give the patient clomiphene citrate, 55% (128 of 232) returned to that physician; if the patient had been given one to four clomiphene cycles, 54% (37 of 69) returned, and if given more than four cycles, 25% (2 of 8) returned.

CONCLUSIONS

Although many factors may affect a patient's decision to return to the referring doctor, patient satisfaction with the referring physician may be related to timely referral to a specialist.

Understanding and Measuring Patients' Assessment of the Quality of Nursing Care

BACKGROUND

Traditionally, patients have been considered incapable of evaluating the quality of care they receive, leading to their minimal involvement.

OBJECTIVE

To develop the Patient's Assessment of Quality Scale--Acute Care Version (PAQS-ACV) to provide a mechanism through which patients can evaluate meaningfully the nursing care they receive.

METHODS

Developed from qualitative interviews with patients, the original 90-item PAQS-ACV was tested with 1,470 medical surgical patients in 43 units across seven hospitals. The typical patient was a married, 50-year-old, high school-educated patient hospitalized for the fourth time. Every 10th patient was asked to complete the PAQS-ACV 2 weeks later.

RESULTS

After exploratory factor analysis, 45 items remained in five factors, accounting for 54% of the variance. Internal consistency estimates were above.83 for four of the five factors, with the fifth factor being.68. Test-retest reliability ranged from .58 to .71. Content validity was established and construct validity has been explored preliminarily by examining the relationship between the PAQS-ACV scores and patients' compliance.

DISCUSSION

Although the PAQS-ACV is a relatively new measure of quality nursing care, it has met many criteria for an adequate measure of quality care. The instrument fills a void in the assessment of quality by including patients in the direct evaluation of the care received.