Analysis of Patient Satisfaction through the Effect of Healthcare Spending on Waiting Times for Consultations and Operations

In recent years, public authorities have invested large amounts of public money in trying to reduce waiting times for consultations and operations with the aim of improving the quality of the healthcare system. Our research aims to analyze the effect of these investments on patient satisfaction through the mediating relationship of waiting times for consultations and operations, as well as from a gender perspective. By studying a series of key indicators of the Spanish healthcare system and applying partial least squares structural equation modelling (PLS-SEM), the findings show that the model explains 12.10% of the variance in consultant waiting times, 51.90% in operation waiting times, and 27.00% in patient satisfaction. We found that increased public spending leads to increased patient satisfaction by reducing waiting times. However, no gender-based differences were found. The results provide exciting implications for theory and practice, indicating how policymakers can orient their strategies towards improving patient satisfaction.

What do humble doctors do? A conceptualization of clinician humility from the patient's perspective

OBJECTIVE

Humility is a desirable trait for clinicians (e.g., physicians, nurse practitioners, physician assistants), but it can be difficult to achieve. Although commentary and empirical studies on clinician humility exist, the literature has overlooked what exactly constitutes a humble clinician through the patients' eyes. Using a mixed-methods approach, this study explored clinician humility from the patient's perspective.

METHOD

Participants (N = 326; 42.1% female; Mage = 40.65, SDage = 11.73) listed humble behaviors that their clinician displayed and evaluated their clinician's overall humility through an online survey. All participants were from the United States of America.

RESULTS

Participants rated their clinician favorably on humility, M = 4.06, SD = 0.94 (on a 1-5 scale). Through thematic analyses, we created five themes about clinician humility: approachability, respect for patient, nonverbal communication, patient-focus, and acknowledgement of limitations.

CONCLUSIONS

The themes coincide with facets of humility within the literature and overlap with important strategies to improve the clinician-patient relationship.

PRACTICE IMPLICATIONS

Clinician humility may serve as a useful framework to categorize important clinician behaviors in the medical interaction. Instead of attempting to remember a myriad of concepts, one may need to keep in mind a modest unifying notion: "be humble".

Psychosocial Predictors of Intention to Vaccinate Against the Coronavirus (COVID-19)

The COVID-19 pandemic has wreaked havoc across the world. Public health efforts to combat the disease and return life to normalcy largely rests upon COVID-19 vaccination distribution and uptake. Thus, it is critical to examine factors that predict people's intentions to vaccinate. This study explored predictors of intention to vaccinate against COVID-19 among demographic and personal factors, health behaviors and beliefs, COVID-19-specific beliefs, and trust in physicians, using a sample of U.S. adults. We employed bivariate correlations and hierarchical regression to analyze the data. We found that the strongest predictors are political orientation, trust in physicians, subjective norms, and prior flu shot uptake. These associations suggest that individuals who held more liberal political views, expressed higher levels of trust in their primary care provider, perceived stronger social pressure to vaccinate against COVID-19, and received a flu shot during the previous flu season, had a stronger intention to vaccinate against COVID-19. Based on our results, we suggest that public health efforts to increase vaccination uptake for COVID-19 vaccines focus on addressing political orientation (conservatism), involve primary care providers, emphasize vaccination as the norm (and not the exception), and use information about previous flu vaccinations to target vaccination campaigns.

Enabling clinician engagement in safety and quality improvement

Objective The aim of this study was to determine how individual, group and leadership factors influence clinician engagement in safety and quality improvement work. Methods The study was conducted through an online questionnaire. Participants were alumni of Australian healthcare safety and quality improvement capability development programs. Relationships between five factors influencing clinicians' perception of value for time and effort in safety and quality improvement work were explored. The five factors were psychological empowerment; task cohesion; social cohesion; transformational leadership behaviour of project leads and sponsors; and value for time and effort for self and patients. Correlation and regression analyses were used to explore the aspects of the hypothesised model. Moderation and mediation analysis was then used to explore the relationships further. Structural equation modelling was used to determine the path model. Results All factors showed strong positive correlations, with psychological empowerment and transformational leadership having the strongest relationships with perceived value for effort for self and patient. The factorial structure of measures was examined, and all indicators loaded significantly on their corresponding latent constructs and the model showed a good fit to the data. Conclusions The findings of this study suggest that the most crucial factor to clinician engagement in safety and quality improvement at the point of care is the leader's behaviour and how that influences team dynamics and individual motivation and empowerment. What is known about the topic? Healthcare organisations remain challenged regarding clinician engagement in safety and quality improvement. Although much is known about clinicians' perceptions of safety and quality, there is more to understand about what practically motivates clinicians to engage. Tapping into individual, group and leadership factors' influences on clinician engagement offers a deeper perspective. What does this paper add? This study explored the individual, group and leadership factors that drive clinician engagement. The factors include the clinician's individual motivation and empowerment to participate, the group dynamics that surround the clinician and the leadership behaviours of the team's leader. The research design allowed for greater understanding about how and to what extent these factors drive clinician engagement. The study's findings can be applied in practice in capability development activities or leadership for safety and quality improvement. What are the implications for practitioners? Rather than taking a perspective that the clinician needs to engage, this study suggests a strong onus on leadership behaviours to engage those clinicians. Focusing on the self as leader and a leader's own behaviours, as well as how those behaviours are fostering positive team dynamics and motivating and empowering individual team members, will have a great benefit on clinician engagement in safety and quality improvement. Higher clinical engagement in safety and quality improvement should translate into better value care.

Using Higher-Order Constructs to Estimate Health-Disease Status: The Effect of Health System Performance and Sustainability

This article aims to provide information to public agencies and policymakers on the determinants of health systems and their relationships that influence citizens’ health–disease status. A total of 61 indicators for each of 17 Spanish autonomous communities were collected from the Spanish Ministry of Health, Social Services, and Equality between 2008 and 2017. The applied technique was partial least squares structural equation modeling (PLS-SEM). Concerning health–disease status, an influence of sustainability and performance on the health system was hypothesized. The findings revealed that health system sustainability had a negative effect on health–disease status, measured in terms of disease incidence. However, the relationship between health system performance and health–disease status is positive. Furthermore, health system performance mediates the relationship between sustainability and health–disease status. According to our study, if we consider the opposite poles that make up the definition of health–disease status (well-being and disease), this concept is defined more by the incidence of the negative aspect.

Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective

The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming that the perceived experience is identical for men and women. A cross-sectional study of 31 variables was applied using partial least squares structural equation modeling (PLS-SEM) as a research tool. The data were obtained from the Spanish Ministry of Health, Consumption, and Social Welfare for the entire Spanish territory between 2005 and 2018. The influence of expenditure, resource allocation, and mortality was hypothesized with regard to patient satisfaction according to disconfirmation theory. Patient satisfaction reflects clinical effectiveness, and therefore is a measure of health system quality. The results show that women are more sensitive to public investment in health than men, i.e., an increase in the level of spending and resources increases satisfaction more in women. In both sexes, the level of expenditure has a direct influence on patient satisfaction, and therefore on the quality of the healthcare system. It is important to increase spending on primary care, especially on specialized medical care and diagnostic equipment. However, reducing the use of drugs in favor of alternative treatments or therapies is considered to be positive. Likewise, spending has an impact on available resources, and these, in turn, have a positive influence on the level of use and a negative impact on mortality. Resources, especially healthcare staff, nuclear magnetic resonance equipment, and the number of posts in day hospitals, increase patients’ positive perception of the NHS.

A little shot of humility: Intellectual humility predicts vaccination attitudes and intention to vaccinate against COVID-19

Vaccinations remain a critical, albeit surprisingly controversial, health behavior, especially with the promise of widely available COVID‐19 vaccine. Intellectual humility, a virtue characterized by nonjudgmental recognition of one's own intellectual fallibility, may counter rigidity associated with anti‐vaccination attitudes and help promote vaccine‐related behaviors. This study investigated whether intellectual humility is related to anti‐vaccination attitudes and intentions to vaccinate against COVID‐19, and whether intellectual humility can predict unique variance in these outcomes beyond participant demographic and personal factors. Participants (N = 351, 57.23% male, mean age = 37.41 years, SD = 11.51) completed a multidimensional measure for intellectual humility, the anti‐vaccination attitudes (VAX) scale, and a two‐item COVID‐19 vaccination intention scale. Bivariate correlations demonstrated that intellectual humility was negatively related with anti‐vaccination attitudes overall, r(349) = −.46, p < .001, and positively related to intentions to vaccinate against COVID‐19, r(349) = .20, p < .001. Hierarchical multiple regression revealed that intellectual humility predicted all four types anti‐vaccination attitudes, overall anti‐vaccination attitudes, and COVID‐19 vaccination intentions above and beyond demographic and personal factors (i.e., sex, race/ethnicity, age, education, socioeconomic status, and political orientation), ΔR² between .08 and .18, ps < .001. These results bolster intellectual humility as a malleable psychological factor to consider in efforts to combat anti‐vaccination attitudes and promote COVID‐19 vaccination uptake.

Positioning work related stress - GPs' reasoning about using the WSQ combined with feedback at consultation

BACKGROUND

General practitioners (GPs) regularly handle cases related to stress and work capacity, but often find this work difficult. However, using an assessment tool in a structured way can increase GPs' awareness of the risk for sick leave and need of referrals to preventive measures. Today there is no established methodical practice for this in primary health care. The aim of this study was to explore GPs' reasoning about using the Work Stress Questionnaire combined with feedback at consultation as an early intervention to reduce sick leave.

METHODS

A focus group study was performed with 23 GPs at six primary health care centres. The discussions were analysed based on a method by Krueger.

RESULTS

Three themes emerged. Positioning work-related stress describes the need to make fundamental standpoints on stress and how it should be handled, to make sense of their work concerning work-related stress. Making use of resources focuses on GPs performing to the best of their ability using assigned resources to treat patients with stress-related ill health, even if the resources were perceived as insufficient. Practising daily work focuses on the GPs' regular and preferred way of working set against the degree of intrusion and benefits. The two related themes making use of resources and practising daily work were mirrored through the third theme, positioning work-related stress, to form an understanding of how GPs should work with patients perceiving work-related stress.

CONCLUSIONS

The GPs own competence and tools, those of other professionals and the time allocated were seen as important when treating patients perceiving ill health due to work-related stress. When resources were insufficient though, the GPs questioned their responsibility for these patients. The results also indicate that the GPs viewed their ordinary consultative way of working as sufficient to identify these patients. The intervention was therefore not seen as useful for early treatment of patients at risk of sick leave due to work-related stress. However, prevention is an important part of the PHC's responsibility, and strategies concerning stress-related ill health therefore need to be more thoroughly formulated and incorporated.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02480855 . Registered 20 May 2015.

"Very humble" vs. "Not humble": What do ratings of fictitious physician profiles with humility descriptors reveal about potential patient preferences and behaviors?

OBJECTIVES

The current study examined the impact of physician humility on future medical interactions and physician-related outcomes (e.g., patient patronage, loyalty) using a non-patient, community sample.

METHODS

Participants (N = 417) were recruited online through Amazon Mechanical Turk (mTurk) and paid a nominal fee for their participation. They reviewed randomly assigned fictitious physician profiles that differed in humility (high, low), general effectiveness (high, low), physician gender (male, female), and specialty (family practice, orthopedic surgery). Then they reported their likelihood to trust, adhere to recommendations, and be satisfied with the physician. They also conveyed how likely they would select and recommend this physician to others, and how much out-of-pocket money they would be willing to spend to see the physician.

RESULTS

Humble physicians were rated higher than their non-humble counterparts on all five outcomes. For physicians who were generally ineffective, the physicians low in humility scored lower on intended adherence, trust, and anticipated satisfaction than the physicians high in humility. Additionally, for physicians specializing in family practice, physicians low in humility scored lower on anticipated satisfaction and out-of-pocket expenditure than the physicians high in humility.

CONCLUSIONS

Findings from this study highlight how physician humility can affect the process of care even before it begins.

PRACTICE IMPLICATIONS

The study emphasizes the need for deliberate pursuit of humility to improve outcomes for patients and physicians.

Is the worship of celebrities associated with resistance to vaccinations? Relationships between celebrity admiration, anti-vaccination attitudes, and beliefs in conspiracy

Vaccinations and anti-vaccination attitudes have reclaimed the spotlight as a crucial health behavior because of the recent surge in outbreaks of preventable diseases. One factor that may be contributing to this trend is the outspoken role that anti-vaccination celebrities play. The main purpose of the present study was to determine whether anti-vaccination attitudes are related to celebrity admiration. We hypothesized a positive correlation between anti-vaccination attitudes and celebrity interest and admiration. We also hypothesized that persons who are very concerned about the commercial profiteering of vaccinations will also tend to believe in conspiracies. Participants (N = 320, 40% female, mean age = 36.28, SD = 11.32) completed the Celebrity Attitude Scale (CAS) and the Vaccination Attitudes Examination Scale (VAX) through an online survey management system. We found significant positive associations between anti-vaccination attitudes and celebrity admiration and interest. However, celebrity admiration and interest did not correlate with mistrust of vaccine benefits, as measured by a subdomain of the VAX. Additionally, we found that concerns about commercial profiteering from vaccines correlated with beliefs in conspiracy theories. Our study suggests a new way of approaching people's anti-vaccination attitudes that may be used to effectively educate the public about the importance of vaccinations.

Intellectual humility's association with vaccine attitudes and intentions

Vaccinations are critical to public health but uptake levels remain suboptimal. Intellectual humility, a virtue characterized by nonjudgmental recognition of one's own intellectual fallibility, may support the promotion of favorable vaccine attitudes. The current study investigated whether intellectual humility is related to anti-vaccination attitudes and intentions to vaccinate against the flu. Through an online survey management system, participants (N = 246, M_age = 39.06 years, SD_age = 10.57, 50.80% female, 79.20% White, 6.50% Black/African American, 7.80% Asian, 1.20% Hispanic/Latino, and 5.30% Other) completed a measure for intellectual humility, the anti-vaccination attitudes (VAX) scale, and a three-item flu vaccine intention scale. We found that intellectual humility negatively correlated with anti-vaccination attitudes. This correlation was largely driven by openness to revising one's viewpoint and lack of intellectual overconfidence. Additionally, we found that intellectual humility did not relate to flu vaccination intentions. Finally, we discuss the implications of these findings and their potential to support the eventual development of strategies to leverage intellectual humility into a health promotion strategy.

Patient Satisfaction in the Spanish National Health Service: Partial Least Squares Structural Equation Modeling

The aim of this article was to determine which key indicators influence patient satisfaction with the Spanish NHS to provide useful information for policy decision-making. A total of 33 variables for each of the 17 Spanish autonomous communities were collected from the statistical portal of the Spanish Ministry of Health, Social Services, and Equality between 2005 and 2016. A cross-sectional study was applied using Partial Least Squares to a Structural Equation Model (PLS-SEM). The influence of expenditures, resource allocation, and safety were hypothesized about patient satisfaction. Gross Domestic Product (GDP) and life expectancy were used as control variables. Moreover, the influence of resource allocation on use was tested. The model explained 57.1% of patient satisfaction with the Spanish NHS. It was positively influenced mainly by resource allocation and expenditures, followed by safety and life expectancy. Additionally, resources directly influenced the level of use. The number of hospital beds, hemodialysis equipment, rate of adverse drug reactions, and expenditure positively influenced patient satisfaction. In contrast, the number of posts in day hospitals, the hospital infection rate, and the percentage of pharmacy spending negatively influenced patient satisfaction.