Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting

What every intensivist should know about: Trust in the ICU

Trust is an essential element in the relationship between patients and intensive care unit (ICU) clinicians. Without a foundation of trust, communication is difficult, conflict is more likely, and even clinical outcomes can be affected. The ICU is a particularly challenging environment for trust to flourish. Illness occurs suddenly, emotions can be charged, the environment is impersonal, and there is rarely a prior relationship between patients and their caregivers. Therefore, intensivists must have some understanding of the factors that impact patient and family trust, as well as the actions they can take to improve it.

Building confidence and trust in Ireland's National Maternity Services Workforce -What matters most and how?

National surveys on care experiences are increasingly adopted as regulatory mechanisms for improving care quality and increasing public trust in healthcare services. Based on data collected as part of Ireland's 2020 National Maternity Experience Survey, this study investigates care-related factors that contribute most to confidence and trust in the professional workforce (or carers) within Irish maternity services. The survey covered the full spectrum of maternity care and received 3,206 responses which were analysed using structural equation modelling. Results show that trust in carers may be enhanced through greater attention to the quality of interpersonal aspects of maternity care in a few core areas. We found that factors related to dignity and respect (β=0.270), involvement in decision-making (β=0.186), pain management (β=0.172), and communication (β=0.151) are core determinants of confidence and trust in the professional workforce of maternity services. Perceived quality of care in these four aspects increased on average, with the women's age. Women under 29 rated their experiences in these areas as significantly lower than the average. Women with a disability also rated their experiences significantly lower than average in three core areas. Our results suggest that trustworthy, equitable, and high-quality maternity care requires ongoing development of interpersonal skills within the maternity services professional workforce particularly in caring for younger women (under 29 years) and those with a disability.

The Association of Name Recognition, Empathy Perception, and Satisfaction With Resident Physicians' Care Amongst Patients in an Academic Emergency Department

Background

Recognition of the provider's name, provider empathy, and the patient's satisfaction with their care are patient-provider rapport measures. This study aimed to determine: 1) resident physicians' name recognition by patients in the emergency department; and 2) name recognition in association with patient perception of the resident's empathy and their satisfaction with the resident's care.

Methods

This was a prospective observational study. A patient recognizing a resident physician was defined as the patient remembering a resident's name, understanding the level of training, and understanding a resident's role in patient care. A patient's perception of resident physician empathy was measured by the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE). Patient satisfaction of the resident was measured utilizing a real-time satisfaction survey. Multivariate logistic regressions were performed to determine the association amongst patient recognition of resident physicians, JSPPPE, and patient satisfaction after adjustments were made for demographics and resident training level.

Results

We enrolled 30 emergency medicine resident physicians and 191 patients. Only 26% of studied patients recognized resident physicians. High JSPPPE scores were given by 39% of patients recognizing resident physicians compared to 5% of those who were not recognized (P = 0.013). High patient satisfaction scores were recorded in 31% of patients who recognized resident physicians compared to 7% who did not (P = 0.008). The adjusted odds ratios of patient recognition of resident physicians to high JSPPPE and high satisfaction scores were 5.29 (95% confidence interval (CI): 1.33 - 21.02, P = 0.018) and 6.12 (1.84 - 20.38, P = 0.003) respectively.

Conclusions

Patient recognition of resident physicians is low in our study. However, patient recognition of resident physicians is associated with a higher patient perception of physician empathy and higher patient satisfaction. Our study suggests that resident education advocating for patient recognition of their healthcare provider's status needs to be emphasized as part of patient-centered health care.

Physician Perceptions of Performance Feedback and Impact on Personal Well-Being: A Qualitative Exploration of Patient Satisfaction Feedback in Neurology

BACKGROUND

To understand neurologists' experiences and perspectives on patient satisfaction feedback and its impact on personal well-being and behavior.

METHODS

From May to June 2021, the researchers conducted 19 semistructured interviews with neurologists from a large academic medical center. Clinical Performance Feedback Intervention Theory informed a combined inductive and deductive thematic analysis of the qualitative data, which focused on perceptions of current feedback practices, its impact on physician behavior, and recommendations for improvement.

RESULTS

Participants tended to be female (n = 12/19, 63.2%), aged 30-39 (n = 8/19, 42.1%), white (n = 9/19, 47.4%), and were 10+ years into clinical practice (n = 18/19, 94.7%). Physicians were receptive to feedback overall, but perceptions varied by feedback type. Physicians preferred informal feedback (delivered unprompted directly by patients), given its tendency toward actionability. They disliked formal feedback (derived from anonymous surveys) due to low actionability, bias and validity issues, lack of contextual considerations, delivery through public reports, and links to financial incentives. Nearly all physicians reported formal feedback programs had the potential to negatively affect well-being and were not beneficial to their practice; a few reported adjusting their clinical practice to improve patient satisfaction performance. Five recommendations to improve patient satisfaction feedback programs emerged: Align on feedback intent, acknowledge survey limitations during program administration, increase actionability of feedback through specificity and control, support direct patient-physician feedback and problem resolution, and support empathetic integration of feedback.

CONCLUSION

Understanding physician perceptions of current approaches to patient satisfaction feedback offers the opportunity to shape subsequent collection and distribution methods to improve physician performance and optimize professional fulfillment.