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The Relationship between Mindfulness, Triage Accuracy, and Patient Satisfaction in the ED
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Author: Mor Saban, U. of Haifa
Author: Efrat Dagan, U. of Haifa
Author: Anat Drach-Zahavy, U. of Haifa
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Background. Individual and collective mindfulness attract growing research attention, yet their impact on behaviors at work are scarce, especially in the emergency department. Objectives. To examine whether the association between individual mindfulness and triage accuracy is moderated by a dynamic emergency department environment. Furthermore, to explore whether this association promotes patient satisfaction subject to levels of collective mindfulness. Design. A prospective-consecutive nested design. Participants. Ninety-six emergency department teams (triage nurses, colleague nurses and physicians), and 960 patients. Data collection. Data were collected in two steps. The first step included collection of participants’ individual socio-demographic and professional characteristics, as well as individual mindfulness. The second step included data collection at the specific patient– emergency department team encounter. In this step, data on emergency department accuracy, emergency department triage team characteristics, collective mindfulness, overload, and patient satisfaction were collected. Results. Findings indicated that emergency department dynamic environment (b=0.24, p<.01), individual mindfulness (b=1.80, p<.01), and their interaction (b=-0.04, p<.05) were significantly correlated with triage accuracy. The positive association between individual mindfulness and triage accuracy was found only under a high but not under extreme levels of emergency department dynamics environment. Triage accuracy (b=1.81, p<.001), collective mindfulness (b=1.29, p<.001), and their interaction (b=-0.32, p<.001) were significantly associated with patient satisfaction. When collective mindfulness was low, triage accuracy was significantly and positively related to patient satisfaction; however, when collective mindfulness was high, patients’ satisfaction was higher regardless of triage accuracy levels. The moderating-mediating model was found to be significant under high but not under extreme levels of emergency department dynamic environment and each of the three levels of collective mindfulness (i.e. low, medium or high). Discussion and conclusion. Individual and collective mindfulness are substantial to emergency department practices and performance, but their effects are bounded: the beneficial gain of nurses’ individual mindfulness on triage accuracy is prevalent only under a high-dynamic environment but limited under extreme-dynamic emergency department environments. Further, collective mindfulness is central to achieving patient satisfaction, compensating even for low triage accuracy. Given the importance of mindfulness, nursing managers should help cultivate it in nursing wards. Individual mindfulness could be improved via careful selection processes and/or mindfulness training, and collective mindfulness is more a matter of shaping work structures and values that promote mindfulness.
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Paper is No Longer Available Online: Please contact the author(s).
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Assembling Homo Qualitus: Medical Professionalism in the Age of Quality
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Author: Dane Paul Pflueger, HEC Paris
Author: Kirstine Zinck Pedersen, Copenhagen Business School
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Discourse of quality has increasingly moved or multiplied from professional medical enclosures into public policies and reforms of healthcare systems since the mid-1990s. This paper offers an approach to the study of medical work that accounts for the significance of this movement. More specifically, it documents the relations between the discourse of quality and an assemblage of diverse elements (doctrines, devices and affects), and the construction of a new idealized image of the healthcare worker, homo qualitus, in the UK National Health Service (NHS). This worker is shown to be surrounded and equipped to speak a particular kind of quantitative, systemic and patient-centred language of quality, to engage in continual experimentation and tests of change, and to become an enthusiastic champion of the quality improvement agenda. Thus, it is a healthcare worker distinguished in relation not to tasks, jurisdictions, or classical professional skills, but to her individual characteristics of enthusiasm, engagement, and entrepreneurialism. These characteristics challenge, recombine, and reconstitute the distinctions – such as the classic professional- managerial analytical grid – upon which studies of medical work have historically relied.
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Paper is No Longer Available Online: Please contact the author(s).
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Determinants of Sustained Superior Hospital Performance
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Author: Mona Al-Amin, Suffolk U.
Author: Jennifer Hefner, Ohio State U.
Author: Tory H. Hogan, Ohio State U.
Author: Kate Li, Suffolk U.
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The objective of this paper is to investigate the organizational and market level variables associated with sustained superior hospital performance on Value Based Purchasing Total Performance Scores (TPS). We rely on Resource Based View of the Firm and Resource Dependence Theory to develop our model. Data was obtained CMS Hospital Compare website, Area Health Resource File and American Hospital Association Annual Survey Database. We estimated a logistic regression model to identify significant predictors of hospitals with sustained superior performance on TPS, i.e. “sustainers”. Based on our analysis, hospitals located in rural markets with a high percentage of the population eligible for Medicare Advantage penetration had a higher likelihood of being classified as sustainers. High RN and employed hospitalist staffing levels, lower Medicare share of inpatient days, not-for-profit ownership, and small size were all significant organizational predictors of sustainers. In conclusion, managers need to carefully examine their staffing levels as they pursue to sustain high TPS overtime. Moreover, factors such as Medicare share of inpatient days and size need to be considered when understanding barriers to sustained performance on VBP domains.
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Paper is No Longer Available Online: Please contact the author(s).
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The Quality Impact of Home Health Agency Work Practices in a Changing Employment Landscape
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Author: Rebecca Ranucci, U. of Hartford
Author: Daphne Berry, U. of Hartford
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As the population of the United States ages, increasing numbers of the elderly and people with disabilities prefer home care to institutionalization. Accordingly, the number of home care agencies has grown, the number of home health aide jobs are now the fastest growing in the healthcare industry, and the quality of care delivered by home health agencies is increasingly transparent as the Center for Medicare and Medicaid Services (CMS) collects and distributes this data. However, less is known about the work conditions and practices that motivate those on the frontlines of delivering home health services to deliver quality services. We conduct a large-scale longitudinal archival study on home health agencies and find support for the quality impact of work practices directed specifically at home health aides who provide caring labor remote from their employing organization. Further, we find the effect of these work practices varies as agencies decrease employment security by increasing use of contract home health aides.
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Paper is No Longer Available Online: Please contact the author(s).
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Quality Matters: Exploring the Influence of Relationship Quality on Type 2 Diabetes Outcomes
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Author: Yolonda Freeman-Hildreth, Case Western Reserve U.
Author: Yunmei Wang, Case Western Reserve U.
Author: Philip A. Cola, Weatherhead School of Management, Case Western Reserve U.
Author: David Aron, Weatherhead School of Management, Case Western Reserve U.
Author: Richard J. Boland, Case Western Reserve U.
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U.S. healthcare systems are struggling to cope with rising costs and demands imposed by the burden the of diabetes. In response to patients’ demand for quality, health systems have increased their efforts to improve quality by placing emphasis on providing value-based service. Although interpersonal communication is emphasized as a critical component of quality care, there’s limited research on how the patient’s perception of relationship quality affect health outcomes. This study explores how the patient’s perception of relationship quality with their provider influences Type 2 Diabetes (T2DM) outcomes. Specifically, we examined the influence of a shared connection, provider support, and trust in their provider on T2DM outcomes. This quantitative study sampled 422 people with T2DM using a 62-item online survey. The sample population included people over the age of 18 diagnosed with T2DM. Results indicate that patients’ perceptions of relationship quality influence T2DM treatment satisfaction and self-management outcomes. We found that patients with a greater perception of provider trust (ß = .51, ? < .001) and provider support (ß = .17, ? < .05) had more treatment satisfaction while self-management adherence was increased in patients with a greater perception of greater provider support (ß = .40, ? < .001). However, patients who had a greater shared connection with their provider had lower treatment satisfaction and self-management adherence. This research has implications for healthcare providers, healthcare management, and leaders regarding the behaviors perceived to increase relationship quality. Also, there are implications regarding understanding patient’s perspective of the burdens, social conditions, and challenges affecting adherence. Further, this study has implications for creating structures and policies to facilitate the coordination of tasks to ease patient SM burdens.
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Paper is No Longer Available Online: Please contact the author(s).
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