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Social Disconnection among Frequent Users of Community Hospital Emergency Departments
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Author: Chris Louis, Boston U. School of Public Health
Author: Victoria Parker, U. of New Hampshire
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Background: Chapter 224 authorized Massachusetts to establish the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program. CHART awarded funds to 27 community hospitals to develop innovations aimed at reducing unnecessary utilization and readying them for value-based care. Objective: We examined how CHART stakeholders described social disconnection, a public health priority, and which levels (structural, functional, quality or multilevel) of a social connection framework that CHART innovations addressed, among frequent emergency department (ED) users. Research Design: Qualitative interviews, one year post CHART implementation, were analyzed using a directed content analysis approach. This paper focuses on the emergent code of social disconnection, with data mapped to the levels of the social connection framework. Subjects: 236 hospital managers, team members, and community partners involved in the healthcare innovations. Results: Social disconnection, described as “loneliness” and “social isolation” by stakeholders, led patients to the ED for problems not always related to their physical health. These definitions mapped to the structural level of the social connection framework. Innovations involving home visit programs, elder services interventions, work flow changes in the ED, and regular telephone follow-ups provided functional level emotional and tangible support. Stakeholders did not mention relationship distress or quality of relationships in describing social disconnection or hospital innovations. Conclusion: Innovations to address high ED use, according to stakeholders, provided functional level emotional and tangible support to address structural level definitions of social disconnection. Future work should examine the sustainability of these innovations in a value-based healthcare climate, and the effectiveness of these programs on reducing ED utilization.
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Paper is No Longer Available Online: Please contact the author(s).
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Healthcare Complaints as an Indicator of Hospital Safety Performance
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Author: Tom Reader, London School of Economics
Author: Alex Gillespie, London School of Economics and Political Science
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It has been suggested that hospital safety can be evaluated through information provided by patients and their families, with them being close to care delivery, able to observe institutional blind spots (e.g., post-care problems), and independent from cultural factors that shape employee reporting. To investigate the validity of this idea, we examined whether healthcare complaints, which are frequently submitted to hospitals and report safety problems, are associated with hospital mortality rates. In total, 1061 redacted complaints, collected from 46 acute NHS hospital trusts were analysed by two independent coders using the Healthcare Complaints Analysis Tool. Each institution was profiled in terms of complaint frequency, the subjects complained about (management issues, clinical issues, relationship issues), and the severity of problems reported. The average hospital complaint profile for frequency, subject and severity was: 5.7 complaints per thousand admissions; 35% clinical, 34% management, and 31% relationships; 18% low severity, 51% medium severity, and 31% high severity. Multiple regression found complaint severity was associated with standardised hospital mortality rates, but not complaint frequency or subject. This indicates that healthcare complaints are a potentially valid indicator of hospital-safety performance, and more generally, that external stakeholders (i.e., non-employees, service-users) can provide useful information on organizational safety.
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Paper is No Longer Available Online: Please contact the author(s).
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Influence of Caregiver Perceived Value of Physician on Adherence in Paediatric Long-term Treatment
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Author: Krithika Venkat Raman, Indian Institute of Technology, Madras
Author: Nandan Sudarsanam, Indian Institute of Technology, Madras
Author: V Vijayalakshmi, Indian Institute of Technology, Madras
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Pediatric treatment adherence is a complex multidimensional construct due to the presence of entities other than the patient/child. The primary caregivers, physician and the patient form the triad which is central to adherence and related behaviors in the pediatric context. The role of primary caregivers in the pediatric context is inevitable as they act as the decision makers of treatment-related aspects like continuity and adherence. The perceptions of the primary caregiver impact their likelihood to adhere in the pediatric context but less is known on the collective impact of the physician’s consultation and relationship building on primary caregivers’ adherence to their child’s treatment. While the influence of the physician on adherence related behaviors might seem intuitive it involves understanding the complex interplay through individualized interventions. A lot of research is focused on understanding treatment abandonment, non-adherence, dropouts and interventions in the pediatric long-term treatment context, research explaining how patients complete the treatment despite the odds remains scanty. Our work attempts to answer this question through the Primary Caregiver Perceived Value (PCPV) of the physician in the pediatric long-term treatment context. We present the relevant theory, conceptual model, research propositions and the preliminary findings and reliability analysis from our pilot study and conclude with suggesting opportunities to further extend this line of work.
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Paper is No Longer Available Online: Please contact the author(s).
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Exploring the Impact of Perceived Organizational Support in the Context of Patient Violence
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Author: Josianne Lamothe, U. de Montréal
Author: Stéphane Guay, U. de Montréal
Author: Richard Boyer, U. de Montréal
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Workplace violence is known risk factor for diminished mental health and turnover intentions. Yet, to this day, researchers still do not know how victimized workers cope over time or how organizations can best help them recover. This study sought to document the evolution of psychological distress in a sample of recently victimized professionals (N=81) immediately after the event and over the course of one year. Mixed-modeling was used to assess distress scores at four different time points (3, 11, 27, 52 weeks). Findings suggest that patient violence had a serious impact on staff mental health with close to 35% of women and 11% of men suffering from severe distress after returning to work. Perceived organizational support proved to be a good protective factor against severe distress but its effect eroded with cumulative exposure to violence. Considering the high risk of experiencing violence in certain work settings, this article concludes by discussing how organizations can be more considerate of the needs of traumatized workers.
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Paper is No Longer Available Online: Please contact the author(s).
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