| Comprehending patient service quality expectations for health care. |
| | O'Connor, Stephen J. | U. of Wisconsin, Milwaukee | sjo@alpha2.csd.uwm.edu | 414-229-6537 |
| | Trinh, Hanh Q. | U. of Wisconsin, Milwaukee | hanht@uwm.edu | (414) 229-6051 |
| | Shewchuk, Richard M. | U. of Alabama, Birmingham | shewchuk@uab.edu | (205)-934-4061 |
| | This study assesses how well physicians, health administrators, patient-contact employees, and especially medical and nursing students understand patient expectations for service quality as measured by the SERVQUAL scale. It extends and seeks to answer questions raised from an earlier study. The previous research found that employees, administrators, and practicing physicians uniformily underestimated their patients' expectations for service reliability, assurance, responsiveness, and empathy, with physicians exhibiting the poorest understanding and administrators coming closest to identifying them. It was proposed that the study be extended to determine if students arrive at medical school with this misunderstanding of patient expectations or if they are infused with it at some point during their educational, training, and socialization process. The present study addresses this issue by comparing and contrasting medical as well as nursing students' understanding of patient expectations for
service quality with the patients themselves, practicing physicians, administrators, and patient-contact employees. Using discriminant analysis, it was found that the medical and nursing students underestimated patient expectations for each of the five SERVQUAL dimensions (reliability, assurance, responsiveness, empathy, and tangibles). It appears that they arrive at medical and nursing school with a significant misunderstanding, and that these misconceptions do not change substantially as they progress through their four year educational process. Moreover, the medical and nursing students are remarkably similar to one another in their assessments of what they believe patients expect. Implications and future research directions are discussed. |
| | Keywords: SERVQUAL; Patient expectations; Medical/nursing students |
| The Effectiveness of Teaching Medical and Allied Health Professionals Methods and Tools for Improving Practice |
| | Irvine, Diane M. | U. of Toronto | d.irvine@utoronto.ca | (416)-978-2866 |
| | Baker, Ross G. | U. of Toronto | ross.baker@utoronto.ca | (416)-978-7804 |
| | Bohnen, John | St. Michael's Hospital | none | (416)-926-7798 |
| | Zahn, Catherine | Toronto Hospital | none | (416-926-7798 |
| | Murray, Michael | U. of Toronto | michael.murray@utoronto.ca | (416)-978-8326 |
| | Carryer, Jennifer | U. of Toronto | none | (416)-978-1694 |
| | A waiting list control group design was used to evaluate whether training
health care teams in continuous quality improvement (CQI) methods and
strategies for effective group work would result in improvements in the
care and outcomes for patients. Twenty five health care teams from four
hospitals attended a training workshop and engaged in a quality improvement
project over four months.Data were collected on team members' CQI knowledge,
team interaction style, and behaviors related to CQI principles at baseline,
3 months, 6 months, and 9 months. Team problem solving effectiveness was
evaluated through independent review by external experts. Two independent
reviewers rated each team's performance in achieving improvements in the
quality of care and outcomes for patients.
Teams demonstrated an increase in CQI knowledge and functional group
interactions over time, although there was a loss in knowledge by the six
and nine month follow-up. Nine teams were successful in improving the care/
outcomes for patients. Successful teams were more effective at
problem-solving, engaged in more functional group interactions, and were
more likely to have physician participation. Leadership that set high
performance standards and encouraged initiative and participation in
decision making was positively related to job behaviors related to CQI
principles. Training to promote effective teamwork, the involvement of
physicians in mulit-disciplinary quality improvement, and leadership that
encourages participation and high performance standards is recommended. |
| | Keywords: Quality Improvement; Health Care Teams; Teamwork |
| Implementing computerized medical records: physicians' response to change |
| | Barsukiewicz, Camille K. | State U. of New York, Cortland | barsukiewicz@cortland.edu | (607) 753-2976 |
| | Implementation of a computerized medical record (CMR) in the ambulatory care setting of a large integrated health system is a complex process. Previous studies of CMR cite planning, selection, training, and installation methods as keys to successful implementation. Success is often based on user satisfaction surveys. However, satisfaction is not universally defined.
The purpose of this study is to explore implementation of the CMR from the perspective of the physician - when, where, and how it is used, how it changes the work habits of the physician, and how it affects the physician-patient relationship. The goal is not merely to identify implmentation processes which enhance user acceptance but to understand what broader implications the CMR may have on the provision of medical care.
The research method is an ethnography conducted in three primary care sites over an 18 month period. Thirteen physicians participated prior to implementation, during the early use of the CMR, and after six months of experience with the system. Observation occurred throughtout pre-implementation, training, first days of going on-line, and approximately six months post-implementation.
Results indicate a substantial change in work habits, increased demands on physician time, and perceived changes in the physician-patient relationship. Although early implementation responses to the CMR were diverse among individuals and between sites, six-month responses produced similar accounts of problems and benefits inherent in the process. |
| | Keywords: computerized medical records; change; physicians |