Hospital & health services administration
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Nursing home administrators represent wide variations in academic training. General education levels do not seem to affect administrative preparation in key domains of practice--specific academic fields of study are more relevant. Hence, sole emphasis on higher educational requirements for licensure appears to be a misdirected strategy for improving quality of care and enhancing management efficiencies in nursing homes. ⋯ A specialized long-term care model that incorporates appropriate clinical and business skills is recommended. The roles of continuing education and executive educational offerings also need streamlining. These initiatives would require a joint effort from policymakers, academicians, and practitioners.
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Hosp Health Serv Adm · Jan 1997
Salaried physicians' intent to retain hospital membership: the effects of position and work attitudes.
This study examined the anticipation of salaried hospital physicians in Israel to retain hospital membership for a long term until their retirement. Examined are attitudinal and position factors, as well as hospital standing personal and situational factors that relate to this anticipation. ⋯ It was found that factors reflecting the physician's standing within the hospital were the main predictors of this anticipation, whereas work-related attitudes had little or no effect on it. The implications of these finding to hospital-physician integration strategies in the United States are discussed.
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Hosp Health Serv Adm · Jan 1997
Components of the costs of controlling quality: a transaction cost economics approach.
This article identifies the components that contribute to a healthcare organization's costs in controlling quality. A central tenet of our argument is that at its core, quality is the result of a series of transactions among members of a diverse network. Transaction cost economics is applied internally to analyze intraorganizational transactions that contribute to quality control, and questions for future research are posed.
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Hosp Health Serv Adm · Jan 1997
Patient satisfaction with ambulatory healthcare services: waiting time and filling time.
Customer satisfaction is an important measure of service quality in healthcare organizations. This study investigated the relationship between patient waiting and satisfaction with ambulatory healthcare services, with waiting times divided into segments of the patient-care episode. ⋯ Informing patients how long their wait would be and being occupied during the wait were also significant predictors of patient satisfaction. These results show that waiting times, even if they cannot be shortened, can be managed more effectively to improve patient satisfaction.
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This study examines the relationship between outlier status based on adjusted mortality rates and theoretical underlying quality of care in hospitals. We use Monte Carlo stimulation to determine, in the absence of case mix variation, if random variation noise could obscure the signal of differences in underlying rates of quality of care problems. ⋯ Using overall death rates as an indicator of underlying quality of care problems may lead to substantial predictive error rates, even when adjustment for case mix is excellent. Outlier status should only be used as a screening tool and not as the information provided to the public to make informed choices about hospitals.