WorldWideScience

Sample records for hospital-physician relations

  1. How to govern physician-hospital exchanges: contractual and relational issues in Belgian hospitals.

    Science.gov (United States)

    Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

    2014-07-01

    Our aim was to investigate contractual mechanisms in physician-hospital exchanges. The concepts of risk-sharing and the nature of physician-hospital exchanges - transactional versus relational - were studied. Two qualitative case studies were performed in Belgium. Hospital executives and physicians were interviewed to develop an in-depth understanding of contractual and relational issues that shape physician-hospital contracting in acute care hospitals. The underlying theoretical concepts of agency theory and social exchange theory were used to analyse the data. Our study found that physician-hospital contracting is highly complex. The contract is far more than an economic instrument governing financial aspects. The effect of the contract on the nature of exchange - whether transactional or relational - also needs to be considered. While it can be argued that contractual governance methods are increasingly necessary to overcome the difficulties that arise from the fragmented payment framework by aligning incentives and sharing financial risk, they undermine the necessary relational governance. Relational qualities such as mutual trust and an integrative view on physician-hospital exchanges are threatened, and may be difficult to sustain, given the current fragmentary payment framework. Since health care policy makers are increasing the financial risk borne by health care providers, it can be argued that this also increases the need to share financial risk and to align incentives between physician and hospital. However, our study demonstrates that while economic alignment is important in determining physician-hospital contracts, the corresponding impact on working relationships should also be considered. Moreover, it is important to avoid a relationship between hospital and physician predominantly characterized by transactional exchanges thereby fostering an unhealthy us-and-them divide and mentality. Relational exchange is a valuable alternative to contractual

  2. Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness.

    Science.gov (United States)

    Trybou, Jeroen; Gemmel, Paul; Van Vaerenbergh, Yves; Annemans, Lieven

    2014-05-21

    Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. This study shows that initiatives aimed at strengthening physicians' positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.

  3. Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness

    Science.gov (United States)

    2014-01-01

    Background Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Methods Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. Results The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. Conclusions This study shows that initiatives aimed at strengthening physicians’ positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians. PMID:24884491

  4. Hospital-physician relations: overcoming barriers to cooperation.

    Science.gov (United States)

    Orr, S R; Siegal, J T

    1986-01-01

    In the September-October 1986 issue of Physician Executive, we discussed the application of strategic business units (SBUs) to health care. SBUs are those corporate entities that market similar products to one or more target populations with similar characteristics. Examples of SBUs in health care are obstetrics, cardiology, orthopedics, etc. When the services within each SBU are linked together, they might resemble a vertically integrated health care system. In the case of obstetrics, a woman may have contact with physicians, a hospital, home care nurses, house-cleaning services, birthing teachers, and maternity clothing boutiques. Each of these are products/services within the SBU of obstetrics. Strategy development by SBU implies an external focus on the marketplace in terms of the specific mission of the SBU (clinical specialty). It also implies responding to the needs of consumers for whom the historical and present divisiveness between hospitals and physicians is immaterial and irrelevant. In this article, we will focus on ways to stabilize the relationship between hospitals and physicians within an SBU context in order to compete more successfully as a team in today's health care environment.

  5. Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness

    OpenAIRE

    Trybou, Jeroen; Gemmel, Paul; Van Vaerenbergh, Yves; Annemans, Lieven

    2014-01-01

    Background: Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Methods: Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using valida...

  6. Comparison of burnout pattern between hospital physicians and family physicians working in Suez Canal University Hospitals.

    Science.gov (United States)

    Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed

    2014-01-01

    The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a "high" score on at least 2 of the three dimensions of MBI. In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout.

  7. Preventing dehydration-related hospitalizations: a mixed-methods study of parents, inpatient attendings, and primary care physicians.

    Science.gov (United States)

    Shanley, Leticia; Mittal, Vineeta; Flores, Glenn

    2013-07-01

    The goal of this study was to identify the proportion of dehydration-related ambulatory care-sensitive condition hospitalizations, the reasons why these hospitalizations were preventable, and factors associated with preventability. A cross-sectional survey of primary care providers (PCPs), inpatient attending physicians, and parents was conducted in a consecutive series of children with ambulatory care-sensitive conditions admitted to an urban hospital over 14 months. Eighty-five children were diagnosed with dehydration. Their mean age was 1.6 years; most had public (74%) or no (17%) insurance, and were nonwhite (91%). The proportion of hospitalizations assessed as preventable varied from 12% for agreement among all 3 sources to 45% for any source. Parents identified inadequate prevention (50%), poor self-education (34%), and poor quality of care (38%) as key factors. PCPs identified parents providing insufficient home rehydration (33%), not visiting the clinic (25%), and not calling earlier (16%) as reasons. Inpatient attending physicians cited home rehydration (40%), delays in seeking care (40%), and lacking a PCP (20%) as contributors. Physicians (PCPs and inpatient attending physicians) were more likely than parents to describe the admission as inappropriate (75% vs 67% vs 0%; P dehydration-related hospitalizations may be preventable. Inadequate parental education by physicians, insufficient home rehydration, deferring clinic visits, insurance and cost barriers, inappropriate admissions, poor quality of care, and parental dissatisfaction with PCPs are the reasons that these hospitalizations might have been prevented.

  8. Overview of physician-hospital ventures.

    Science.gov (United States)

    Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard

    2005-01-01

    An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

  9. [Issues related to national university medical schools: focusing on the low wages of university hospital physicians].

    Science.gov (United States)

    Takamuku, Masatoshi

    2015-01-01

    University hospitals, bringing together the three divisions of education, research, and clinical medicine, could be said to represent the pinnacle of medicine. However, when compared with physicians working at public and private hospitals, physicians working at university hospitals and medical schools face extremely poor conditions. This is because physicians at national university hospitals are considered to be "educators." Meanwhile, even after the privatization of national hospitals, physicians working for these institutions continue to be perceived as "medical practitioners." A situation may arise in which physicians working at university hospitals-performing top-level medical work while also being involved with university and postgraduate education, as well as research-might leave their posts because they are unable to live on their current salaries, especially in comparison with physicians working at national hospitals, who focus solely on medical care. This situation would be a great loss for Japan. This potential loss can be prevented by amending the classification of physicians at national university hospitals from "educators" to "medical practitioners." In order to accomplish this, the Japan Medical Association, upon increasing its membership and achieving growth, should act as a mediator in negotiations between national university hospitals, medical schools, and the government.

  10. Reimbursement in hospital-based vascular surgery: Physician and practice perspective.

    Science.gov (United States)

    Perri, Jennifer L; Zwolak, Robert M; Goodney, Philip P; Rutherford, Gretchen A; Powell, Richard J

    2017-07-01

    The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care. Adjustments were made for work performed, case complexity, and inflation. To reflect the effect of these variables, net revenue was indexed to work relative value units (wRVUs), case mix index, and consumer price index, which adjusted for work, case complexity, and inflation, respectively. Differences in physician and hospital net revenue were compared over time. Physician work, measured in RVUs per year, increased by 4%; case complexity, assessed with case mix index, increased by 10% for the 6-year measurement period. Despite stability in payer mix at 64% to 69% Medicare, both physician and hospital vascular-related revenue/wRVU decreased during this period. Unadjusted professional revenue/wRVU declined by 14.1% (P = .09); when considering case complexity, physician revenue/wRVU declined by 20.6% (P = .09). Taking into account both case complexity and inflation, physician revenue declined by 27.0% (P = .04). Comparatively, hospital revenue for vascular surgery services decreased by 13.8% (P = .07) when adjusting for unit work, complexity, and inflation. At medical centers where vascular surgeons are hospital based, vascular care reimbursement decreased substantially from 2010 to 2015 when case complexity and inflation were considered. Physician reimbursement (professional fees) decreased at a significantly greater rate than hospital reimbursement for vascular care. This trend has significant implications for salaried vascular surgeons in hospital

  11. Improving patient safety and physician accountability using the hospital credentialing process

    OpenAIRE

    Forster, Alan J; Turnbull, Jeff; McGuire, Shaun; Ho, Michael L; Worthington, JR

    2011-01-01

    Abstract The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; ...

  12. Physicians' job satisfaction and motivation in a public academic hospital.

    Science.gov (United States)

    de Oliveira Vasconcelos Filho, Paulo; de Souza, Miriam Regina; Elias, Paulo Eduardo Mangeon; D'Ávila Viana, Ana Luiza

    2016-12-07

    Physician shortage is a global issue that concerns Brazil's authorities. The organizational structure and the environment of a medical institution can hide a low-quality life of a physician. This study examines the relationship between the hospital work environment and physicians' job satisfaction and motivation when working in a large public academic hospital. The study was restricted to one large, multispecialty Brazil's hospital. Six hundred hospital physicians were invited to participate by e-mail. A short version of the Physician Worklife Survey (PWS) was used to measure working satisfaction. Physicians were also asked for socio-demographic information, medical specialty, and the intention to continue working in the hospital. Data from 141 questionnaires were included in the analyses. Forty-five physicians graduated from the hospital's university, and they did not intend to leave the hospital under any circumstance (affective bond). The motivating factor for beginning the career at the hospital and to continue working there were the connection to the medical school and the hospital status as a "prestigious academic hospital"; the physicians were more satisfied with the career than the specialty. Only 30% completely agreed with the statement "If I had to start my career over again, I would choose my current specialty," while 45% completely agreed with the statement "I am not well compensated given my training and experience." The greater point of satisfaction was the relationship with physician colleagues. They are annoyed about the amount of calls they are requested to take and about how work encroaches on their personal time. No significant differences between medical specialties were found in the analysis. The participants were satisfied with their profession. The fact that they remained at the hospital was related to the academic environment, the relationship with colleagues, and the high prestige in which society holds the institution. The points of

  13. Tailoring hospital marketing efforts to physicians' needs.

    Science.gov (United States)

    Mackay, J M; Lamb, C W

    1988-12-01

    Marketing has become widely recognized as an important component of hospital management (Kotler and Clarke 1987; Ludke, Curry, and Saywell 1983). Physicians are becoming recognized as an important target market that warrants more marketing attention than it has received in the past (Super 1987; Wotruba, Haas, and Hartman 1982). Some experts predict that hospitals will begin focusing more marketing attention on physicians and less on consumers (Super 1986). Much of this attention is likely to take the form of practice management assistance, such as computer-based information system support or consulting services. The survey results reported here are illustrative only of how one hospital addressed the problem of physician need assessment. Other potential target markets include physicians who admit patients only to competitor hospitals and physicians who admit to multiple hospitals. The market might be segmented by individual versus group practice, area of specialization, or possibly even physician practice life cycle stage (Wotruba, Haas, and Hartman 1982). The questions included on the survey and the survey format are likely to be situation-specific. The key is the process, not the procedure. It is important for hospital marketers to recognize that practice management assistance needs will vary among markets (Jensen 1987). Therefore, hospitals must carefully identify their target physician market(s) and survey them about their specific needs before developing and implementing new physician marketing programs. Only then can they be reasonably confident that their marketing programs match their customers' needs.

  14. Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children.

    Science.gov (United States)

    King, Marta A; Nkoy, Flory L; Maloney, Christopher G; Mihalopoulos, Nicole L

    2015-10-01

    To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2-18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Factors driving physician-hospital alignment in orthopaedic surgery.

    Science.gov (United States)

    Page, Alexandra E; Butler, Craig A; Bozic, Kevin J

    2013-06-01

    The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.

  16. Trends in hospital-physician integration in medical oncology.

    Science.gov (United States)

    Clough, Jeffrey D; Dinan, Michaela A; Schulman, Kevin A

    2017-10-01

    Hospitals have rapidly acquired medical oncology practices in recent years. Experts disagree as to whether these trends are related to oncology-specific market factors or reflect a general trend of hospital-physician integration. The objective of this study was to compare the prevalence, geographic variation, and trends in physicians billing from hospital outpatient departments in medical oncology with other specialties. Retrospective analysis of Medicare claims data for 2012 and 2013. We calculated the proportion of physicians and practitioners in the 15 highest-volume specialties who billed the majority of evaluation and management visits from hospital outpatient departments in each year, nationally and by state. We included 338,998 and 352,321 providers in 2012 and 2013, respectively, of whom 9715 and 9969 were medical oncologists. Among the 15 specialties examined, medical oncology had the highest proportion of hospital outpatient department billing in 2012 and 2013 (35.0% and 38.3%, respectively). Medical oncology also experienced the greatest absolute change (3.3%) between the years, followed by thoracic surgery (2.4%) and cardiology (2.0%). There was marked state-level variation, with the proportion of medical oncologists based in hospital outpatient departments ranging from 0% in Nevada to 100% in Idaho. Hospital-physician integration has been more pronounced in medical oncology than in other high-volume specialties and is increasing at a faster rate. Policy makers should take these findings into consideration, particularly with respect to recent proposals that may continue to fuel these trends.

  17. [Communication between the primary care physician, hospital staff and the patient during hospitalization].

    Science.gov (United States)

    Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach

    2011-04-01

    HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through

  18. Hospital employment of physicians and supply chain performance: An empirical investigation.

    Science.gov (United States)

    Young, Gary J; Nyaga, Gilbert N; Zepeda, E David

    2016-01-01

    As hospital employment of physicians becomes increasingly common in the United States, much speculation exists as to whether this type of arrangement will promote hospital operating efficiency in such areas as supply chain management. Little empirical research has been conducted to address this question. The aim of this study was to provide an exploratory assessment of whether hospital employment of physicians is associated with better supply chain performance. Drawing from both agency and stewardship theories, we examined whether hospitals with a higher proportion of employed medical staff members have relatively better supply chain performance based on two performance measures, supply chain expenses and inventory costs. We conducted the study using a pooled, cross-sectional sample of hospitals located in California between 2007 and 2009. Key data sources were hospital annual financial reports from California's Office of Statewide Health Policy and Development and the American Hospital Association annual survey of hospitals. To examine the relationship between physician employment and supply chain performance, we specified physician employment as the proportion of total employed medical staff members as well as the proportion of employed medical staff members within key physician subgroups. We analyzed the data using generalized estimating equations. Study results generally supported our hypothesis that hospital employment of physicians is associated with better supply chain performance. Although the results of our study should be viewed as preliminary, the trend in the United States toward hospital employment of physicians may be a positive development for improved hospital operating efficiency. Hospital managers should also be attentive to training and educational resources that medical staff members may need to strengthen their role in supply chain activities.

  19. Physician-Owned Hospitals

    Data.gov (United States)

    U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...

  20. Associations between non-discrimination and training policies and physicians' attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals.

    Science.gov (United States)

    Jabson, Jennifer M; Mitchell, Jason W; Doty, S Benjamin

    2016-03-12

    Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM) individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians' knowledge, attitudes, and gender and sexual minority affirmative practices. A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians' attitudes and knowledge about SGM patients. Policies that mandate non-discrimination and training as they currently exist may not improve physicians' attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians' SGM affirmative practices.

  1. Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns?

    Science.gov (United States)

    Mitchell, Jean M

    2008-07-01

    Although physician-owned specialty hospitals have become increasingly prevalent in recent years, little research has examined whether the financial incentives linked to ownership influence physicians' referral rates for services performed at the specialty hospital. We compared the practice patterns of physician owners of specialty hospitals in Oklahoma, before and after ownership, to the practice patterns of physician nonowners who treated similar cases over the same time period in Oklahoma markets without physician-owned specialty hospitals. We constructed episodes of care for injured workers with a primary diagnosis of back/spine disorders. We used pre-post comparisons and difference-in-differences analysis to evaluate changes in practice patterns for physician owners and nonowners over the time period spanned by the entry of the specialty hospital. Findings suggest the introduction of financial incentives linked to ownership coincided with a significant change in the practice patterns of physician owners, whereas such changes were not evident among physician nonowners. After physicians established ownership interests in a specialty hospital, the frequency of use of surgery, diagnostic, and ancillary services used in the treatment of injured workers with back/spine disorders increased significantly. Physician ownership of specialty hospitals altered the frequency of use for an array of procedures rendered to patients treated at these hospitals. Given the growth in physician-owned specialty hospitals, these findings suggest that health care expenditures will be substantially greater for patients treated at these institutions relative to persons who obtain care from nonself-referral providers.

  2. Determinants of workplace violence against clinical physicians in hospitals.

    Science.gov (United States)

    Wu, Jeng-Cheng; Tung, Tao-Hsin; Chen, Peter Y; Chen, Ying-Lin; Lin, Yu-Wen; Chen, Fu-Li

    2015-01-01

    Workplace violence in the health sector is a worldwide concern. Physicians play an essential role in health-care teamwork; thus, understanding how organizational factors influence workplace violence against physicians is critical. A total of 189 physicians from three public hospitals and one private hospital in Northern Taiwan completed a survey, and the response rate was 47.1%. This study was approved by the institutional review board of each participating hospital. The 189 physicians were selected from the Taipei area, Taiwan. The results showed that 41.5% of the respondents had received at least one workplace-related physical or verbal violent threat, and that 9.8% of the respondents had experienced at least one episode of sexual harassment in the 3 months before the survey. Logistic regression analysis revealed that physicians in psychiatry or emergency medicine departments received more violent threats and sexual harassment than physicians in other departments. Furthermore, physicians with a lower workplace safety climate (OR=0.89; 95% CI=0.81-0.98) and more job demands (OR=1.15; 95% CI=1.02-1.30) were more likely to receive violent threats. This study found that workplace violence was associated with job demands and the workplace safety climate. Therefore, determining how to develop a workplace safety climate and ensure a safe job environment for physicians is a crucial management policy issue for health-care systems.

  3. The effects of health information technology adoption and hospital-physician integration on hospital efficiency.

    Science.gov (United States)

    Cho, Na-Eun; Chang, Jongwha; Atems, Bebonchu

    2014-11-01

    To determine the impact of health information technology (HIT) adoption and hospital-physician integration on hospital efficiency. Using 2010 data from the American Hospital Association's (AHA) annual survey, the AHA IT survey, supplemented by the CMS Case Mix Index, and the US Census Bureau's small area income and poverty estimates, we examined how the adoption of HIT and employment of physicians affected hospital efficiency and whether they were substitutes or complements. The sample included 2173 hospitals. We employed a 2-stage approach. In the first stage, data envelopment analysis was used to estimate technical efficiency of hospitals. In the second stage, we used instrumental variable approaches, notably 2-stage least squares and the generalized method of moments, to examine the effects of IT adoption and integration on hospital efficiency. We found that HIT adoption and hospital-physician integration, when considered separately, each have statistically significant positive impacts on hospital efficiency. Also, we found that hospitals that adopted HIT with employed physicians will achieve less efficiency compared with hospitals that adopted HIT without employed physicians. Although HIT adoption and hospital-physician integration both seem to be key parts of improving hospital efficiency when one or the other is utilized individually, they can hurt hospital efficiency when utilized together.

  4. IRS proposes ruling on physician recruitment. How a hospital recruits physicians would affect its tax-exempt status.

    Science.gov (United States)

    Griffith, G M

    1996-01-01

    On March 15, 1995, the Internal Revenue Service (IRS) announced a proposed revenue ruling stating how certain physician recruitment practices could be implemented without threatening hospitals' tax-exemption. As proposed, the IRS ruling would provide flexibility for recruitment incentives rather than a list of strict physician recruitment guidelines. The proposed ruling is not legally binding until issued in final form, and there is no deadline for finalizing it. In the meantime, however, the standards outlined in the proposed ruling reflect arrangements the IRS likely would approve, which should be an incentive for tax-exempt hospitals to follow reasonable physician recruitment practices. Assuming a hospital complies with other legal requirements such as fraud and abuse laws, it must answer two key tax-exempt status questions for its recruitment or retention package: Will the incentives result in a disguised distribution of profits from the operation of the organization? Is the total incentive package reasonable under all the facts and circumstances, both in absolute total value for physician(s) recruited and in relation to services required by the hospital and the community? The proposed ruling also provides guidance on basic documentation requirements and a process for approving recruitment arrangements.

  5. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko

    2010-06-01

    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  6. Total expenditures per patient in hospital-owned and physician-owned physician organizations in California.

    Science.gov (United States)

    Robinson, James C; Miller, Kelly

    Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and

  7. Physician-Hospital Alignment in Orthopedic Surgery.

    Science.gov (United States)

    Bushnell, Brandon D

    2015-09-01

    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery. Copyright 2015, SLACK Incorporated.

  8. The Effects of Hospital-Level Factors on Patients' Ratings of Physician Communication.

    Science.gov (United States)

    Al-Amin, Mona; Makarem, Suzanne C

    2016-01-01

    The quality of physician-patient communication influences patient health outcomes and satisfaction with healthcare delivery. Yet, little is known about contextual factors that influence physicians' communication with their patients. The main purpose of this article is to examine organizational-level factors that influence patient perceptions of physician communication in inpatient settings. We used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and American Hospital Association data to determine patients' ratings of physician communication at the hospital level, and to collect information about hospital-level factors that can potentially influence physician communication. Our sample consisted of 2,756 hospitals. We ran a regression analysis to determine the predictors of poor physician communication, measured as the percentage of patients in a hospital who reported that physicians sometimes or never communicated well. In our sample of hospitals, this percentage ranged between 0% and 21%, with 25% of hospitals receiving poor ratings from more than 6% of patients. Three organizational factors had statistically significant negative associations with physician communication: for-profit ownership, hospital size, and hospitalists providing care in the hospital, On the other hand, the number of full-time-equivalent physicians and dentists per 10,000 inpatient days, physician ownership of the hospital, Medicare share of inpatient days, and public ownership were positively associated with patients' ratings of physician communication. Physician staffing levels are an understudied area in healthcare research. Our findings indicate that physician staffing levels affect the quality of physician communication with patients. Moreover, for-profit and larger hospitals should invest more in physician communication given the role that HCAHPS plays in value-based purchasing.

  9. ACA Marketplace premiums and competition among hospitals and physician practices.

    Science.gov (United States)

    Polyakova, Maria; Bundorf, M Kate; Kessler, Daniel P; Baker, Laurence C

    2018-02-01

    To examine the association between annual premiums for health plans available in Federally Facilitated Marketplaces (FFMs) and the extent of competition and integration among physicians and hospitals, as well as the number of insurers. We used observational data from the Center for Consumer Information and Insurance Oversight on the annual premiums and other characteristics of plans, matched to measures of physician, hospital, and insurer market competitiveness and other characteristics of 411 rating areas in the 37 FFMs. We estimated multivariate models of the relationship between annual premiums and Herfindahl-Hirschman indices of hospitals and physician practices, controlling for the number of insurers, the extent of physician-hospital integration, and other plan and rating area characteristics. Premiums for Marketplace plans were higher in rating areas in which physician, hospital, and insurance markets were less competitive. An increase from the 10th to the 90th percentile of physician concentration and hospital concentration was associated with increases of $393 and $189, respectively, in annual premiums for the Silver plan with the second lowest cost. A similar increase in the number of insurers was associated with a $421 decrease in premiums. Physician-hospital integration was not significantly associated with premiums. Premiums for FFM plans were higher in markets with greater concentrations of hospitals and physicians but fewer insurers. Higher premiums make health insurance less affordable for people purchasing unsubsidized coverage and raise the cost of Marketplace premium tax credits to the government.

  10. The physician as a source of hospital capital.

    Science.gov (United States)

    Fried, J M

    1984-06-01

    As hospitals search for means of financing renovation during the next decade, physicians will represent a source of capital through tax-shelter financing. Limited partnerships, condominiums , and joint ventures in acquiring medical equipment or syndicating existing facilities are among the most promising investment vehicles for taking advantage of tax benefits that normally do not apply to nonprofit institutions. In a hospital-physician limited partnership, tax deductions are passed through to the partners, of which there are two kinds: general partners and limited partners. Income (or loss) and tax credits from the entire venture can be divided among the partners and reflected on an individual limited partner's tax return. Rather than shouldering the whole cost of renovating a medical office building, thereby losing the potential tax credit, a hospital could carry out the renovation through a limited partnership with physicians. This would reduce the hospital's capital costs and debt requirements, maintain its credit, and enable it to take advantage of the depreciation deduction. In a condominium venture, the individual physician actually owns the office within which he or she works. As with the limited partnership, the hospital will want to restrict physicians' ability to dispose of their ownership interests.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. The effect of hospital-physician integration on health information technology adoption.

    Science.gov (United States)

    Lammers, Eric

    2013-10-01

    The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co-invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology. Copyright © 2012 John Wiley & Sons, Ltd.

  12. Much ado about nothing? The financial impact of physician-owned specialty hospitals.

    Science.gov (United States)

    Chakravarty, Sujoy

    2016-06-01

    The U.S. hospital industry has recently witnessed a number of policy changes aimed at aligning hospital payments to costs and these can be traced to significant concerns regarding selection of profitable patients and procedures by physician-owned specialty hospitals. The policy responses to specialty hospitals have alternated between payment system reforms and outright moratoriums on hospital operations including one in the recently enacted Affordable Care Act. A key issue is whether physician-owned specialty hospitals pose financial strain on the larger group of general hospitals through cream-skimming of profitable patients, yet there is no study that conducts a systematic analysis relating such selection behavior by physician-owners to financial impacts within hospital markets. The current paper takes into account heterogeneity in specialty hospital behavior and finds some evidence of their adverse impact on profit margins of competitor hospitals, especially for-profit hospitals. There is also some evidence of hospital consolidation in response to competitive pressures by specialty hospitals. Overall, these findings underline the importance of the payment reforms aimed at correcting distortions in the reimbursement system that generate incentives for risk-selection among providers groups. The identification techniques will also inform empirical analysis on future data testing the efficacy of these payment reforms.

  13. Vertical integration: hospital ownership of physician practices is associated with higher prices and spending.

    Science.gov (United States)

    Baker, Laurence C; Bundorf, M Kate; Kessler, Daniel P

    2014-05-01

    We examined the consequences of contractual or ownership relationships between hospitals and physician practices, often described as vertical integration. Such integration can reduce health spending and increase the quality of care by improving communication across care settings, but it can also increase providers' market power and facilitate the payment of what are effectively kickbacks for inappropriate referrals. We investigated the impact of vertical integration on hospital prices, volumes (admissions), and spending for privately insured patients. Using hospital claims from Truven Analytics MarketScan for the nonelderly privately insured in the period 2001-07, we constructed county-level indices of prices, volumes, and spending and adjusted them for enrollees' age and sex. We measured hospital-physician integration using information from the American Hospital Association on the types of relationships hospitals have with physicians. We found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians--ownership of physician practices--was associated with higher hospital prices and spending. We found that an increase in contractual integration reduced the frequency of hospital admissions, but this effect was relatively small. Taken together, our results provide a mixed, although somewhat negative, picture of vertical integration from the perspective of the privately insured.

  14. Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

    Directory of Open Access Journals (Sweden)

    ALI AZEEZ ALI AL-JUMAILI

    2016-08-01

    Full Text Available The objectives of this study were to measure the incidence and types of medication prescribing errors (MPEs in Iraqi hospitals, to calculate for the first time the percentage of physician agreement with pharmacist medication regimen review (MRR recommendations regarding MPEs, and to identify the factors influencing the physician agreement rate with these recommendations. Methods: Fourteen pharmacists (10 females and 4 males reviewed each hand-written physician order for 1506 patients who were admitted to two public hospitals in Al-Najaf, Iraq during August 2015. The pharmacists identified medication prescribing errors using the Medscape WebMD, LCC phone application as a reference. The pharmacists contacted the physicians (2 females and 34 males in-person to address MPEs that were identified. Results: The pharmacists identified 78 physician orders containing 99 MPEs with an incidence of 6.57 percent of all the physician orders reviewed. The patients with MPEs were taking 4.8 medications on average. The MPEs included drug-drug interactions (65.7%, incorrect doses (16.2%, unnecessary medications (8.1%, contra-indications (7.1%, incorrect drug duration (2%, and untreated conditions (1%. The physicians implemented 37 (37.4% pharmacist recommendations. Three factors were significantly related to physician acceptance of pharmacist recommendations. These were physician specialty, pharmacist gender, and patient gender. Pediatricians were less likely (OR= 0.1 to accept pharmacist recommendations compared to internal medicine physicians. Male pharmacists received more positive responses from physicians (OR=7.11 than female pharmacists. Lastly, the recommendations were significantly more likely to be accepted (OR= 3.72 when the patients were females. Conclusions: The incidence of MPEs is higher in Iraqi hospitalized patients than in the U.S. and U.K, but lower than in Brazil, Ethiopia, India, and Croatia. Drug-drug interactions were the most common type of

  15. Attitudes of pharmacists and physicians to antibiotic policies in hospitals.

    Science.gov (United States)

    Adu, A; Simpson, J M; Armour, C L

    1999-06-01

    Antibiotic therapy in hospitals has substantial impact on patient outcome and the pharmacy drug budget. Antibiotic policies have been implemented by some hospitals to improve the quality of patient outcome and cost of antibiotic therapy. Antibiotic policies impose certain requirements on pharmacists and physicians. Pharmacists' and physicians' attitudes to and opinions about antibiotic policies are likely to affect the usefulness of such policies. To determine the attitudes of pharmacists and physicians to antibiotic policies in New South Wales (NSW) hospitals. Pharmacists and physicians in NSW public hospitals were surveyed to determine their attitudes to and opinions on antibiotic policies. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the attitudinal dimensions. General linear modelling was used to investigate the effects of predictor variables on outcome variables. The response rates were 91% and 77% for pharmacists and physicians, respectively. Factor analysis identified three dimensions of attitude to antibiotic policies: that they encourage rational antibiotic use; that they improve the quality of antibiotic prescribing and that they are associated with some problems. The reliability of these factors (Cronbach's alpha) ranged from 0.71 to 0.74, and was 0.90 for the overall attitude scale. Pharmacists and physicians had a positive overall attitude to antibiotic policies. Whereas physicians recognize that antibiotic policies improve the quality of prescribing, this was highly correlated with identification of problems (alpha = 0.71). In urban hospitals, pharmacists were more likely than physicians to associate antibiotics with problems. There was a positive overall attitude to hospital antibiotic policies expressed by pharmacists and physicians.

  16. Hospital employment of physicians does not improve quality

    OpenAIRE

    Robbins RA

    2016-01-01

    No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1). In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rate...

  17. Referring physician satisfaction: toward a better understanding of hospital referrals.

    Science.gov (United States)

    Ponzurick, T G; France, K R; Logar, C M

    1998-01-01

    Customer satisfaction literature has contributed significantly to the development of marketing strategies in the health-care arena. The research has led to the development of hospital-driven relationship marketing programs. This study examines the inclusion of referring physicians as partners in the hospital's relationship marketing program. In exploring this relationship, medical and hospital facility characteristics that referring physicians find important in making patient referrals to specialty care hospitals are identified and analyzed. The results lead to the development of strategic initiatives which hospital marketers should consider when developing relationship marketing programs designed to satisfy their referring physicians.

  18. Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction.

    Science.gov (United States)

    Prasad, Shailendra; Hung, Peiyin; Henning-Smith, Carrie; Casey, Michelle; Kozhimannil, Katy

    2018-02-01

    Workforce issues constrain obstetric care services in rural US hospitals, and one strategy hospitals use is to employ physicians to provide obstetric care. However, little is known about the relationship between hospital employment of maternity care physicians and use of obstetric care procedures in rural hospitals. We examined the association between obstetric physician employment and use of cesareans and nonindicated labor induction. We conducted a cross-sectional analysis of a telephone survey of all 306 rural hospitals providing obstetric care in 9 states from November 2013 to March 2014 and linked the survey data (N = 263, 86% response rate) to all-payer childbirth data on maternity care utilization from 2013 Statewide Inpatient Database (SID) hospital discharge data. Using logistic regression models, we assessed the proportion of a hospital's maternity care physicians employed by the hospital and estimated its association with utilization of low-risk and nonindicated cesareans, and nonindicated labor induction. Rural hospitals that employed family physicians but not obstetricians had lower cesarean rates among low-risk pregnancies. Rural hospitals that employed only obstetricians did not show a relationship between employment and procedure utilization. Across hospitals with both obstetricians and family physicians, a 10% higher proportion of obstetricians employed was associated with 4.6% higher low-risk cesarean rates (4.6% [0.7%-8.4%]), while no significant relationship was found for the proportion of family physicians employed by a hospital. In rural US hospitals, associations between physician employment and obstetric procedure use differed by physician mix and the types of physicians employed. © 2017 National Rural Health Association.

  19. Work hours and turnover intention among hospital physicians in Taiwan: does income matter?

    Science.gov (United States)

    Tsai, Yu-Hsuan; Huang, Nicole; Chien, Li-Yin; Chiang, Jen-Huai; Chiou, Shu-Ti

    2016-11-21

    Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician's turnover intention. Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians' turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the "gllamm" command in the statistical software package Stata Version 12.1. The results show that 351 (14.5%) of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in Taiwan.

  20. Impact of HMO market structure on physician-hospital strategic alliances.

    Science.gov (United States)

    Burns, L R; Bazzoli, G J; Dynan, L; Wholey, D R

    2000-04-01

    To assess the impact of HMO market structure on the formation of physician-hospital strategic alliances from 1993 through 1995. The two trends, managed care and physician-hospital integration have been prominent in reshaping insurance and provider markets over the past decade. Pooled cross-sectional data from the InterStudy HMO Census and the Annual Survey conducted by the American Hospital Association (AHA) between 1993 and the end of 1995 to examine the effects of HMO penetration and HMO numbers in a market on the formation of hospital-sponsored alliances with physicians. Because prior research has found nonlinear effects of HMOs on a variety of dependent variables, we operationalized HMO market structure two ways: using a Taylor series expansion and cross-classifying quartile distributions of HMO penetration and numbers into 16 dummy indicators. Alliance formation was operationalized using the presence of any alliance model (IPA, PHO, MSO, and foundation) and the sum of the four models present in the hospital. Because managed care and physician-hospital integration are endogenous (e.g., some hospitals also sponsor HMOs), we used an instrumental variables approach to model the determinants of HMO penetration and HMO numbers. These instruments were then used with other predictors of alliance formation: physician supply characteristics, the extent of hospital competition, hospital-level descriptors, population size and demographic characteristics, and indicators for each year. All equations were estimated at the MSA level using mixed linear models and first-difference models. Contrary to conventional wisdom, alliance formation is shaped by the number of HMOs in the market rather than by HMO penetration. This confirms a growing perception that hospital-sponsored alliances with physicians are contracting vehicles for managed care: the greater the number of HMOs to contract with, the greater the development of alliances. The models also show that alliance formation is

  1. Factors associated with patients' choice of physician in the Korean population: Database analyses of a tertiary hospital.

    Directory of Open Access Journals (Sweden)

    Kidong Kim

    Full Text Available This study aimed to determine the factors influencing patients' choice of physician at the first visit through database analysis of a tertiary hospital in South Korea. We collected data on the first treatments performed by physicians who had treated patients for at least 3 consecutive years over 10 years (from 2003 to 2012 from the database of Seoul National University's affiliated tertiary hospital. Ultimately, we obtained data on 524,012 first treatments of 319,004 patients performed by 115 physicians. Variables including physicians' age and medical school and patients' age were evaluated as influencing factors for the number of first treatments performed by each physician in each year using a Poisson regression through generalized estimating equations with a log link. The number of first treatments decreased over the study period. Notably, the relative risk for first treatments was lower among older physicians than among younger physicians (relative risk 0.96; 95% confidence interval 0.95 to 0.98. Physicians graduating from Seoul National University (SNU also had a higher risk for performing first treatments than did those not from SNU (relative risk 1.58; 95% confidence interval 1.18 to 2.10. Finally, relative risk was also higher among older patients than among younger patients (relative risk 1.03; 95% confidence interval 1.01 to 1.04. This study systematically demonstrated that physicians' age, whether the physician graduated from the highest-quality university, and patients' age all related to patients' choice of physician at the first visit in a tertiary university hospital. These findings might be due to Korean cultural factors.

  2. Excessive working hours and health complaints among hospital physicians: a study based on a national sample of hospital physicians in Germany

    OpenAIRE

    Rosta, Judith; Gerber, Andreas

    2007-01-01

    Objectives: To determine correlations between excessively long working hours and subjectively experienced somatic health complaints among hospital physicians. Methods: Quantitative data were collected as part of the survey “Working life, Lifestyle and Health of Hospital Physicians in Germany 2006” using self-reporting questionnaires. The individually experienced health was assessed on the basis of Zerssen’s [1] list of somatic complaints. The indicator of excessively long working hours was de...

  3. Work hours and turnover intention among hospital physicians in Taiwan: does income matter?

    Directory of Open Access Journals (Sweden)

    Yu-Hsuan Tsai

    2016-11-01

    Full Text Available Abstract Background Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician’s turnover intention. Methods Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians’ turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the “gllamm” command in the statistical software package Stata Version 12.1. Results The results show that 351 (14.5% of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital. Conclusions The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in

  4. Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences

    Directory of Open Access Journals (Sweden)

    Schwappach David

    2008-10-01

    Full Text Available Abstract Background Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict – namely work interfering with family conflict (WIF – which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Methods Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April–July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9% participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ, work interfering with family conflict scale (WIF, and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. Results German hospital physicians reported elevated levels of WIF (mean = 74 compared to the general German population (mean = 45, p p Conclusion In our study, work interfering with family conflict (WIF as part of Work-Family Conflict (WFC was highly prevalent among German hospital physicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WIF. Some of these predictors are accessible to alteration by improving work organisation in hospitals.

  5. Physician practice management companies: implications for hospital-based integrated delivery systems.

    Science.gov (United States)

    Burns, L R; Robinson, J C

    1997-01-01

    Physician practice management companies (PPMCs) are one of the most visible entrants into the industry of managing physician practices, and anywhere from 100-150 are already in operation. Although PPMCs and hospital-based integrated delivery systems (IDSs) differ from each other in many ways, they share a number of common features, including the pursuit of capitation contracts from payors. As a result, PPMCs pose a growing, direct threat to hospital systems in competing for managed care contracts that cover physician service. PPMCs also provide an alternative to hospital-based IDSs at the local market level for physician group consolidation. This article looks at the structure, operation, and strategy of PPMCs and examines what implications their growth will have for hospital-based IDSs.

  6. Hospital employment of physicians does not improve quality

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1. In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions for 803 hospitals that switched to the employment model compared with 2085 control hospitals that did not switch. Switching hospitals were more likely to be large (11.6% vs. 7.1% or major teaching hospitals (7.5% vs. 4.5% and less likely to be for-profit institutions (8.8% vs. 19.9% (all p values <0.001. The authors used Medicare Provider Analysis and Review File (MedPAR from 2002 to 2013 to calculate hospital-level risk-adjusted performance on mortality ...

  7. Physician-industry relations. Part 1: individual physicians.

    Science.gov (United States)

    Coyle, Susan L

    2002-03-05

    This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships.

  8. Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians

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    Zupanc Andrea

    2009-06-01

    Full Text Available Abstract Background Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact – a key principle of effective medical care. Second, simultaneous task performance ('multitasking' which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested. Methods 35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument. Results Hospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17–20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities. Conclusion Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.

  9. Physicians lead the way at America's top hospitals.

    Science.gov (United States)

    Weber, D O

    2001-01-01

    The 100 Top hospitals are selected annually based on seven critical parameters for each of the 6,200-plus U.S. hospitals with 25 or more beds. They include the previous year's risk-adjusted patient mortality and complication rates, severity-adjusted average patient lengths of stay, expenses, profitability, proportional outpatient revenue, and asset turnover ratio (a measure of facility and technological pace-keeping ability). The winners are selected from five comparable size groupings--small, medium, large community, teaching, and large academic hospitals. Conspicuous among the winners at every level are physician-led organizations. Even in the majority of hospitals headed by non-physician administrators, however, the managerial capabilities of medical directors are the key to success. The most common characteristic of these award-winning hospitals is that the leadership is working together and communicating the institution's goals effectively to all levels of the organization.

  10. Feasibility and acceptability of a workers' health surveillance program for hospital physicians.

    Science.gov (United States)

    Ruitenburg, Martijn M; Plat, Marie-Christine J; Frings-Dresen, Monique H W; Sluiter, Judith K

    2015-01-01

    A Workers' Health Surveillance (WHS) program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. All hospital physicians of the general surgery, radiotherapy and obstetrics and gynecology departments from 1 academic hospital were invited to participate in the WHS by the in-company occupational health service. An occupational physician and a medical assistant were trained to use the protocol. Feasibility was operationalized as the received and delivered dose, observed success factors and potential obstacles. Acceptability was assessed by asking whether the WHS was desirable and feasible for future use and by estimating the effects on health and work ability. Written questions and semi-structured interviews were conducted with the participating physicians, 5 department managers and the 2 occupational health professionals involved in the study. One-third of the hospital physicians (34%) participated in every part of the WHS. The delivered dose was 77/84 (92%). Almost all hospital physicians who received recommendations expected to adhere to this advice. The study participants appreciated the organization of the WHS. This WHS was positively graded (8 out of 10 max) in terms of acceptability. Positive effects of the WHS on health, work functioning and long-term work ability were perceived by 2/3 of the physicians. The new job-specific WHS for hospital physicians showed good feasibility and acceptability among participating hospital physicians, occupational health professionals and medical managers. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  11. Feasibility and acceptability of a workers’ health surveillance program for hospital physicians

    Directory of Open Access Journals (Sweden)

    Martijn M. Ruitenburg

    2015-08-01

    Full Text Available Objectives: A Workers’ Health Surveillance (WHS program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. Material and Methods: All hospital physicians of the general surgery, radiotherapy and obstetrics and gynecology departments from 1 academic hospital were invited to participate in the WHS by the in-company occupational health service. An occupational physician and a medical assistant were trained to use the protocol. Feasibility was operationalized as the received and delivered dose, observed success factors and potential obstacles. Acceptability was assessed by asking whether the WHS was desirable and feasible for future use and by estimating the effects on health and work ability. Written questions and semi-structured interviews were conducted with the participating physicians, 5 department managers and the 2 occupational health professionals involved in the study. Results: One-third of the hospital physicians (34% participated in every part of the WHS. The delivered dose was 77/84 (92%. Almost all hospital physicians who received recommendations expected to adhere to this advice. The study participants appreciated the organization of the WHS. This WHS was positively graded (8 out of 10 max in terms of acceptability. Positive effects of the WHS on health, work functioning and long-term work ability were perceived by 2/3 of the physicians. Conclusions: The new job-specific WHS for hospital physicians showed good feasibility and acceptability among participating hospital physicians, occupational health professionals and medical managers.

  12. Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

    Science.gov (United States)

    Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

    2016-06-01

    Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital

  13. The organizational commitment of emergency physicians in Spanish public hospitals

    Science.gov (United States)

    Noval de la Torre, A; Bulchand Gidumal, J; Melián González, S

    2016-12-30

    Background. There are not too many studies that deal with the organizational commitment of emergency physicians. This commitment has been shown to impact organizational performance. The aim of this paper is to analyse the degree of commitment of the emergency physicians in Spanish public hospitals and the factors that may influence it. Method. Online survey using SurveyMonkey to emergency physicians in Spanish public hospitals. Results. Two hundred and five questionnaires were received, 162 from physicians and 43 from heads of the emergency service. Results show an intermediate level of commitment, with affective commitment showing the lowest level and continuance commitment showing the highest level. The capabilities of the physician have an influence on their affective commitment; specific training in emergency procedures and seniority has an influence on their continuance commitment; and the opinion they hold about the organization of their service influences affective commitment. Conclusions. Emergency physicians show an average involvement in the hospital in which they work (average 3.8 on a range of 1 to 5), feel an average affection for it (3.4), and have a high intention to keep working there (4.0). The resources the hospital has due to its level do not have an influence on this commitment, while the training and perceptions of the service do have an influence.

  14. Front-Line Physicians' Satisfaction with Information Systems in Hospitals.

    Science.gov (United States)

    Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna

    2018-01-01

    Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.

  15. Breast cancer patients' trust in physicians: the impact of patients' perception of physicians' communication behaviors and hospital organizational climate.

    Science.gov (United States)

    Kowalski, Christoph; Nitzsche, Anika; Scheibler, Fueloep; Steffen, Petra; Albert, Ute-Susann; Pfaff, Holger

    2009-12-01

    To examine whether patients' perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians' communication behaviors as perceived by the patients and patient characteristics. Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed. 80.5% of the patients responded to the survey. 37% of the variance in patients' trust in physicians can be explained by the variables included in our final model (N=2226; R(2) adj.=0.372; porganizational climate. The impact of their perception of physicians' communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust. A trusting physician-patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians' communication behaviors. With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.

  16. Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences.

    Science.gov (United States)

    Fuss, Isabelle; Nübling, Matthias; Hasselhorn, Hans-Martin; Schwappach, David; Rieger, Monika A

    2008-10-07

    interfering with family conflict (WIF) as part of Work-Family Conflict (WFC) was highly prevalent among German hospital physicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WIF. Some of these predictors are accessible to alteration by improving work organisation in hospitals.

  17. Depressive symptoms and overwork among physicians employed at a university hospital in Japan

    Directory of Open Access Journals (Sweden)

    Toru Maruyama

    2017-11-01

    Full Text Available Introduction: The excessive workload of Japanese hospital physicians is a serious social problem due to effects on their mental health status, as well as the potential for medical errors and lawsuits. The extent of overwork among resident physicians employed at national university hospitals in Japan is unknown and needs to be investigated. Methods: This study used a questionnaire recommended by the Japanese Ministry of Health for hospital physicians working overtime, administered through an interview carried out by an occupational physician during the health surveillance to evaluate: 1 the severity of chronic fatigue; 2 the burden of work; 3 an overwork score derived from these two measures; and 4 presence of depressive symptoms. After the feasibility of the questionnaire was confirmed, both a cross-sectional and a longitudinal study were performed, while statistics analysis included multiple linear regression analysis and chi-square test set at P < 0.05. Results: Most of the overworked physicians were young medical staffs (48%, whereas postgraduate residents formed a small group (10%. In the cross-sectional study (n = 135; mean age 32.7 years ± 5.6, the histograms of scores for the four factors investigated showed a strong positive skewness, while overtime histograms showed a negative skewness at 4, 3, and 2 months prior to the interview with occupational physician, but positive skewness 1 month prior to the interview. The longitudinal study (n = 26 showed an increase or reduction of overtime respectively having a significant impact on exacerbation or improvement of the overwork score (P = 0.028 and depressive symptoms (P = 0.025. Discussion and Conclusions: A strong positive skewness of the histograms for items related to overwork might indicate fear of stigma of mental illness amongst young physicians. Physicians employed at Japanese national university hospitals should be protected by the institution, and the roles of occupational physician

  18. How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?

    NARCIS (Netherlands)

    Ruitenburg, Martijn M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2016-01-01

    Background: A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps

  19. 5 CFR 890.905 - Limits on inpatient hospital and physician charges.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905 Limits on inpatient...

  20. Monitoring technology and firm boundaries: physician-hospital integration and technology utilization.

    Science.gov (United States)

    McCullough, Jeffrey S; Snir, Eli M

    2010-05-01

    We study the relationship between physician-hospital integration and its relation to monitoring IT utilization. We develop a theoretical model in which monitoring IT may complement or substitute for integration and test these relationships using a novel data source. Physician labor market heterogeneity identifies the empirical model. We find that monitoring IT utilization is increasing in integration, implying that expanded firm boundaries complement monitoring IT adoption. We argue that the relationship between monitoring IT and firm boundaries depends upon the contractibility of the monitored information.

  1. Physician recruitment in Ontario Provincial Psychiatric Hospitals.

    Science.gov (United States)

    Draper, R; Galbraith, D; Frost, B

    1989-11-01

    Recruitment of Physicians/Psychiatrists to staff the Ontario Provincial Psychiatric Hospitals remains an ongoing problem despite the introduction of measures such as University Affiliation and Incentive Grants. Historically there has been heavy reliance upon Foreign Medical Graduates (GOFM's) who have been denied the possibility of professional mobility and advancement because of restrictive licences. Recent changes in regulations have severely restricted the recruitment of GOFM's. During 1987, details of all physicians employed in the provincial hospitals during the preceeding five years were entered into a computerized data base. This paper presents some initial analyses which indicate that Canadian graduates have provided low levels of service, especially outside major urban centres, quite insufficient to replace the GOFM's. These findings raise urgent social and professional concerns.

  2. Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries.

    Science.gov (United States)

    Blumenthal, Daniel M; Olenski, Andrew R; Tsugawa, Yusuke; Jena, Anupam B

    2017-12-05

    ), significantly longer mean length of stay (5.64 days vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34 to 0.52), and significantly lower 30-day readmissions (22.80% vs 23.83%; adjusted difference, -1.00%; 95% CI -1.57% to -0.54%). Among hospitalized Medicare beneficiaries treated by a general internist, there were no significant differences in overall 30-day mortality rates among patients treated by locum tenens compared with non-locum tenens physicians. Additional research may help determine hospital-level factors associated with the quality and costs of care related to locum tenens physicians.

  3. Fulfillment of administrative and professional obligations of hospitals and mission motivation of physicians.

    Science.gov (United States)

    Trybou, Jeroen; Gemmel, Paul; Desmidt, Sebastian; Annemans, Lieven

    2017-01-13

    To be successful, hospitals must increasingly collaborate with their medical staff. One strategic tool that plays an important role is the mission statement of hospitals. The goal of this research was to study the relationship between the fulfillment of administrative and professional obligations of hospitals on physicians' motivation to contribute to the mission of the hospital. Furthermore the mediating role of the physicians' emotional attachment to the hospital and moderation effect of the exchange with the head physicians were considered. Self-employed physicians of six hospitals participated in a survey. Descriptive analyses and linear regression were used to analyse the data. The results indicate that affective commitment mediated the relationship between psychological contract fulfillment and mission statement motivation. In addition, the quality of exchange with the Chief Medical Officer moderated the relationship between the fulfillment of administrative obligations and affective commitment positively. This study extends our understanding of social exchange processes and mission statement motivation of physicians. We showed that when physicians perceive a high level of fulfillment of their psychological contract they are more committed and more motivated to contribute to the mission statement. A high quality relationship between physician and Chief Medical Officer can enhance this reciprocity dynamic.

  4. Current market trends in hospital/physician integration.

    Science.gov (United States)

    Bauman, Randy R

    2009-01-01

    This article explores recent trends that are dramatically changing the landscape of typical hospital/physician integration models and provides the reader with useful insights to better evaluate this dynamically changing marketplace.

  5. The impact of the hospital work environment on social support from physicians in breast cancer care.

    Science.gov (United States)

    Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole

    2014-09-01

    Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Consensus on the leadership of hospital CEOs and its impact on the participation of physicians in improvement projects.

    Science.gov (United States)

    Dückers, Michel L A; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P

    2009-08-01

    The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation, between the extent to which physicians notice their CEOs stimulate improvement initiatives and the number of projects joined by physicians, is moderated by the consensus among physicians working in the same hospital. Multilevel analyses are applied on data of 286 physicians from eight hospitals to: (1) estimate whether participation depends on noticing if CEOs stimulate improvement, (2) test if an individual's participation differs when more colleagues have the same opinion (effect modification). Significant moderator effects are found. The participation of physicians, noticing that CEOs stimulate improvement is higher when more colleagues share this opinion. For physicians not knowing whether improvement is encouraged, higher consensus coincides with lower participation. Project involvement of physicians depends on their consensus about encouragement by CEOs. This confirms the importance of strategic leaders in dissemination programs. Further research is recommended into causes of CEO leadership visibility and methods to strengthen leadership climate.

  7. Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices.

    Science.gov (United States)

    Neprash, Hannah T; Chernew, Michael E; Hicks, Andrew L; Gibson, Teresa; McWilliams, J Michael

    2015-12-01

    Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. To assess the association between recent increases in physician-hospital integration and changes in spending and prices for outpatient and inpatient services. Using regression analysis, we estimated the relationship between changes in physician-hospital integration from January 1, 2008, through December 31, 2012, in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending. Adjustments were made for patient, plan, and market characteristics, including physician, hospital, and insurer market concentration. The study population included a cohort of 7,391,335 nonelderly enrollees in preferred-provider organizations or point-of-service plans included in the Truven Health MarketScan Commercial Database during the study period. Data were analyzed from December 1, 2013, through July 13, 2015. Physician-hospital integration, measured using Medicare claims data as the share of physicians in an MSA who bill for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. Annual inpatient and outpatient spending per enrollee and associated use of health care services, with utilization measured by price-standardized spending (the sum of annual service counts multiplied by the national mean of allowed charges for the service). Among the 240 MSAs, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs (interquartile range, 0.8-5.2 percentage points). For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean

  8. Physician' entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics.

    Science.gov (United States)

    Koelewijn, Wout T; de Rover, Matthijs; Ehrenhard, Michel L; van Harten, Wim H

    2014-05-19

    Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics. We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians' groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic. These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are 'glued' to the central medical logic.

  9. Evaluating opportunities for direct contracting between employers and physician-hospital organizations.

    Science.gov (United States)

    Straley, P F; Swaim, C R

    1994-01-01

    Employers seeking to reduce health care expenditures are turning to direct contracting as a way to control provider cost increases. In a direct contract, the participation of third parties is minimized. The health care provider and a corporate buyer directly negotiate a price agreement for the delivery of health care services. However, as managed care penetration increases, the ability of hospitals and physicians to assume risk while providing high quality, cost effective care will be paramount. Physicians and hospitals who choose to work together may find a physician-hospital organization an effective vehicle to meet the current and future market challenges of direct contracting.

  10. [Clinical pharmacy: Evaluation of physician's satisfactions and expectations in a French regional hospital].

    Science.gov (United States)

    Jennings, P; Lotito, A; Baysson, H; Pineau-Blondel, E; Berlioz, J

    2017-03-01

    The purpose of the study was to evaluate physician's satisfaction with the clinical pharmacy activities in a French regional hospital. Data were collected by face-to-face interviews carried out by a public health intern with physicians from 14 different departments of medicine and surgery. A specifically designed questionnaire was used for this study. This contained 18 closed-ended questions, 3 open-ended questions and 6 questions relating to the multidisciplinary analysis of prescriptions of elderly patients. The questionnaire was proposed to 78 physicians, of which 62 replied (participation rate of 79%). Thirty-seven percent were interns (23/62), 19% were assistants (12/62) and 44% were senior physicians (27/62). Clinical pharmacy satisfaction levels were generally very high. In regard to clinical skills, 87% of the physicians were satisfied with pharmacists' competencies and 91% by the pertinence of transmitted information. Ninety-five percent of the physicians were also satisfied by the logistical aspect and the relationship with pharmacists (reactivity, availability and communication). Analysis of the open-ended questions showed that physicians were in favour of the increased presence of clinical pharmacists on the wards. This study shows a high level of physician satisfaction in relation to the clinical pharmacy activities in our hospital, and should be viewed as a strong endorsement of the work of the clinical pharmacy. This study highlights some areas of improvement such as increase presence of the clinical pharmacists on the wards. In order to assess periodically our activity, this study must be repeated in the future. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  11. Physician-hospital relationships: from historical failures to successful "new kids on the block".

    Science.gov (United States)

    Payton, Bruce

    2012-01-01

    Trends in healthcare reveal that increasing numbers of physicians prefer to work directly with hospitals-whether through employment models, new or revived partnership structures, or other such "deals". Meanwhile, hospital executives are vigorously seeking ways to create win-win arrangements that satisfy both parties-models that will ensure medical coverage for the hospital, along with revenue gains and cost savings when possible. Add to this a competitive environment, physician shortages, and high regulatory activity and healthcare reform, and the path to clinical, operational, and financial viability in the context of a hospital/physician partnership can be a challenging one. Models such as The physician enterprise and co-management agreements are gaining popularity, each with distinct benefits. With market forces dynamically changing, along with accountable care, it is time for hospitals, health systems, and physicians to prioritize their partnering relationships, a strategy that is now key to achieving success in the future...and that's a trend that's likely to continue far into the years ahead.

  12. Prospective-pricing strategies for hospital and departmental effectiveness: the physician's response.

    Science.gov (United States)

    Shapleigh, C

    1985-10-01

    Physician-practice patterns are discussed, and programs of decentralization designed to reduce ancillary use are described. The New England Medical Center (NEMC) conducted a study with two other major hospitals in Boston comparing physician-practice patterns for patients who had had carotid endarterectomies. The indications for surgery for these patients did not appear to be different among the hospitals; however, average charges and length of stay varied considerably. Operating-room time and postoperative management also varied substantially. Strategies to change physician-practice patterns must address the issues of incentives to physicians and hospitals. At NEMC, a program of decentralization is being implemented that involves physician participation in budgeting hospital resources. A program of product pricing has been developed, whereby the NEMC offers an HMO a fixed price for certain kinds of cases upon admission. A daily use report was started to report resource use for specific cases compared with annual medians for that type of case. Case types from many different surgical specialties are involved. The reports show physicians the difference between the actual and expected costs in terms of variances. The NEMC has reoriented its budgeting process to include clinical divisions. Clinical services are planning to budget the use of intermediate products across different cost centers. The clinical budgeting program makes the planning process more objective, lowers the use of ancillary services, and reduces costs.

  13. Hospital's activity-based financing system and manager-physician [corrected] interaction.

    Science.gov (United States)

    Crainich, David; Leleu, Hervé; Mauleon, Ana

    2011-10-01

    This paper examines the consequences of the introduction of an activity-based reimbursement system on the behavior of physicians and hospital's managers. We consider a private for-profit sector where both hospitals and physicians are initially paid on a fee-for-service basis. We show that the benefit of the introduction of an activity-based system depends on the type of interaction between managers and physicians (simultaneous or sequential decision-making games). It is shown that, under the activity-based system, a sequential interaction with physician leader could be beneficial for both agents in the private sector. We further model an endogenous timing game à la Hamilton and Slutsky (Games Econ Behav 2: 29-46, 1990) in which the type of interaction is determined endogenously. We show that, under the activity-based system, the sequential interaction with physician leader is the unique subgame perfect equilibrium.

  14. How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?

    Science.gov (United States)

    Ruitenburg, Martijn M; Frings-Dresen, Monique H W; Sluiter, Judith K

    2016-03-01

    A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps should be taken to determine the content of a job-specific WHS for hospital physicians and outlines that content. Based on four questions, decision trees were developed for physical and psychological job demands and for biological, chemical, and physical exposures to decide whether or not to include work-related health effects related to occupational exposures or aspects of health reflecting insufficient job requirements. Information was gathered locally through self-reporting and systematic observations at the workplace and from evidence in international publications. Information from the decision trees on the prevalence and impact of the health- or work-functioning effect led to inclusion of occupational exposures (e.g., biological agents, emotionally demanding situations), job requirements (e.g., sufficient vision, judging ability), or health effects (e.g., depressive symptoms, neck complaints). Additionally, following the Dutch guideline for occupational physicians and based on specific job demands, screening for cardiovascular diseases, work ability, drug use, and alcohol consumption was included. Targeted interventions were selected when a health or work functioning problem existed and were chosen based on evidence for effectiveness. The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.

  15. THE PREVALENCE OF STRESS AND BURNOUT SYNDROME IN HOSPITAL DOCTORS AND FAMILY PHYSICIANS.

    Science.gov (United States)

    Stanetic, Kosana D; Savic, Suzana M; Racic, Maja

    2016-11-01

    Introducti on. Burnout syndrome is the result of chronic emotional stress. It is characterized by high levels of emotional exhaustion and depersonalization, and reduced level of personal accomplishment. The aim of this study was to determine the level of stress and risk ror burnout syndrome in doctors employed in health centers and hospitals, and to investigate the impact of socio-derrdgraphic characteristics on the level of stress and the o ccurrence of burnout syndrome. A cross-sectional study was conducted in the period from October I to December 31, 2015 in three health centers and in the University Clinical Center of the Republic of Srpska. The survey was anonymous. A socio-demographic questionnaire and a questionnaire for self-assessment of the level of stress and Maslach Burnout Inventory were used as research instruments. Out of 151 doctors included in the study, 49% were family physicians, and 51% were hospital doctors. The analysis of responses to questionnaires for self-assessment of stress level revealed that 51.7% of participants had high levels of stress (52.7% of family physicians, 50.6% of doctors working in hospital). A high degree of emotional exhaustion was found in 27.2% of participants (29.7% of fam ily physicians, 24.6% of doctors working in hospital), high depersonalization was found in 23.8% of participants (25.7% of family physicians, 22. 1% of doctors working in hospital), a low level of personal accomplishment was found in 39.7% of participants (37.8% of family physicians. 41.6% of doctors working in hospital). No statistically significant difference regarding stress degree, emotional exhaustion and depersonalizaion and personal accomplishment was found between hospital doctors and family physicians. The physicians aged over 45 years had a significantly (p = 0.030) higher level of emotional exhaustion than their younger colleagues. This study found that there was a high risk of burnout syndrome in physicians in the Republic of Srpska

  16. Hospital restructuring and physician job satisfaction: an empirical study.

    Science.gov (United States)

    Mascia, Daniele; Morandi, Federica; Cicchetti, Americo

    2014-02-01

    The adoption of clinical directorates through the internal reconfiguration of hospital organizations has been one of the most widespread restructuring interventions in many Western European countries. Despite its extensive adoption, a lack of knowledge remains on the analysis of how this reorganization affects professionals' job satisfaction. This paper contributes to the debate on clinical directorates by exploring how the structural characteristics of newly adopted organizational models influence physician's job satisfaction. More than 300 physicians in 18 clinical directorates in the Italian National Health Service were surveyed regarding their overall job satisfaction following the introduction of departmental arrangements. Survey results were then linked to another survey that classified newly adopted models according to the criteria used to merge hospital wards into directorates, by recognizing "Process-integration", "Specialty-integration" and "Mixed-integration" types of directorates. Our findings show that structural aspects of change significantly influenced overall job satisfaction, and that a physician's openness to experience moderated the adoption and implementation of new clinical directorates. Specifically, results demonstrate that physicians with high openness to experience scores were more receptive to the positive impacts of change on overall job satisfaction. Implications for how these findings may facilitate organizational shifts within hospital settings are discussed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. A survey of workplace violence against physicians in the hospitals, Myanmar.

    Science.gov (United States)

    Kasai, Yuichi; Mizuno, Tetsutaro; Sakakibara, Toshihiko; Thu, Si; Kyaw, Thein Aung; Htun, Kyaw Aung

    2018-02-15

    Workplace violence in hospitals is recently becoming a major global concern in many countries. However, in Myanmar, we have felt that patients and their families have rarely made unreasonable complaints in hospitals, and then, the purpose of this study is to report the current state of workplace violence in hospitals in Myanmar. Participants are 196 physicians (108 males and 88 females) in hospitals in Myanmar. A descriptive survey was conducted in regard to verbal abuse and physical violence from patients or the people concerned. At the results of this study, the percentages of physicians who have encountered verbal abuse and those who have encountered physical violence are markedly low (8.7 and 1.0%, respectively). The present study is the first to report the frequencies of verbal abuse and physical violence against physicians in a least developed country, and the results of the present study are important in terms of discussing workplace violence in hospitals.

  18. The communication between patient relatives and physicians in intensive care units.

    Science.gov (United States)

    Cicekci, Faruk; Duran, Numan; Ayhan, Bunyamin; Arican, Sule; Ilban, Omur; Kara, Iskender; Turkoglu, Melda; Yildirim, Fatma; Hasirci, Ismail; Karaibrahimoglu, Adnan; Kara, Inci

    2017-07-17

    Patients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient's relatives and the physician. This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties. For data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals. Based on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients' relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients' relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient's relatives, the level of education, the physician's perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician. This study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.

  19. Hospital physician payment mechanisms in Austria: do they provide gateways to institutional corruption?

    Science.gov (United States)

    Sommersguter-Reichmann, Margit; Stepan, Adolf

    2017-12-01

    Institutional corruption in the health care sector has gained considerable attention during recent years, as it acknowledges the fact that service providers who are acting in accordance with the institutional and environmental settings can nevertheless undermine a health care system's purposes as a result of the (financial) conflicts of interest to which the service providers are exposed. The present analysis aims to contribute to the examination of institutional corruption in the health sector by analyzing whether the current payment mechanism of separately remunerating salaried hospital physicians for treating supplementary insured patients in public hospitals, in combination with the public hospital physician's possibility of taking up dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals, has the potential to undermine the primary purposes of the Austrian public health care system. Based on the analysis of the institutional design of the Austrian public hospital sector, legal provisions and directives have been identified, which have the potential to promote conduct on the part of the public hospital physician that systematically undermines the achievement of the Austrian public health system's primary purposes.

  20. Excessive working hours and health complaints among hospital physicians: a study based on a national sample of hospital physicians in Germany

    Directory of Open Access Journals (Sweden)

    Rosta, Judith

    2007-11-01

    Full Text Available Objectives: To determine correlations between excessively long working hours and subjectively experienced somatic health complaints among hospital physicians. Methods: Quantitative data were collected as part of the survey “Working life, Lifestyle and Health of Hospital Physicians in Germany 2006” using self-reporting questionnaires. The individually experienced health was assessed on the basis of Zerssen’s [1] list of somatic complaints. The indicator of excessively long working hours was defined as 10 or more working hours per working day and 6 or more on-call shifts a month among full-time employees. The net sample consisted of 3295 randomly selected physicians from 515 hospitals. Results: The response rate was 58% (n=1917. Physicians with excessively long working hours (19% had significantly higher sum score of health complaints (p=0.0001 and significantly increased mental and physical fatigue symptoms (feeling faint, languor, uneasiness, heavy legs, excessive need for sleep, trembling; p=0.0001 to 0.047, mood changes (irritability, brooding; p=0.008 to 0.014, gastrointestinal (nausea, loss of weight; p=0.0001 to 0.014 and heart disorders (lumpy sensation in the throat, chest pain; p=0.0001 to 0.042. When the sum score of health complaints was controlled for selected confounders, being female (B=-3.44, p=0.0001 and having excessively long working hours (B=2.76, p=0.0001 were significantly correlated with health complaints. In a separate gender analysis, being exposed to excessively long working hours remained a significant predictor for health complaints among both females (B=3.78, p=0.001 and males (B=2.28, p=0.004. Conclusions: Excessively long working hours are associated with an increased risk of health complaints. Reducing working hours may be the first step to improving physicians' health.

  1. How to create a marketing strategy based on hospital characteristics that attract physicians.

    Science.gov (United States)

    Nordstrom, R D; Horton, D E; Hatcher, M E

    1987-03-01

    Through use of multivariate statistical and research techniques, the authors analyzed 30 hospital features that contribute to a physician's image of a hospital as being a good or a poor place for patient admission and in which to practice. Use of the data obtained in this study can enable a hospital administrator to monitor changes in physicians' attitudes, plan strategies to encourage quality physicians to admit their patients, improve aspects perceived to be weak or unresponsive, and capitalize on strengths.

  2. The MeSH model for hospital-physician joint ventures.

    Science.gov (United States)

    Anderson, J G

    1985-01-01

    The MeSH (Medical Staff-Hospital Joint Venture Company) concept has arisen to meet the perceived need for hospital-physician cooperation in a modern age of prospective payment systems, increased supply of health-care providers, cost conscious consumers, corporate health care organizations, and a general trend toward industrialization of health care. Supply and demand economics have created a situation which threatens the autonomy and financial integrity of both hospitals ans physicians, forcing cooperation or mutual destruction. MeSH seeks to preserve the autonomy and financial integrity of both parties through the creation of a free-standing business entity jointly owned by a hospital and those members of its medical staff who choose to participate. This article presents reasons for the need for cooperation, the objectives of MeSH, a description of its structure and operation, and a list of potential projects the program could include.

  3. Do family physicians, emergency department physicians, and pediatricians give consistent sport-related concussion management advice?

    Science.gov (United States)

    Stoller, Jacqueline; Carson, James D; Garel, Alisha; Libfeld, Paula; Snow, Catherine L; Law, Marcus; Frémont, Pierre

    2014-06-01

    To identify differences and gaps in recommendations to patients for the management of sport-related concussion among FPs, emergency department physicians (EDPs), and pediatricians. A self-administered, multiple-choice survey was e-mailed to FPs, EDPs, and pediatricians. The survey had been assessed for content validity. Two community teaching hospitals in the greater Toronto area in Ontario. Two hundred seventy physicians, including FPs, EDPs, and pediatricians, were invited to participate. Identification of sources of concussion management information, usefulness of concussion diagnosis strategies, and whether physicians use common terminology when explaining cognitive rest strategies to patients after sport-related concussions. The response rate was 43.7%. Surveys were completed by 70 FPs, 23 EDPs, and 11 pediatricians. In total, 49% of FP, 52% of EDP, and 27% of pediatrician respondents reported no knowledge of any consensus statements on concussion in sport, and 54% of FPs, 86% of EDPs, and 78% of pediatricians never used the Sport Concussion Assessment Tool, version 2. Only 49% of FPs, 57% of EDPs, and 36% of pediatricians always advised cognitive rest. This study identified large gaps in the knowledge of concussion guidelines and implementation of recommendations for treating patients with sport-related concussions. Although some physicians recommended physical and cognitive rest, a large proportion failed to consistently advise this strategy. Better knowledge transfer efforts should target all 3 groups of physicians. Copyright© the College of Family Physicians of Canada.

  4. An investigation on physicians' acceptance of hospital information systems: a case study.

    Science.gov (United States)

    Chen, Rai-Fu; Hsiao, Ju-Ling

    2012-12-01

    Information technology is used to support a wide range of highly specified healthcare tasks and services. There is, therefore, a need to understand the factors affecting the acceptance of this technology by healthcare professionals. Physicians are key providers of healthcare services and are among the principal users of hospital information systems. Their acceptance of hospital information systems is hence of great significance when evaluating the success of those systems. The survey methodology was employed to targeted physicians in the selected case hospital for investigating factors affecting physicians' acceptance of hospital information systems. A total of 202 questionnaires were sent out, with 124 completed copies returned, indicating a valid response rate of 61.4%. We used structural equation modeling to analyze the data. The results indicated that top management support (γ=0.431, psystem quality (γ=0.369, pinformation systems. Physicians' perceptions of the usefulness (β=0.132, pinformation systems had a significant impact on the acceptance of the systems, accounting for 81.4% of total explained variance. Through the understanding of the identified critical factors affecting physicians' HIS acceptance, the planners and managers should ensure that hospital information systems to be introduced into a hospital are useful and ease to use. Effort should be focuses on providing sufficient top management support, selecting qualified project team members, and delivering higher system quality in addressing physicians' clinical needs. Thus, our research results can help planners and managers understand key considerations affecting HIS development and use, and may be used as a reference for system design, development and implementation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. Associations between non-discrimination and training policies and physicians’ attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals

    Directory of Open Access Journals (Sweden)

    Jennifer M. Jabson

    2016-03-01

    Full Text Available Abstract Background Some physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians’ knowledge, attitudes, and gender and sexual minority affirmative practices. Method A random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did. Results Physicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians’ attitudes and knowledge about SGM patients. Conclusion Policies that mandate non-discrimination and training as they currently exist may not improve physicians’ attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians’ SGM affirmative practices.

  6. The optimality of hospital financing system: the role of physician-manager interactions.

    Science.gov (United States)

    Crainich, David; Leleu, Hervé; Mauleon, Ana

    2008-12-01

    The ability of a prospective payment system to ensure an optimal level of both quality and cost reducing activities in the hospital industry has been stressed by Ma (Ma, J Econ Manage Strategy 8(2):93-112, 1994) whose analysis assumes that decisions about quality and costs are made by a single agent. This paper examines whether this result holds when the main decisions made within the hospital are shared between physicians (quality of treatment) and hospital managers (cost reduction). Ma's conclusions appear to be relevant in the US context (where the hospital managers pay the whole cost of treatment). Nonetheless, when physicians partly reimburse hospitals for the treatment cost as it is the case in many European countries, we show that the ability of a prospective payment system to achieve both objectives is sensitive to the type of interaction (simultaneous, sequential or joint decision-making) between the agents. Our analysis suggests that regulation policies in the hospital sector should not be exclusively focused on the financing system but should also take the interaction between physicians and hospital managers into account.

  7. Physicians interrupted by mobile devices in hospitals: understanding the interaction between devices, roles, and duties.

    Science.gov (United States)

    Solvoll, Terje; Scholl, Jeremiah; Hartvigsen, Gunnar

    2013-03-07

    A common denominator of modern hospitals is a variety of communication problems. In particular, interruptions from mobile communication devices are a cause of great concern for many physicians. To characterize how interruptions from mobile devices disturb physicians in their daily work. The gathered knowledge will be subsequently used as input for the design and development of a context-sensitive communication system for mobile communications suitable for hospitals. This study adheres to an ethnographic and interpretive field research approach. The data gathering consisted of participant observations, non-structured and mostly ad hoc interviews, and open-ended discussions with a selected group of physicians. Eleven physicians were observed for a total of 135 hours during May and June 2009. The study demonstrates to what degree physicians are interrupted by mobile devices in their daily work and in which situations they are interrupted, such as surgery, examinations, and during patients/relatives high-importance level conversations. The participants in the study expected, and also indicated, that wireless phones probably led to more interruptions immediately after their introduction in a clinic, when compared to a pager, but this changed after a short while. The unpleasant feeling experienced by the caller when interrupting someone by calling them differs compared to sending a page message, which leaves it up to the receiver when to return the call. Mobile devices, which frequently interrupt physicians in hospitals, are a problem for both physicians and patients. The results from this study contribute to knowledge being used as input for designing and developing a prototype for a context-sensitive communication system for mobile communication suitable for hospitals. We combined these findings with results from earlier studies and also involved actual users to develop the prototype, CallMeSmart. This system intends to reduce such interruptions and at the same time

  8. Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?

    DEFF Research Database (Denmark)

    Horsted, Tina I; Rasmussen, Lars S; Lippert, Freddy K

    2004-01-01

    To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.......To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts....

  9. [Subjective Workload, Job Satisfaction, and Work-Life-Balance of Physicians and Nurses in a Municipal Hospital in a Rural Area Compared to an Urban University Hospital].

    Science.gov (United States)

    Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes

    2018-05-01

    Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, pwork and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective

  10. Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study.

    Science.gov (United States)

    Klingler, Corinna; Marckmann, Georg

    2016-09-23

    With Germany facing a shortage of doctors, hospitals have been increasingly recruiting physicians from abroad. Studies in other countries have shown that migrant physicians experience various difficulties in their work, which might impact the quality of patient care, physician job satisfaction, and, accordingly, retention. The experiences of migrant doctors in Germany have not been systematically studied so far and will likely differ from experiences migrant physicians make in other contexts. A thorough understanding of challenges faced by this group, however, is needed to develop adequate support structures-as required by the WHO Global Code of Practice on the International Recruitment of Health Personnel. A qualitative study was conducted to give an overview of the multifaceted difficulties migrant physicians might face in German hospitals. Twenty semi-structured interviews with foreign-born and foreign-trained physicians were conducted in German. Participants were recruited via the State Chambers of Physicians and snowballing based on a maximum variation sampling strategy varying purposefully by source country and medical specialty. The interviews were recorded, transcribed verbatim, and analysed using qualitative content analysis. Participants described difficulties relating to healthcare institutions, own competencies, and interpersonal interactions. Participants experienced certain legal norms, the regulation of licensure and application for work, and the organization of the hospital environment as inadequate. Most struggled with their lack of setting-specific (language, cultural, clinical, and system) knowledge. Furthermore, behaviour of patients and co-workers was perceived as discriminating or inadequate for other reasons. This is the first study to describe the broad range of issues migrant physicians experience in Germany. Based on this information, institutional actors should devise support structures to ensure quality of care, physician wellbeing, and

  11. Physicians' occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals.

    Science.gov (United States)

    Bernburg, Monika; Vitzthum, Karin; Groneberg, David A; Mache, Stefanie

    2016-06-15

    This study aimed to analyse and compare differences in occupational stress, depressive symptoms, work ability and working environment among residents working in various medical specialties. 435 German hospital residents in medical training working in 6 different medical specialties participated in a cross-sectional survey study. Physicians were asked about their working conditions and aspects of mental health and work ability. The Copenhagen Psychosocial Questionnaire, the Work Ability Index, the ICD-10 Symptom Rating and the Perceived Stress Questionnaire were used to measure working conditions, mental health and work ability. Results show that up to 17% of the physicians reported high levels of occupational distress and 9% reported high levels of depressive symptoms. 11% of the hospital physicians scored low in work ability. Significant differences between medical specialties were demonstrated for occupational distress, depressive symptoms, work ability, job demands and job resources. Surgeons showed consistently the highest levels of perceived distress but also the highest levels of work ability and lowest scores for depression. Depressive symptoms were rated with the highest levels by anaesthesiologists. Significant associations between physicians' working conditions, occupational distress and mental health-related aspects are illustrated. Study results demonstrated significant differences in specific job stressors, demands and resources. Relevant relations between work factors and physicians' health and work ability are discussed. These findings should be reinvestigated in further studies, especially with a longitudinal study design. This work suggests that to ensure physicians' health, hospital management should plan and implement suitable mental health promotion strategies. In addition, operational efficiency through resource planning optimisation and work process improvements should be focused by hospital management. Published by the BMJ Publishing Group

  12. Work stress associated cool down reactions among nurses and hospital physicians and their relation to burnout symptoms.

    Science.gov (United States)

    Büssing, Arndt; Falkenberg, Zarah; Schoppe, Carina; Recchia, Daniela Rodrigues; Poier, Désirée

    2017-08-10

    Hospital staff experience high level of work stress and they have to find strategies to adapt and react to it. When they perceive emotional exhaustion and job dissatisfaction in response to constant work stress, one reaction might be emotional withdrawal. This emotional distancing can be seen as an adaptive strategy to keep 'functionality' in the job. Both, perception of emotional exhaustion and emotional distancing as a strategy, can be operationalized as 'Cool Down'. We assume that work stress associated variables are positively associated with Cool Down reactions, while internal and external resources are negatively associated and might function as a buffer against emotional distancing. Moreover, we assume that the perception of stress and work burden might be different between nurses and physicians and women and men, but not their cool down reactions as a strategy. Anonymous cross-sectional survey with standardized instruments among 1384 health care professionals (66% nurses, 34% hospital physicians). Analyses of variance, correlation and also stepwise regression analyses were performed to analyze the influence of demands and resources on Cool Down reactions. As measured with the Cool Down Index (CDI), frequency and strength of Cool Down reactions did not significantly differ between women and men, while women and men differ significantly for their burnout symptoms, stress perception and perceived work burden. With respect to profession, Cool Down and stress perception were not significantly different, but burnout and work burden. For nurses, "Emotional Exhaustion" was the best CDI predictor (51% explained variance), while in physicians it was "Depersonalization" (44% explained variance). Among putative resources which might buffer against Cool Down reactions, only team satisfaction and situational awareness had some influence, but not self-efficacy expectation. The perceptions of emotional exhaustion and distancing of nurses and physicians (and women and men

  13. The ties that bind: an integrative framework of physician-hospital alignment

    Directory of Open Access Journals (Sweden)

    Gemmel Paul

    2011-02-01

    Full Text Available Abstract Background Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Discussion Empirical studies and management theory (agency theory and social exchange theory are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Summary Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

  14. The ties that bind: an integrative framework of physician-hospital alignment.

    Science.gov (United States)

    Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

    2011-02-15

    Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Empirical studies and management theory (agency theory and social exchange theory) are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

  15. The Ideal Hospital Discharge Summary: A Survey of U.S. Physicians.

    Science.gov (United States)

    Sorita, Atsushi; Robelia, Paul M; Kattel, Sharma B; McCoy, Christopher P; Keller, Allan Scott; Almasri, Jehad; Murad, Mohammad Hassan; Newman, James S; Kashiwagi, Deanne T

    2017-09-06

    Hospital discharge summaries enable communication between inpatient and outpatient physicians. Despite existing guidelines for discharge summaries, they are frequently suboptimal. The aim of this study was to assess physicians' perspectives about discharge summaries and the differences between summaries' authors (hospitalists) and readers (primary care physicians [PCPs]). A national survey of 1600 U.S. physicians was undertaken. Primary measures included physicians' preferences in discharge summary standardization, content, format, and audience. A total of 815 physicians responded (response rate = 51%). Eighty-nine percent agreed that discharge summaries "should have a standardized format." Most agreed that summaries should "document everything that was done, found, and recommended in the hospital" (64%) yet "only include details that are highly pertinent to the hospitalization" (66%). Although 74% perceived patients as an important audience of discharge summaries, only 43% agreed that summaries "should be written in language that patients…can easily understand," and 68% agreed that it "should be written solely for provider-to-provider communication." Compared with hospitalists, PCPs preferred comprehensive summaries (68% versus 59%, P = 0.002). More PCPs agreed that separate summaries should be created for patients and for provider-to-provider communication than hospitalists (60% versus 47%, P summary" (44% versus 23%, P summary" (60% versus 38%, P summaries should have a standardized format but do not agree on how comprehensive or in what format they should be. Efforts are necessary to build consensus toward the ideal discharge summary.

  16. Reduction of Hospital Physicians' Workflow Interruptions: A Controlled Unit-Based Intervention Study

    Directory of Open Access Journals (Sweden)

    Matthias Weigl

    2012-01-01

    Full Text Available Highly interruptive clinical environments may cause work stress and suboptimal clinical care. This study features an intervention to reduce workflow interruptions by re-designing work and organizational practices in hospital physicians providing ward coverage. A prospective, controlled intervention was conducted in two surgical and two internal wards. The intervention was based on physician quality circles - a participative technique to involve employees in the development of solutions to overcome work-related stressors. Outcome measures were the frequency of observed workflow interruptions. Workflow interruptions by fellow physicians and nursing staff were significantly lower after the intervention. However, a similar decrease was also observed in control units. Additional interviews to explore process-related factors suggested that there might have been spill-over effects in the sense that solutions were not strictly confined to the intervention group. Recommendations for further research on the effectiveness and consequences of such interventions for professional communication and patient safety are discussed.

  17. Intra-organizational dynamics as drivers of entrepreneurship among physicians and managers in hospitals of western countries.

    Science.gov (United States)

    Koelewijn, Wout T; Ehrenhard, Michel L; Groen, Aard J; van Harten, Wim H

    2012-09-01

    During the past decade, entrepreneurship in the healthcare sector has become increasingly important. The aging society, the continuous stream of innovative technologies and the growth of chronic illnesses are jeopardizing the sustainability of healthcare systems. In response, many European governments started to reform healthcare during the 1990s, replacing the traditional logic of medical professionalism with business-like logics. This trend is expected to continue as many governments will have to reduce their healthcare spending in response to the current growing budget deficits. In the process, entrepreneurship is being stimulated, yet little is known about intra-hospital dynamics leading to entrepreneurial behavior. The purpose of this article is to review existing literature concerning the influence of intra-organizational dynamics on entrepreneurship among physicians and managers in hospitals of Western countries. Therefore, we conducted a theory-led, systematic review of how intra-organizational dynamics among hospital managers and physicians can influence entrepreneurship. We designed our review using the neo-institutional framework of Greenwood and Hinings (1996). We analyze these dynamics in terms of power dependencies, interest dissatisfaction and value commitments. Our search revealed that physicians' dependence on hospital management has increased along with healthcare reforms and the resulting emphasis on business logics. This has induced various types of responses by physicians. Physicians can be pushed to adopt an entrepreneurial attitude as part of a defensive value commitment toward the business-like healthcare logic, to defend their traditionally dominant position and professional autonomy. In contrast, physicians holding a transformative attitude toward traditional medical professionalism seem more prone to adopt the entrepreneurial elements of business-like healthcare, encouraged by the prospect of increased autonomy and income. Interest

  18. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes.

    Science.gov (United States)

    Brown, Kyla N; Leigh, Jeanna Parsons; Kamran, Hasham; Bagshaw, Sean M; Fowler, Rob A; Dodek, Peter M; Turgeon, Alexis F; Forster, Alan J; Lamontagne, Francois; Soo, Andrea; Stelfox, Henry T

    2018-01-28

    Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.

  19. Consensus on the leadership of hospital CEOs and its impact on the participation of physicians in improvement projects

    NARCIS (Netherlands)

    Dückers, Michel L.A.; Stegeman, Inge; Spreeuwenberg, Peter; Wagner, Cordula; Sanders, Karin; Groenewegen, Peter P.

    2009-01-01

    Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

  20. Consensus on the leadership of hospital CEOs and its impact on the participation of physicians in improvement projects

    NARCIS (Netherlands)

    Duckers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.

    2009-01-01

    OBJECTIVES: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

  1. Consensus on the leadership of hospital CEO's and its impact on the participation of physicians in improvement projects

    NARCIS (Netherlands)

    Dückers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.

    2009-01-01

    Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

  2. The catastrophic collapse of morale among hospital physicians in Japan

    Directory of Open Access Journals (Sweden)

    Hideo Yasunaga

    2008-11-01

    Full Text Available Hideo YasunagaDepartment of Health Management and Policy, Graduate School of Medicine, University of Tokyo, Tokyo, JapanAbstract: The past few decades have witnessed bleak pictures of unhappy physicians worldwide. Japanese physicians working in hospitals are particularly distressed. Today, Japan’s healthcare system is near collapse because physicians are utterly demoralized. Their loss of morale is due to budget constraints, excessive demands, physician shortages, poor distribution, long working hours, hostile media, increasing lawsuits, and violence by patients. Severe cost-saving policies, inadequate distribution of healthcare resources, and the failure to communicate risks has damaged physicians’ morale and created conflicts between physicians and society. Physicians should communicate the uncertainty, limitations, and risks of modern medicine to all members of society. No resolution can be achieved unless trust exists between physicians, patients, the public, the media, bureaucrats, politicians and jurists.Keywords: physician’s morale, physician shortages, overwork, health policy

  3. Eliciting views on antibiotic prescribing and resistance among hospital and outpatient care physicians in Berlin, Germany: results of a qualitative study.

    Science.gov (United States)

    Velasco, Edward; Ziegelmann, Antina; Eckmanns, Tim; Krause, Gérard

    2012-01-01

    To better understand physicians' views on factors of influence for the prescribing of antibiotics and on antibiotic resistance in the Berlin region, Germany. Qualitative study with focus groups. Outpatient care and hospital care practice in the Berlin region, Germany. 7 General practitioners, two urologists, one paediatrician from outpatient care and eight internists, two paediatricians, two ear, nose and throat specialists and two urologists from hospital care. Physicians showed differential interest in topics related to antibiotic prescribing and antibiotic resistance. Outpatient care physicians were interested in topics around their own prescribing, such as being able to diagnose and prescribe precisely, and topics about patient demand and non-compliance. Hospital care physicians were interested in hygiene challenges, limited consult time and multi-resistant pathogens. Physicians considered the development of resistance to be more in the domain of clinical treatment than that of the patient. Major challenges related to antibiotic resistance for this group of physicians are access to and clarity of treatment recommendations, implementation of hygienic measures, as well as increased outsourcing of laboratory services. Results raise questions about whether meeting physicians' expectations should be a focus when developing intervention that aims to influence antibiotic resistance in this and other areas of Germany.

  4. Reconsidering the Affordable Care Act's Restrictions on Physician-Owned Hospitals: Analysis of CMS Data on Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Courtney, P Maxwell; Darrith, Brian; Bohl, Daniel D; Frisch, Nicholas B; Della Valle, Craig J

    2017-11-15

    Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA). With use of the U.S. Centers for Medicare & Medicaid Services (CMS) Inpatient Charge Data, we identified 45 physician-owned and 2,657 non-physician-owned hospitals that performed ≥11 primary TKA and THA procedures in 2014. Cost data, patient-satisfaction scores, and risk-adjusted complication and 30-day readmission scores for knee and hip arthroplasty patients were obtained from the multiyear CMS Hospital Compare database. Physician-owned hospitals received lower mean Medicare payments than did non-physician-owned hospitals for THA and TKA procedures ($11,106 compared with $12,699; p = 0.002). While the 30-day readmission score did not differ significantly between the 2 types of hospitals (4.48 compared with 4.62 for physician-owned and non-physician-owned, respectively; p = 0.104), physician-owned hospitals had a lower risk-adjusted complication score (2.83 compared with 3.04; p = 0.015). Physician-owned hospitals outperformed non-physician-owned hospitals in all patient-satisfaction categories, including mean linear scores for recommending the hospital (93.9 compared with 87.9; p CMS payment methodology. Our findings suggest that physician-owned hospitals are associated with lower mean Medicare costs, fewer complications, and higher patient satisfaction following THA and TKA than non-physician-owned hospitals. Policymakers should consider these data when debating the current moratorium on physician-owned hospital expansion. Therapeutic Level III. See

  5. A theory of physician-hospital integration: contending institutional and market logics in the health care field.

    Science.gov (United States)

    Rundall, Thomas G; Shortell, Stephen M; Alexander, Jeffrey A

    2004-01-01

    This article proposes a theory of physician-hospital integration. The theory is developed by building on three streams of scholarship: "new" institutionalism, "old" institutionalism, and the theory of economic markets. The theory uses several key concepts from these theoretical frameworks, including the notions of environmental demands for legitimacy, market demands for efficiency, and agency. To enhance the predictive power of the theory, two new concepts are introduced: directionality of influence between institutional and market forces at the macro-societal level, and degree of separation of institutional and market domains at the local level--which add important predictive power to the theory. Using these concepts, a number of hypotheses are proposed regarding the ideal types of physician-hospital arrangements that are likely to emerge under different combinations of directionality of influence and institutional and market domain separation. Moreover, the theory generates hypotheses regarding organizational dynamics associated with physician-hospital integration, including the conditions associated with high and low prevalence of physician-hospital integration, the extent to which the integrated organization is physician-centric or hospital-centric, and whether physician-hospital integration is likely to be based on loose contractual arrangements or tight, ownership-based arrangements.

  6. Hospital-physician collaboration: landscape of economic integration and impact on clinical integration.

    Science.gov (United States)

    Burns, Lawton Robert; Muller, Ralph W

    2008-09-01

    Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously.

  7. Medical tourism in India: perceptions of physicians in tertiary care hospitals.

    Science.gov (United States)

    Qadeer, Imrana; Reddy, Sunita

    2013-12-17

    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  8. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.

    Science.gov (United States)

    Janssen, Patricia A; Saxell, Lee; Page, Lesley A; Klein, Michael C; Liston, Robert M; Lee, Shoo K

    2009-09-15

    Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians. We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes. The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00-1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00-1.43) among women attended by a midwife and 0.64 (95% CI 0.00-1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29-0.36; assisted vaginal delivery, RR 0.41, 95% 0.33-0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28-0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49-0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14-0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24-0.59). The findings were similar in the comparison with

  9. Implementation Issues of Virtual Desktop Infrastructure and Its Case Study for a Physician's Round at Seoul National University Bundang Hospital.

    Science.gov (United States)

    Yoo, Sooyoung; Kim, Seok; Kim, Taegi; Kim, Jon Soo; Baek, Rong-Min; Suh, Chang Suk; Chung, Chin Youb; Hwang, Hee

    2012-12-01

    The cloud computing-based virtual desktop infrastructure (VDI) allows access to computing environments with no limitations in terms of time or place such that it can permit the rapid establishment of a mobile hospital environment. The objective of this study was to investigate the empirical issues to be considered when establishing a virtual mobile environment using VDI technology in a hospital setting and to examine the utility of the technology with an Apple iPad during a physician's rounds as a case study. Empirical implementation issues were derived from a 910-bed tertiary national university hospital that recently launched a VDI system. During the physicians' rounds, we surveyed patient satisfaction levels with the VDI-based mobile consultation service with the iPad and the relationship between these levels of satisfaction and hospital revisits, hospital recommendations, and the hospital brand image. Thirty-five inpatients (including their next-of-kin) and seven physicians participated in the survey. Implementation issues pertaining to the VDI system arose with regard to the highly availability system architecture, wireless network infrastructure, and screen resolution of the system. Other issues were related to privacy and security, mobile device management, and user education. When the system was used in rounds, patients and their next-of-kin expressed high satisfaction levels, and a positive relationship was noted as regards patients' decisions to revisit the hospital and whether the use of the VDI system improved the brand image of the hospital. Mobile hospital environments have the potential to benefit both physicians and patients. The issues related to the implementation of VDI system discussed here should be examined in advance for its successful adoption and implementation.

  10. Hospital Readmissions Following Physician Call System Change: A Comparison of Concentrated and Distributed Schedules.

    Science.gov (United States)

    Yarnell, Christopher J; Shadowitz, Steven; Redelmeier, Donald A

    2016-07-01

    Physician call schedules are a critical element for medical practice and hospital efficiency. We compared readmission rates prior to and after a change in physician call system at Sunnybrook Health Sciences Centre. We studied patients discharged over a decade (2004 through 2013) and identified whether or not each patient was readmitted within the subsequent 28 days. We excluded patients discharged for a surgical, obstetrical, or psychiatric diagnosis. We used time-to-event analysis and time-series analysis to compare rates of readmission prior to and after the physician call system change (January 1, 2009). A total of 89,697 patients were discharged, of whom 10,001 (11%) were subsequently readmitted and 4280 died. The risk of readmission was increased by about 26% following physician call system change (9.7% vs 12.2%, P system change (95% confidence interval, 22%-31%; P system change persisted across patients with diverse ages, estimated readmission risks, and medical diagnoses. The net effect was equal to 7240 additional patient days in the hospital following call system change. A modest increase was observed at a nearby acute care hospital that did not change physician call system, and no increase in risk of death was observed with increased hospital readmissions. We suggest that changes in physician call systems sometimes increase subsequent hospital readmission rates. Further reductions in readmissions may instead require additional resources or ingenuity. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study.

    Science.gov (United States)

    Trimmel, Helmut; Beywinkler, Christoph; Hornung, Sonja; Kreutziger, Janett; Voelckel, Wolfgang G

    2017-04-26

    Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer's qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems. From 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5-42.5) vs. 19.0 (15.0-27.0) during initial training; 62.0 (41.8-86.5) vs. 33.5 (18.0-54.5) during the first, and 64.0 (34.5-93.8) vs. 27 (12.5-56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0-14.8) TIs vs. 0.0 (0.0-0.0) SGA cases during the first, and 9.0 (7.0-13.8) TIs vs. 0.0 (0.0-0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%. Number of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to

  12. Quantifying culture gaps between physicians and managers in Dutch hospitals: a survey

    Directory of Open Access Journals (Sweden)

    Meerdink Nienke

    2010-04-01

    Full Text Available Abstract Background The demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers. The complex relationship between both groups has been described in literature. We aim to add a perspective to literature, by developing a questionnaire which provides an opportunity to quantitatively report and elaborate on the size and content of differences between physicians and managers. Insight gained from use of the questionnaire might enable us to reflect on these differences and could provide practical tools to improve cooperation between physicians and managers, with an aim to enhance hospital performance. Methods The CG-Questionnaire was developed by adjusting, pre-testing, and shortening Kralewski's questionnaire, and appeared suitable to measure culture gaps. It was shortened by exploratory factor analysis, using principal-axis factoring extraction with Varimax rotation. The CG-Questionnaire was sent to all physicians and managers within 37 Dutch general hospitals. ANOVA and paired sample T-tests were used to determine significant differences between perceptions of daily work practices based in both professional cultures; culture gaps. The size and content of culture gaps were determined with descriptive statistics. Results The total response (27% consisted of 929 physicians and 310 managers. The Cronbachs alpha's were 0.70 - 0.79. Statistical analyses showed many differences; culture gaps were found in the present situation; they were even larger in the preferred situation. Differences between both groups can be classified into three categories: (1 culture gaps in the present situation and not in the preferred, (2 culture gaps in the preferred situation and not in the present, and (3 culture gaps in both situations. Conclusions With data from the CG-Questionnaire it is now possible to measure the size and content of culture gaps between physicians and

  13. The impact of professional and organizational identification on the relationship between hospital-physician exchange and customer-oriented behaviour of physicians.

    Science.gov (United States)

    Trybou, Jeroen; De Caluwé, Gaelle; Verleye, Katrien; Gemmel, Paul; Annemans, Lieven

    2015-02-17

    Hospitals face increasingly competitive market conditions. In this challenging environment, hospitals have been struggling to build high-quality hospital-physician relationships. In the literature, two types of managerial strategies for optimizing relationships have been identified. The first focuses on optimizing the economic relationship; the second focuses on the noneconomic dimension and emphasizes the cooperative structure and collaborative nature of the hospital-physician relationship. We investigate potential spillover effects between the perceptions of physicians of organizational exchange and their customer-oriented behaviors. A cross-sectional study was conducted on 130 self-employed physicians practicing at six Belgian hospitals. Economic exchange was measured using the concept of distributive justice (DJ); noneconomic exchange was measured by the concept of perceived organizational support (POS). Our outcomes consist of three types of customer-oriented behaviours: internal influence (II), external representation (ER), and service delivery (SD). Our results show a positive relationship between DJ and II (adjusted R(2) = 0.038, t = 2.35; p = 0.028) and ER (adjusted R(2) = 0.15, t = 4.59; p relationship between POS and II (adjusted R(2) = 0.032, t = 2.26; p = 0.026) and ER (adjusted R(2) = 0.22, t = 5.81; p relationship was present between DJ (p = 0.54) or POS (p = 0.57) and SD. Organizational identification positively moderates the relationship between POS and ER (p = 0.045) and between DJ and ER (p = 0.056). The relationships between POS and II (p = 0.54) and between DJ and II (p = 0.99) were not moderated by OI. Professional identification did not moderate the studied relationships. Our results demonstrate that both perceptions of economic and noneconomic exchange are important to self-employed physicians' customer-oriented behaviours. Fostering organizational identification could enhance this reciprocity dynamic.

  14. Prevalence and factors associated with pregnancy loss among physicians in King Abdul-Aziz University Hospital, Saudi Arabia.

    Science.gov (United States)

    Alshora, Weam Bashier I; Mohammad Kalo, Bakr

    2018-04-01

    Medical profession is a stressful occupation as it carries potential risk for pregnancy outcome. There is lack of researches regarding the pregnancy loss among physicians working in hospitals in Saudi Arabia. The current study aims at estimating the prevalence and factors associated with pregnancy loss among female physicians working at King Abdul-Aziz University Hospital in Jeddah, September, 2015. A cross sectional study has been conducted, which included all the female physicians working at King Abdul-Aziz University Hospital in Jeddah by filling a self-administered online questionnaire. Out of all responding physicians (n = 92), the majority were Saudis (93.5%), who were mostly married (89.1%) and rest were either divorced (8.7%) or widowed (2.2%). Seventeen female physicians had pregnancy loss before (18.5%) with a total of 25 losses, which were mostly occurred during first trimester, especially while working as residents (40%), the average monthly working hours in the first pregnancy loss was (median; IQR, 160, 110-198 h). No statistically significant difference could be detected regarding the variation in pregnancy losses according to nationality marital status nor specialty. Most of the pregnancy losses in physicians occurred in first trimester during residency with a relatively longer monthly working hours. Further researches are needed on a larger sample and wider scale with inclusion of other pertinent factors to enable judging on the independent relationship of pregnancy loss and medical profession. Copyright © 2018. Published by Elsevier B.V.

  15. Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice.

    Science.gov (United States)

    Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

    2003-01-01

    It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

  16. Taking care of hospital physicians: Development and implementation of a job-specific workers’ health surveillance

    NARCIS (Netherlands)

    Ruitenburg, M.M.

    2016-01-01

    A Workers’ Health Surveillance (WHS) can serve as an occupational health strategy to maintain or promote work-related health and work functioning of employees. The aims of this thesis were to assess the evidence-based content of a job-specific WHS for hospital physicians (medical specialists and

  17. Assessment of the relation of violence and burnout among physicians working in the emergency departments in Turkey.

    Science.gov (United States)

    Erdur, Bülent; Ergin, Ahmet; Yüksel, Aykut; Türkçüer, İbrahim; Ayrık, Cüneyt; Boz, Bora

    2015-05-01

    Violence and burnout are frequently seen among medical doctors; however, the relation is not clear. This study aimed to assess the violence and its possible effects on burnout in physicians working in emergency units. This cross-sectional study targeted all physicians working in the emergency units of Pamukkale University Hospital, County and City Hospitals, 112 Emergency Services, and Private Hospitals in Denizli. Data were obtained by means of a self-administered questionnaire that consisted of questions on the demographics of the participants, Turkish version of the Maslach Burnout Inventory, and of the perpetrators of violence. What was also documented on the questionnaire was whether participants had been subjected to or had witnessed any verbal or physical violence during the previous one month of emergency physicians' certification program. A total of one hundred and seventy-four physicians were included into the study (85% of the targeted group). Many of the participants were between 24 and 59 years of age, with a mean age of 36.8±5.8 years. Married male doctors working in the City Hospital made up the majority. There were significant associations between emotional exhaustion and total violence (p=0.012) and verbal violence (p=0.016); depersonalization and total violence (p=0.021) and verbal violence (p=0.012). The results presented here indicated that there was a strong relation between burnout and violence experienced by physicians working in emergency units. Violence in the emergency department has a substantial effect on the physicians' well-being.

  18. [Exposure to limited resources in the gastroenterology - results of a survey of hospital physicians].

    Science.gov (United States)

    Kerkemeyer, L; Reifferscheid, A; Pomorin, N; Wasem, J

    2016-11-01

    Background and research question: The hospital sector is currently characterized by a high economic pressure. As well the DRG system as the investment financing by the federal states imply financial limitations. Hospitals react to this situation by trying to reduce costs and to increase case volume. It is questionable whether and to what extent patient care and the working conditions of the physicians are affected by these circumstances. Especially, gastroenterological patients were considered to be insufficiently covered by the DRG system in the past. Therefore, this study focuses on the gastroenterology. Method: Based on prior studies and several semi-structured interviews with gastroenterologists working in hospitals a discipline-specific questionnaire was developed. Three versions of the questionnaire were differentiated to correspond to the respective experiences of the target population (chief physician, senior physician, assistant physician). All in all, 1751 members of the "Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten" (DGVS) were addressed. The questionnaire was answered by 642 participants resulting in a response rate of 36.7 %. The answers were interpreted by using descriptive and multivariate analyses. Results: A significant economic pressure is perceived by the participating gastroenterologists. This pressure manifests itself primary in perceived deficits in nursing care and human attention towards the patients. Moreover, the work satisfaction is negatively affected. Identified difficulties in the personnel recruitment can only be partially attributed to economic reasons. However, rationing of services is relatively seldom. Also, a financially-oriented overprovision is not perceived as a primary concern. In general, assistant physicians were a bit more skeptical about the situation in the gastroenterology, e. g. patient care, than the chief physicians. Conclusions: In total, the situation in the

  19. Medical tourism in india: perceptions of physicians in tertiary care hospitals

    Science.gov (United States)

    2013-01-01

    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  20. Job satisfaction and the work situation of physicians: a survey at a German university hospital.

    Science.gov (United States)

    Laubach, Wilfried; Fischbeck, Sabine

    2007-01-01

    Job demands and workload of hospital physicians are increasing. The object of this survey was to examine the factors that constitute job satisfaction and to analyse physicians' work situation in the area of in-patient care. 447 physicians at a German University Hospital received questionnaires with regard to work situation, job satisfaction and personal health. Data were analysed by MANOVA and multiple regression models. A first regression model explained 53% of the variance in satisfaction with "work and profession". Among the explanatory variables "superiors and hierarchy" showed the highest beta-weight (beta = -0.49). "Personal health" also determined job satisfaction, for female physicians stronger (beta = -0.31) than for male physicians (beta = -0.11). In a second regression model on satisfaction with "Financial situation" only 18% of the variance was explained, whereby "work condition on the ward", "personal health" and "collaboration between occupational groups" showed the highest beta-weights. Among resident physicians, work conditions, superiors, hierarchy, transparency and participation in decisions are very important variables for job satisfaction. Improvements in these aspects may improve job satisfaction and help to reduce physician shortage in hospitals.

  1. Relation Between Physicians' Work Lives and Happiness.

    Science.gov (United States)

    Eckleberry-Hunt, Jodie; Kirkpatrick, Heather; Taku, Kanako; Hunt, Ronald; Vasappa, Rashmi

    2016-04-01

    Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. We sampled 2000 full-time physician members of the American Academy of Family Physicians. Respondents completed a demographics questionnaire, questions about workload, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Subjective Happiness Scale. We performed a hierarchical regression analysis with the burnout and wellness subscales as predictor variables and physician happiness as the outcome variable. Our response rate was 22%. Career purpose, personal accomplishment, and perception of workload manageability had significant positive correlations with physician happiness. Distress had a significant negative correlation with physician happiness. A sense of career meaning and accomplishment, along with a lack of distress, are important factors in determining physician happiness. The number of hours a physician works is not related to happiness, but the perceived ability to manage workload was significantly related to happiness. Wellness-promotion efforts could focus on assisting physicians with skills to manage the workload by eliminating unnecessary tasks or sharing workload among team members, improving feelings of work accomplishment, improving career satisfaction and meaning, and managing distress related to patient care.

  2. 42 CFR 415.162 - Determining payment for physician services furnished to beneficiaries in teaching hospitals.

    Science.gov (United States)

    2010-10-01

    ... furnished to beneficiaries in teaching hospitals. 415.162 Section 415.162 Public Health CENTERS FOR MEDICARE... BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.162 Determining payment for physician services...

  3. Relationships of hospital-based emergency department culture to work satisfaction and intent to leave of emergency physicians and nurses.

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Wan, Thomas T H; Hsu, Chung-Ping Cliff; Hung, Feng-Ru; Juan, Chi-Wen; Lin, Cheng-Chieh

    2012-05-01

    Given the limited studies on emergency care management, this study aimed to explore the relationships of emergency department (ED) culture values to certain dimensions of ED physicians' and nurses' work satisfaction and intent to leave. Four hundred and forty-two emergency medical professionals completed the employee satisfaction questionnaire across 119 hospital-based EDs, which had culture value evaluations filed, were used as unit of analysis in this study. Adjusting the personal and employment backgrounds, and the surrounded EDs' unit characteristics and environmental factors, multiple regression analyses revealed that clan and market cultures were related to emergency physicians' work satisfaction and intent to leave. On the other hand, adhocracy, market and hierarchical cultures were related to emergency nurses' work satisfaction. There do exist different patterns among various culture types on various work satisfaction dimensions and intent to leave of emergency physicians and nurses. The findings could offer hospital and ED leaders insights for changes or for building a better atmosphere to enhance the work life of emergency physicians and nurses.

  4. Four minutes for a patient, twenty seconds for a relative - an observational study at a university hospital

    Directory of Open Access Journals (Sweden)

    Xander Carola J

    2010-04-01

    Full Text Available Abstract Background In the modern hospital environment, increasing possibilities in medical examination techniques and increasing documentation tasks claim the physicians' energy and encroach on their time spent with patients. This study aimed to investigate how much time physicians at hospital wards spend on communication with patients and their families and how much time they spend on other specific work tasks. Methods A non-participatory, observational study was conducted in thirty-six wards at the University Medical Center Freiburg, a 1700-bed academic hospital in Germany. All wards belonging to the clinics of internal medicine, surgery, radiology, neurology, and to the clinic for gynaecology took part in the study. Thirty-four ward doctors from fifteen different medical departments were observed during a randomly chosen complete work day. The Physicians' time for communication with patients and relatives and time spent on different working tasks during one day of work were assessed. Results 374 working hours were analysed. On average, a physician's workday on a university hospital ward added up to 658.91 minutes (10 hrs 58 min; range 490 - 848 min. Looking at single items of time consumption on the evaluation sheet, discussions with colleagues ranked first with 150 minutes on average. Documentation and administrative requirements took an average time of 148 minutes per day and ranked second. Total time for communication with patients and their relatives was 85 minutes per physician and day. Consequently, the available time for communication was 4 minutes and 17 seconds for each patient on the ward and 20 seconds for his or her relatives. Physicians assessed themselves to communicate twice as long with patients and sevenfold with relatives than they did according to this study. Conclusions Workload and time pressure for physicians working on hospital wards are high. To offer excellent medical treatment combined with patient centred care and

  5. Wide variation in hospital and physician payment rates evidence of provider market power.

    Science.gov (United States)

    Ginsburg, Paul B

    2010-11-01

    Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets--Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin--average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation.

  6. Building a Physician Culture for Healthcare Transformation: A Hospital's Leadership Challenge.

    Science.gov (United States)

    Hemker, Robert A; Solomon, Leslie A

    2016-01-01

    Engaging and integrating physicians has become the veritable "brass ring" for many hospital systems: many attempts and few actual wins. This is especially true in California's managed care environment and for public entities such as Palomar Health in Escondido, California. Our commitment to engage and integrate physicians continues to be a vital element of a larger cultural shift toward delivery of care that puts the patients' needs first. A key determinant of success has been the ability to align a diverse medical staff culture with administrative priorities. This alignment involves a carefully executed strategy and a structure to build a collective identity among diverse players. Palomar Health is in the third year of the journey. Some of the critical milestones have been the implementation of a physician leadership development process, creation of a physician onboarding process to codify the desired physician culture, delineation of roles and expectations for physician leadership, and formalization of dyad and triad partnerships between physicians and their clinical and administrative partners.

  7. Distribution of physicians and hospital beds based on Gini coefficient and Lorenz curve: A national survey

    Directory of Open Access Journals (Sweden)

    Satar Rezaei

    2016-06-01

    Full Text Available Introduction: Inequality is prevalent in all sectors, particularly in distribution of and access to resources in the health sector. The aim of current study was to investigate the distribution of physicians and hospital beds in Iran in 2001, 2006 and 2011. Methods: This retrospective, cross-sectional study evaluated the distribution of physicians and hospital beds in 2001, 2006 and 2011 using Gini coefficient and Lorenz curve. The required data, including the number of physicians (general practitioners and specialists, number of hospital beds and number of hospitalized patients were obtained from the statistical yearbook of Iranian Statistical Center (ISC. The data analysis was performed by DASP software. Results: The Gini Coefficients for physicians and hospital beds based on population in 2001 were 0.19 and 0.16, and based on hospitalized patients, were 0.48 and 0.37, respectively. In 2006, these values were found to be 0.18 and 0.15 based on population, and 0.21 and 0.21 based on hospitalized patients, respectively. In 2011, however, the Gini coefficients were reported to be 0.16 and 0.13 based on population, and 0.47 and 0.37 based on hospitalized patients, respectively. Although distribution status had improved in 2011compared with 2001 in terms of population and number of hospitalized patients, there was more inequality in distribution based on the number of hospitalized patients than based on population. Conclusion: This study indicated that inequality in distribution of physicians and hospital beds was declined in 2011 compared with 2001. This distribution was based on the population, so it is suggested that, in allocation of resource, the health policymakers consider such need indices as the pattern of diseases and illness-prone areas, number of inpatients, and mortality.

  8. Maternity Care Services Provided by Family Physicians in Rural Hospitals.

    Science.gov (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  9. Attitudes and relationship between physicians and the pharmaceutical industry in a public general hospital in Lima, Peru.

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    Aldo De Ferrari

    Full Text Available BACKGROUND: The interaction between physicians and the pharmaceutical industry influences physicians' attitudes and prescribing behavior. Although largely studied in the US, this topic has not been well studied in resource-poor settings, where a close relationship between physicians and industry still exists. OBJECTIVE: To describe physician interactions with and attitudes towards the pharmaceutical industry in a public general hospital in Lima, Peru. DESIGN: Descriptive, cross-sectional study through an anonymous, self-filled questionnaire distributed among faculty and trainee physicians of five different clinical departments working in a Peruvian public general hospital. A transcultural validation of an existing Spanish questionnaire was performed. Exposure to marketing activities, motivations to contact pharmaceutical representatives and attitudes towards industry were studied. Collected data was analyzed by degree of training, clinical department, gender and teaching status. Attitudes were measured on a four-point LIKERT scale. RESULTS: 155 physicians completed the survey, of which 148 were included in the study sample. 94.5% of attending physicians reported ongoing encounters with pharmaceutical representatives. The most common industry-related activities were receiving medical samples (91.2%, promotional material (87.8% and attending meetings in restaurants (81.8%. Respondents considered medical samples and continuing medical education the most ethically acceptable benefits. We found significant differences between attendings and residents, and teaching and non-teaching attendings. An association between the amount of encounters with pharmaceutical representatives, and attitudes towards industry and acceptance of medical samples was found. CONCLUSIONS: A close physician-industry relationship exists in the population under study. The contact is established mainly through pharmaceutical representatives. Medical samples are the most received

  10. [Analysis of drug-related problems in a tertiary university hospital in Barcelona (Spain)].

    Science.gov (United States)

    Ferrández, Olivia; Casañ, Borja; Grau, Santiago; Louro, Javier; Salas, Esther; Castells, Xavier; Sala, Maria

    2018-05-07

    To describe drug-related problems identified in hospitalized patients and to assess physicians' acceptance rate of pharmacists' recommendations. Retrospective observational study that included all drug-related problems detected in hospitalized patients during 2014-2015. Statistical analysis included a descriptive analysis of the data and a multivariate logistic regression to evaluate the association between pharmacists' recommendation acceptance rate and the variable of interest. During the study period 4587 drug-related problems were identified in 44,870 hospitalized patients. Main drug-related problems were prescription errors due to incorrect use of the computerized physician order entry (18.1%), inappropriate drug-drug combination (13.3%) and dose adjustment by renal and/or hepatic function (11.5%). Acceptance rate of pharmacist therapy advice in evaluable cases was 81.0%. Medical versus surgical admitting department, specific types of intervention (addition of a new drug, drug discontinuation and correction of a prescription error) and oral communication of the recommendation were associated with a higher acceptance rate. The results of this study allow areas to be identified on which to implement optimization strategies. These include training courses for physicians on the computerized physician order entry, on drugs that need dose adjustment with renal impairment, and on relevant drug interactions. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. New arrangements, new scrutiny. The IRS reconsiders hospital-physician relationships at tax-exempt facilities.

    Science.gov (United States)

    Sullivan, T J

    1992-01-01

    The pressure to maintain adequate operating margins has forced many not-for-profit hospitals to adopt more overtly competitive behavior than they have in the past. However, in struggling to remain economically viable, these facilities should carefully avoid actions that would threaten their tax-exempt status. Not-for-profit facilities should be particularly careful that their arrangements with physicians, which often appear designed to increase referrals, do not violate the criteria according to which the Internal Revenue Code extends tax exemption to charitable organizations. Section 501(c)(3) of the code exempts organizations "no part of the net earnings of which inures to the benefit of any private shareholder or individual." According to this provision, "insiders" (i.e., those with a personal interest in or opportunity to influence organization activities from the inside) are entitled to no more than reasonable payment for their goods or services. The Internal Revenue Service (IRS) takes the position that, as employees or individuals having a close professional working relationship with a hospital, physicians are insiders. Thus a hospital that pays physicians what the IRS judges to be more than fair market value for services (or charges physicians less than fair market value for office rental) may find its exemption in jeopardy. If not-for-profit hospitals want to maintain their tax-exempt status, they must be certain the arrangements they enter into with physicians truly further their exempt purpose: to promote the health of the community.

  12. Workplace violence against physicians and nurses in Palestinian public hospitals: a cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7%) were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no) and the respondents’ characteristics using logistic regression model. Results The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47), and a lower level of education (OR: 3; 95% CI 1.29-6.67) among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main reasons were lack of

  13. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Hamilton, Annika; Steinmetz, Jacob; Wissenberg, Mads

    2016-01-01

    AIM: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician...

  14. Costs of Planned Home vs. Hospital Birth in British Columbia Attended by Registered Midwives and Physicians.

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    Patricia A Janssen

    Full Text Available Home birth is available to women in Canada who meet eligibility requirements for low risk status after assessment by regulated midwives. While UK researchers have reported lower costs associated with planned home birth, there have been no published studies of the costs of home versus hospital birth in Canada.Costs for all women planning home birth with a regulated midwife in British Columbia, Canada were compared with those of all women who met eligibility requirements for home birth and were planning to deliver in hospital with a registered midwife, and with a sample of women of similar low risk status planning birth in the hospital with a physician. We calculated costs of physician service billings, midwifery fees, hospital in-patient costs, pharmaceuticals, home birth supplies, and transport. We compared costs among study groups using the Kruskall Wallis test for independent groups.In the first 28 days postpartum, we report a $2,338 average savings per birth among women planning home birth compared to hospital birth with a midwife and $2,541 compared to hospital birth planned with a physician. In longer term outcomes, similar reductions were observed, with cost savings per birth at $1,683 compared to the planned hospital birth with a midwife, and $1,100 compared to the physician group during the first eight weeks postpartum. During the first year of life, costs for infants of mothers planning home birth were reduced overall. Cost savings compared to planned hospital births with a midwife were $810 and with a physician $1,146. Costs were similarly reduced when findings were stratified by parity.Planned home birth in British Columbia with a registered midwife compared to planned hospital birth is less expensive for our health care system up to 8 weeks postpartum and to one year of age for the infant.

  15. First and foremost, physicians: the clinical versus leadership identities of physician leaders.

    Science.gov (United States)

    Quinn, Joann Farrell; Perelli, Sheri

    2016-06-20

    Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer

  16. The opinions of nurses and physicians related to euthanasia

    Directory of Open Access Journals (Sweden)

    Nihal İşler

    2010-09-01

    Full Text Available Objective: The research was conducted to investigate the opinions of nurses and physicians pertaining to euthanasia who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital.Methods: The research is a descriptive one. The sample consisted of 154 nurses and physicians who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital and accepted to participate and could be reached. A questionnaire with 30 items was used to collect data to obtain the socio-demographic characteristics and the opinions pertaining to euthanasia of nurses and physicians. Frequencies, mean values and chi-square tests were used in statistical analysis.Results: The participants didn’t approve euthanasia with a high ratio however it was determined that almost half of them asserted it as patient’s rights of a patient who want his/her death to be fastened and who has no chance to be cured and who are spending the last days of their life with unbearable pain. Except the age groups and marital status there was no significant difference found statistically between the opinions of physicians and nurses regarding euthanasia (p>0.05.Conclusion: It was stated that nurses and physicians consider not active euthanasia but passive euthanasia as acceptable.

  17. Matrix organization increases physician, management cooperation.

    Science.gov (United States)

    Boissoneau, R; Williams, F G; Cowley, J L

    1984-04-01

    Because of the development of multihospital systems and the establishment of diagnosis related groups, hospitals increasingly will establish matrix organizations for their corporate structures. St. Luke's Hospital adopted the matrix concept in the mid-1970s, utilizing program administrators for each specialty service or "clinical center of excellence." Such centers have been developed in digestive diseases, cardiovascular and pulmonary medicine, orthopedics and rheumatology, ophthalmology, and behavioral health. The program administrator's functions are diverse: To serve as primary liaison between physicians and the hospital; To project levels of program utilization and patient and physician satisfaction, to identify areas requiring administrative and marketing emphasis, and to develop the program's marketing plan; To develop, implement, and evaluate the program's strategic, operational, and financial plans; To recruit physicians to practice at St. Luke's and to cultivate referrals from outside physicians; To participate in selecting members of all board and medical staff committees relating to the particular specialty area; and To determine the need for new programs within the specialty area and to develop services. As indicated by a medical staff survey, most physicians at St. Luke's believe that the program administrator system has improved communication with the hospital administration, that the program administrator is able to respond effectively to physician requests and problems, and that the quality of patient care has been enhanced. A great majority said they would recommend the system to other hospitals.

  18. Nurse-physician collaboration impacts job satisfaction and turnover among nurses: A hospital-based cross-sectional study in Beijing.

    Science.gov (United States)

    Zhang, Lin; Huang, Lei; Liu, Meng; Yan, Hong; Li, Xiue

    2016-06-01

    This study aims to explore the impact of physician-nurse collaboration on nurse job satisfaction and turnover in a dental hospital. Physician-nurse collaboration is important for the stability of the entire nursing team. Few studies have shown the impact on job satisfaction and turnover among nurses working in Chinese dental hospitals. This was a prospective, cross-sectional study and investigated nurses from a tertiary dental hospital in Beijing using convenience non-randomized sampling. A structured questionnaire was used to collect data, which included general information, the Index of Work Satisfaction, the Nurse-Physician Collaboration Scale and the Turnover Intention Scale. The scores of physician-nurse collaboration correlated positively with those for job satisfaction and negatively with the stated likelihood of turnover intention. Physician-nurse collaboration scores positively predicted job satisfaction and negatively predicted the likelihood of quitting the current job. In conclusion, improving the level of physician-nurse collaboration is helpful to enhance job satisfaction and reduce turnover among nurses in a dental hospital. © 2016 John Wiley & Sons Australia, Ltd.

  19. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study

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    Ruitenburg Martijn M

    2012-08-01

    Full Text Available Abstract Background We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. Methods A questionnaire was sent to all (n = 958 hospital physicians of one academic medical center, using validated scales to assess burnout, work-related fatigue, stress, posttraumatic stress disorder (PTSD, anxiety and depression. Furthermore, respondents were asked to rate their current work ability against the work ability in their own best period (adapted version of the first WAI item. The prevalence of each common mental disorder was calculated. In addition, odds ratios of reporting insufficient work ability for subjects with high complaint scores compared to physicians with low complaint scores were calculated for each mental disorder. Results The response rate was 51%, and 423 questionnaires were eligible for analysis. The mental disorder prevalence rates were as follows: work-related fatigue 42%, depression 29%, anxiety 24%, posttraumatic stress complaints 15%, stress complaints 15% and burnout 6%. The mean score for self-reported work ability was 8.1 (range 0–10, and 4% of respondents rated their own work ability as insufficient. Physicians with high mental health complaints were 3.5- for fatigue, 5.6- for PTSD, 7.1- for anxiety, 9.5- for burnout, 10.8- for depression and 13.6-fold for stress more likely to report their work ability as insufficient. Conclusions The prevalence of common mental disorders among hospital physicians varied from 6% for burnout to 42% for work-related fatigue. Those physicians with high complaints had significantly 4- to 14 times increased odds of reporting their own work ability as insufficient. This work suggests that to ensure future workers health and patients safety occupational health services should plan appropriate intervention strategies.

  20. Resident physicians' attitudes and confidence in communicating with patients: a pilot study at a Japanese university hospital.

    Science.gov (United States)

    Ishikawa, Hirono; Eto, Masato; Kitamura, Kiyoshi; Kiuchi, Takahiro

    2014-09-01

    This study aimed to explore the relationships among physicians' confidence in conducting medical interviews, their attitudes toward the patient-physician relationship, and undergraduate training in communication skills among resident physicians in Japan. Participants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary-Cambridge Guide. Additionally, participants' attitudes toward the patient-physician relationship (Patient-Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire. The internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS. These scales could be useful tools to measure physicians' confidence and attitudes in communicating with patients and to explore their changes through medical education. Residency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study

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    Lauridsen KG

    2017-03-01

    Full Text Available Kasper G Lauridsen,1–3 Anders S Schmidt,1–3 Philip Caap,3,4 Rasmus Aagaard,2,3,5 Bo Løfgren1,3,4 1Department of Internal Medicine, 2Clinical Research Unit, Regional Hospital of Randers, Randers, 3Research Center for Emergency Medicine, Aarhus University Hospital, 4Institute of Clinical Medicine, Aarhus University, Aarhus, 5Department of Anesthesiology, Randers Regional Hospital, Denmark Background: The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods: We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results: In total, 93 physicians (53% male from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39 years. Respondents were medical students working as locum physicians (5%, physicians in training (79% and consultants (16%, and the median postgraduate clinical experience was 48 (19–87 months. Most respondents (92% felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41% and focused cardiac ultrasound (39% during cardiac arrest. Median time since last CPR training was 4 (2–10 months, and 48% had attended a European Resuscitation Council (ERC Advanced Life Support course. The majority (84% felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion: Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have

  2. Measuring clinical management by physicians and nurses in European hospitals: development and validation of two scales.

    Science.gov (United States)

    Plochg, Thomas; Arah, Onyebuchi A; Botje, Daan; Thompson, Caroline A; Klazinga, Niek S; Wagner, Cordula; Mannion, Russell; Lombarts, Kiki

    2014-04-01

    Clinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals. Testing of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE). A sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey. Validity and reliability of professional involvement scales and subscales. Psychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between 'Administration and budgeting' and 'Managing medical practice' among physicians, all inter-scale correlations were measurement instrument can be used for international research on clinical management.

  3. Do hospital physicians really want to go digital? Acceptance of a picture archiving and communication system in a university hospital

    International Nuclear Information System (INIS)

    Duyck, P.; Pynoo, B.; Devolder, P.; Voet, T.; Adang, L.; Vercruysse, J.

    2008-01-01

    Purpose: radiology departments are making the transition from analog film to digital images by means of PACS (Picture Archiving and Communication System). It is critical for the hospital that its physicians adopt and accept the new digital work method regarding radiological information. The aim of this study is to investigate hospital physicians' acceptance of PACS using questionnaires pre- and post-implementation and to identify main influencing factors. Materials and methods: the study was conducted in an 1169 bed university hospital. The UTAUT (Unified Theory of Acceptance and Use of Technology) questionnaire was administered at two times: one month pre-implementation (T1) and 1.5 years post-implementation (T2) of PACS, targeting all hospital physicians with the exemption of radiologists. The UTAUT scales (Behavioral Intention BI; Facilitating Conditions FC; Effort Expectancy EE; Performance Expectancy PE; Anxiety ANX; Social Influence SI; System Use USE; Attitude toward technology ATT; Self-Efficacy SE) were used to assess questions regarding: (a) PACS' usefulness, (b) PACS' ease of learning/using, (c) PACS support availability, (d) the perceived pressure to use PACS, (e) physicians' attitude towards PACS and (f) physicians' intention to use and actual use of PACS. Results: at T1 scale ratings were positive toward the PACS implementation. The ratings on all scales with the exception of self-efficacy improved at T2. Regression analysis revealed that the key factor for intention to use PACS at T1 was the usefulness of PACS, while the availability and awareness of support was its most important predictor at T2. Overall, PE was the best predictor of BI, but all four UTAUT-determinants (PE, FC, EE and SI) were salient for its prediction. Variance explained in BI ranged from 31 to 37% while variance explained in USE was very low (3%). (orig.)

  4. [Innovative culture and diagnosis related groups in a high complexity hospital, Colombia].

    Science.gov (United States)

    Gorbanev, Iouri; Agudelo-Londoño, Sandra; Cortes, Ariel; Yepes, Francisco J

    2016-04-01

    Objectives To characterize the perception of Diagnosis-Related Groups (DRGs) as an innovation among physicians, nurses and administrative staff in a hospital in Colombia. Methods A case study of innovative culture in a hospital. Surveys and focus groups were carried out with the medical, nursing and administrative staff. Descriptive statistics were calculated for the perceptions of innovative culture. Comparative analysis was done between professional groups. The results of the focus groups were transcribed and analyzed to deepen the findings of the surveys. Results Significant differences were found in perceptions of the innovative culture. The nursing staff were more enthusiastic than doctors when evaluating the innovative culture and leadership. Physicians felt more autonomy when discussing professional issues. Administrative staff assessed the Hospital's disposition to acquire new medical technologies as higher than that of physicians. The three groups know little about DRG's. Conclusions When implementing a health innovation it is advisable to analyze its effect on the professionals who participate in the implementation. Physicians perceive DRGs as a threat to their professional autonomy, while nurses see it as a pro-innovation force. It is important to involve nursing and administrative staff when implementing this kind of innovation.

  5. Referring Physicians' Tendency to Collaborate With Radiologists in Managing Contrast Media-Related Risk Factors.

    Science.gov (United States)

    İmamoğlu, Hakan; Doğan, Serap; Erdoğan, Nuri

    2018-02-01

    The aim of this study was to investigate the tendency of referring physicians to collaborate with radiologists in managing contrast media (CM)-related risk factors. The study was conducted at a single academic hospital. Among 150 referring physicians from various specialties, 51 referring physicians (34%) responded to the invitation letter asking for an interview with a radiologist. During the interview, a modified form of the Control Preferences Scale was administered, in which there were five preferences (each displayed on a separate card) that ranged from the fully active to fully passive involvement of referring physicians in managing CM-related risk factors. A descriptive analysis was performed through categorization of the results depending on the respondents' two most preferred roles. Thirty-six referring physicians (70.5%) preferred a collaborative role, and 15 (29.4%) preferred a noncollaborative role (i.e., remained on either the fully active or fully passive side). Among the referring physicians who preferred a collaborative role, the most common response (n = 15 [29.4%]) was collaborative-active. Referring physicians at the authors' institution have basic cognitive and motivational-affective tone toward collaboration in future teamwork aimed at the management of CM-related risk factors. A modified form of the Control Preferences Scale, as in this study, can be used to investigate the tendency of referring physicians to collaborate with radiologists. The results are discussed from ethical and legal perspectives. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  6. Workplace violence against physicians and nurses in Palestinian public hospitals: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kitaneh Mohamad

    2012-12-01

    Full Text Available Abstract Background Violence against healthcare workers in Palestinian hospitals is common. However, this issue is under researched and little evidence exists. The aim of this study was to assess the incidence, magnitude, consequences and possible risk factors for workplace violence against nurses and physicians working in public Palestinian hospitals. Methods A cross-sectional approach was employed. A self-administered questionnaire was used to collect data on different aspects of workplace violence against physicians and nurses in five public hospitals between June and July 2011. The questionnaires were distributed to a stratified proportional random sample of 271 physicians and nurses, of which 240 (88.7% were adequately completed. Pearson’s chi-square analysis was used to test the differences in exposure to physical and non-physical violence according to respondents’ characteristics. Odds ratios and 95% confidence intervals were used to assess potential associations between exposure to violence (yes/no and the respondents’ characteristics using logistic regression model. Results The majority of respondents (80.4% reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. No statistical difference in exposure to violence between physicians and nurses was observed. Males’ significantly experienced higher exposure to physical violence in comparison with females. Logistic regression analysis indicated that less experienced (OR: 8.03; 95% CI 3.91-16.47, and a lower level of education (OR: 3; 95% CI 1.29-6.67 among respondents meant they were more likely to be victims of workplace violence than their counterparts. The assailants were mostly the patients' relatives or visitors, followed by the patients themselves, and co-workers. Consequences of both physical and non-physical violence were considerable. Only half of victims received any type of treatment. Non-reporting of violence was a concern, main

  7. Patient experience with outpatient encounters at public hospitals in Shanghai: Examining different aspects of physician services and implications of overcrowding.

    Science.gov (United States)

    Bao, Yuhua; Fan, Guanrong; Zou, Dongdong; Wang, Tong; Xue, Di

    2017-01-01

    Over 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care. To assess outpatient experience with different aspects of physician services at China's public hospitals and its association with overcrowding of the hospital outpatient departments. Retrospective analysis of a large survey of outpatient experience in Shanghai, China. We tested the hypotheses that patient experience was poorer with physician-patient communication, education, and shared decision-making and where and when there was greater overcrowding of the hospital outpatient departments. Ordered logistic models were estimated separately for general and specialty hospitals. 7,147 outpatients at 40 public hospitals in Shanghai, China, in 2014. Patient experience with physician services were self-reported based on 12 questions as part of a validated instrument. Indicators of overcrowding included time of visit (morning vs. afternoon, Monday vs. rest of the week) and hospital outpatient volume in the first half of 2014. Overall, patients reported very favorable experience with physician services. Two out of the 12 questions pertaining to both communication and shared decision-making consistently received lower ratings. Hospitals whose outpatient volumes were in the top two quartiles received lower patient ratings, but the relationship achieved statistical significance among specialty hospitals only. Inadequate physician-patient communication and shared decision-making and hospital overcrowding compromise outpatient experience with physician services at Chinese public hospitals. Effective diversion of patients with chronic and less complex conditions to community health centers will be critical to alleviate the extreme workloads at hospitals with high patient volumes and, in turn, improve patient experience.

  8. [Access, use and preferences of Information and Communication Technologies by physicians in a general hospital in Peru].

    Science.gov (United States)

    Vásquez-Silva, Luis; Ticse, Ray; Alfaro-Carballido, Luz; Guerra-Castañon, Felix

    2015-01-01

    We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% have mobile Internet. Differences were evident in the frequency of use of ICT in 25-34 year old age group as well as a higher level of skills (pWhatsApp as a means of exchanging images and data related to health, 50% participated in medical blogs, online courses or videoconferences. The use and access of ICT is common among doctors in this hospital and there is positive interest in its use in education.

  9. Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State.

    Science.gov (United States)

    Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A

    2018-01-24

    The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. We performed a cohort study of patients undergoing neurosurgical procedures from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.

  10. Physicians' responses to patients' expressions of negative emotions in hospital consultations: a video-based observational study.

    Science.gov (United States)

    Mjaaland, Trond A; Finset, Arnstein; Jensen, Bård Fossli; Gulbrandsen, Pål

    2011-09-01

    Patients express their negative emotions in medical consultations either implicitly as cue to an underlying unpleasant emotion or explicitly as a clear, unambiguous concern. The health provider's response to such cues and concerns is important for the outcome of consultations. Yet, physicians often neglect patient's negative emotions. Most studies of this subject are from primary health care. We aimed to describe how physicians in a hospital respond to negative emotions in an outpatient setting. Ninety six consultations were videotaped in a general teaching hospital. The Verona Coding Definitions of Emotional Sequences was used to identify patients' expression of negative emotions in terms of cue and concern and to code physicians' subsequent responses. Cohen's kappa was used as interrater reliability measure. Acceptable kappa level was set to .60. We observed 163 expressions of negative emotions. In general, the physician responses to patients' cues and concerns did not include follow up or exploration. Concerns more often than cues led to lack of emotional exploration. When patients expressed negative emotions or cues to such, hospital physicians tended to move away from emotional communication, particularly if the emotion was expressed as an explicit concern. Medical training should enable physicians' to explore the patients' emotions in situations where it will improve the medical treatment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  11. Satisfaction, motivation, and intent to stay among Ugandan physicians: a survey from 18 national hospitals.

    Science.gov (United States)

    Luboga, Sam; Hagopian, Amy; Ndiku, John; Bancroft, Emily; McQuide, Pamela

    2011-01-01

    Uganda faces a colossal shortages of human resources for health. Previous literature has largely focused on those who leave. This paper reports on a study of physicians working in 18 public and private facilities in Uganda as part of a larger study of more than 641 hospital-based health workers in Uganda. We report what could entice physicians to stay longer, satisfaction with current positions, and future career intentions. This study took place in 18 Ugandan hospitals. We describe the 49 physicians who participated in 11 focus groups and the 63 physicians who completed questionnaires, out of a larger sample of 641 health workers overall. Only 37% of physicians said they were satisfied with their jobs, and 46% reported they were at risk of leaving the health sector or the country. After compensation, the largest contributors to dissatisfaction among physicians were quality of management, availability of equipment and supplies (including drugs), quality of facility infrastructure, staffing and workload, political influence, community location, and professional development. Physicians in our study were highly dissatisfied, with almost half the sample reporting a risk to leave the sector or the country. The established link in literature between physician dissatisfaction and departure from the health system suggests national and regional policy makers should consider interventions that address the contributors to dissatisfaction identified in our study. Copyright © 2010 John Wiley & Sons, Ltd.

  12. [Notifiable infectious diseases: knowledge and notification among hospital physicians].

    Science.gov (United States)

    Rubio-Cirilo, Laura; Martín-Ríos, M Dolores; de Las Casas-Cámara, Gonzalo; Andrés-Prado, M José; Rodríguez-Caravaca, Gil

    2013-12-01

    Notifiable infectious diseases represent a public health hazard, which is why they are under surveillance and must be reported. We tried to assess hospital physicians' knowledge of hospital physicians on notifiable infectious diseases and their self-reported attitudes to notification. An observational study was conducted using a questionnaire with 11 multiple choice questions, two yes/no questions and one short-answer question. It was distributed to all senior doctors and residents in 19 medical and surgical departments. A total of 248 questionnaires were sent out, with a response rate of 79.84%. More than three-quarters (76.3%) of the respondents were senior doctors. As regards specific knowledge about whether a particular disease is a notifiable disease, 29.5% identified correctly 100% of the named diseases, 3.2% could not identify any of them. All urgent named notifiable infectious diseases were correctly identified by 25.3% of physicians. Statistically significant differences were found in the knowledge of notifiable diseases knowledge in medical and surgical departments, as well as for senior doctors (P=.047) and residents (P=.035). A high percentage of medical services (40%) and surgical (70%) department reported never failing to notify. When asked about the causes of under-reporting, 72% did not know whether notification was mandatory or not, and 88% did not know what diseases must be notified. Although many respondents are aware that diseases notification is part of their daily activity, many of them admit under-reporting. There is insufficient knowledge about what diseases are considered notifiable infectious diseases and how to notify them. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  13. A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation.

    Science.gov (United States)

    Twibell, Renee; Siela, Debra; Riwitis, Cheryl; Neal, Alexis; Waters, Nicole

    2018-01-01

    To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence. Qualitative exploratory-descriptive. Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared. Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit. Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team. Knowledge of factors that influence the decision-making of interprofessional colleagues

  14. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    Directory of Open Access Journals (Sweden)

    Lockey David

    2011-10-01

    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  15. Power and trust in organizational relations: an empirical study in Turkish public hospitals.

    Science.gov (United States)

    Bozaykut, Tuba; Gurbuz, F Gulruh

    2015-01-01

    Given the salience of the interplay between trust and power relations in organizational settings, this paper examines the perceptions of social power and its effects on trust in supervisors within the context of public hospitals. Following the theoretical background from which the study model is developed, the recent situation of hospitals within Turkish healthcare system is discussed to further elucidate the working conditions of physicians. Sample data were collected employing a structured questionnaire that was distributed to physicians working at seven different public hospitals. The statistical analyses indicate that perceptions of supervisors' social power affect subordinates' trust in supervisors. Although coercive power is found to have the greatest impact on trust in supervisors, the influence of the power base is weak. In addition, the results show that perceptions of social power differ between genders. However, the results do not support any of the hypotheses regarding the relations between trust in supervisors and the examined demographic variables. Copyright © 2014 John Wiley & Sons, Ltd.

  16. Measuring the relative efficiency of Ilam hospitals using data envelopment analysis

    Directory of Open Access Journals (Sweden)

    Ehsan Fazeli

    2012-08-01

    Full Text Available Measuring the relative efficiency is one of the most important issues among hospitals in today's economy. These days, we hear that cost reduction is a necessity for survival of business owners and one primary to reduce the expenditures is to increase relative efficiency. The proposed study of this paper first uses output oriented data envelopment analysis (DEA to measure the relative efficiencies of nine hospitals. The proposed model uses four types of employee namely specialists, physicians, technicians and other staffs as input parameters. The model also uses the number of surgeries, hospitalized and radiography as the outputs of the proposed model. Since the implementation of DEA leads us to have more than one single efficient unit, we implement supper efficiency technique to measure the relative efficiency of efficient units.

  17. Unintended Transformations of Clinical Relations with a Computerized Physician Order Entry System

    DEFF Research Database (Denmark)

    Wentzer, Helle; Böttger, Ulrich; Boye, Niels

    2007-01-01

    A socio-technical approach was used to study the qualitative effects of deploying a medication CPOE (Computerized Physician Order Entry System with no decision support) at two internal medical wards in a hospital in Denmark. Our results show spatial and temporal transformations of core acts...... and relations in medication work, i.e. of the intended use of the system inscribed in hardware and software, in the relations of care between doctors and patients, of collaboration between doctors and nurses, and prospectively of the patients’ trajectories when readmitted to hospital or another health care...... or ‘doing medication’. The paper argues for the project organization to support the local collaboration and renegotiation of time and place of enacting medication with CPOE, as well as set up feedback for maturation of the software for future clinical use....

  18. "It's like texting at the dinner table": A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals.

    Science.gov (United States)

    Pelland, Kimberly D; Baier, Rosa R; Gardner, Rebekah L

    2017-06-30

    nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.

  19. Predictors of distress in hospital physicians: protective and vulnerability factors

    Directory of Open Access Journals (Sweden)

    Fermín Martínez-Zaragoza

    2014-05-01

    Full Text Available This study investigates the relationship between protective and vulnerability factors affecting health (distréss in medical staff. Participants were 127 doctors from four public hospitals, who were administered the Occupational Stress in Health Professionals Inventory, the Ways of Coping Questionnaire, the Maslach Burnout Inventory, the Symptom Check-list-90 Revised Questionnaire, and the Flow Trait Scale-2. Following the methodology of Partial Least Squares modeling (PLS, an explanation is given for distréss in hospital physicians, where the avoidance coping strategy produces distréss directly (β = .296 and indirectly (β = .139 th rough its influence on the increase of burnout (β = .314, which in turn is increased by occupational stress (β = .209. Professional flow, measured by professional efficacy and flow, acts as a good protector against distréss (β = -.133, partly compensating the effects of the variables which have an increasing impact on an individual's distréss (GoF = .983. To sum up, when trying to predict a physician's distréss, four key elements should be considered: avoidance coping and its indirect effect through burnout on distréss; the burnout construct itself and professional flow.

  20. Physicians' professional performance: an occupational health psychology perspective.

    Science.gov (United States)

    Scheepers, Renée A

    2017-12-01

    Physician work engagement is considered to benefit physicians' professional performance in clinical teaching practice. Following an occupational health psychology perspective, this PhD report presents research on how physicians' professional performance in both doctor and teacher roles can be facilitated by work engagement and how work engagement is facilitated by job resources and personality traits. First, we conducted a systematic review on the impact of physician work engagement and related constructs (e. g. job satisfaction) on physicians' performance in patient care. We additionally investigated physician work engagement and job resources in relation to patient care experience with physicians' performance at ten outpatient clinics covering two hospitals. In a following multicentre survey involving 61 residency training programs of 18 hospitals, we studied associations between physician work engagement and personality traits with resident evaluations of physicians' teaching performance. The findings showed that physician work engagement was associated with fewer reported medical errors and that job satisfaction was associated with better communication and patient satisfaction. Autonomy and learning opportunities were positively associated with physician work engagement. Work engagement was positively associated with teaching performance. In addition, physician work engagement was most likely supported by personality trait conscientiousness (e. g. responsibility). Given the reported associations of physician work engagement with aspects of their professional performance, hospitals could support physician work engagement in service of optimal performance in residency training and patient care. This could be facilitated by worker health surveillance, peer support or promoting job crafting at the individual or team level.

  1. The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study.

    Science.gov (United States)

    Reyniers, Thijs; Houttekier, Dirk; Pasman, H Roeline; Stichele, Robert Vander; Cohen, Joachim; Deliens, Luc

    2014-01-01

    Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life. © 2014 Annals of Family Medicine, Inc.

  2. Quantifying culture gaps between physicians and managers in Dutch hospitals: A survey

    NARCIS (Netherlands)

    Klopper-Kes, A.H.J.; Siesling, Sabine; Meerdink, Nienke; Wilderom, Celeste P.M.; van Harten, Willem H.

    2010-01-01

    Background: The demands in hospitals for safety and quality, combined with limitations in financing health care require effective cooperation between physicians and managers. The complex relationship between both groups has been described in literature. We aim to add a perspective to literature, by

  3. Physician use of updated anti-virus software in a tertiary Nigerian hospital.

    Science.gov (United States)

    Laabes, E P; Nyango, D D; Ayedima, M M; Ladep, N G

    2010-01-01

    While physicians are becoming increasingly dependent on computers and the internet, highly lethal malware continue to be loaded into cyberspace. We sought to assess the proportion of physicians with updated anti-virus software in Jos University Teaching Hospital Nigeria and to determine perceived barriers to getting updates. We used a pre-tested semi-structured self-administered questionnaire to conduct a cross-sectional survey among 118 physicians. The mean age (+/- SD) of subjects was 34 (+/- 4) years, with 94 male and 24 female physicians. Forty-two (36.5%) of 115 physicians with anti-virus software used an updated program (95% Cl: 27, 45). The top-three antivirus software were: McAfee 40 (33.9%), AVG 37 (31.4%) and Norton 17 (14.4%). Common infections were: Trojan horse 22 (29.7%), Brontok worm 8 (10.8%), and Ravmonlog.exe 5 (6.8%). Internet browsing with a firewall was an independent determinant for use of updated anti-virus software [OR 4.3, 95% CI, 1.86, 10.02; P malware producers and anti-virus software developers.

  4. [Out-of-hospital pediatric emergencies. Perception and assessment by emergency physicians].

    Science.gov (United States)

    Eich, C; Roessler, M; Timmermann, A; Heuer, J F; Gentkow, U; Albrecht, B; Russo, S G

    2009-09-01

    Out-of-hospital (OOH) pediatric emergencies have a relatively low prevalence. In Germany the vast majority of cases are attended by non-specialized emergency physicians (EPs) for whom these are not routine procedures. This may lead to insecurity and fear. However, it is unknown how EPs perceive and assess pediatric emergencies and how they could be better prepared for them. All active EPs (n=50) of the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University Medical Centre of Göttingen were presented with a structured questionnaire in order to evaluate their perception and assessment of OOH pediatric emergencies. The 43 participating EPs made highly detailed statements on the expected characteristics of OOH pediatric emergencies. Their confidence level grew with the children's age (pemergencies. They felt the greatest deficits were in the care of infrequent but life-threatening emergencies. Three educational groups can be differentiated: knowledge and skills to be gained with children in hospital, clinical experience from adult care also applicable in children and rare diagnoses and interventions to be trained with manikins or simulators.

  5. Physician buy-in for EMRs.

    Science.gov (United States)

    Yackanicz, Lori; Kerr, Richard; Levick, Donald

    2010-01-01

    Implementing an EMR in an ambulatory practice requires intense workflow analysis, introduction of new technologies and significant cultural change for the physicians and physician champion. This paper will relate the experience at Lehigh Valley Health Network in the implementation of an ambulatory EMR and with the physician champions that were selected to assist the effort. The choice of a physician champion involves political considerations, variation in leadership and communication styles, and a cornucopia of personalities. Physician leadership has been shown to be a critical success factor for any successful technology implementation. An effective physician champion can help develop and promote a clear vision of an improved future, enlist the support of the physicians and staff, drive the process changes needs and manage the cultural change required. The experience with various types of physician champions will be discussed, including, the "reluctant leader", the "techie leader", the "whiny leader", and the "mature leader". Experiences with each type have resulted in a valuable, "lessons learned" summary. LVHN is a tertiary academic community medical center consisting of 950 beds and over 450 employed physicians. LVHN has been named to the Health and Hospital Network's 100 Top Wired and 25 Most Wireless Hospitals.

  6. Collaboration of Physician, Pharmacist and Director Model Toward the Improvement of Teamwork Effectiveness in Hospital

    Directory of Open Access Journals (Sweden)

    Widy S. Abdulkadir

    2017-09-01

    Full Text Available Collaboration of physicians and pharmacists is very important in providing treatment to patients. Collaboration includes an exchange of views or ideas that give perspective to all collaborators. In order to make collaborative relationship optimal, all members of the different professions should have a desire to cooperate. Pharmacists and physicians should plan and practice as colleagues, work interdependence within the limits of the scope of practice with a variety of values and knowledge. The role of director in cooperation between doctor and pharmacist takes decision-making which refers to treatment of patients to be decided together between health professionals (physician and pharmacist. The study was a quasi-experimental design with a pre-test-post-test control group design, using paired t-test analysis. The study was conducted from October 2012 until February 2013. The paired t-test results showed that the variable of teamwork effectiveness in M. M. Dunda Hospital increased significantly (p=0.038, which means that the three-party (physician-pharmacist-director collaboration model may increase teamwork effectiveness. Three-party collaboration model can improve physician-pharmacist relationship in the hospital. Leadership has a positive and significant effect on employees’ organizational commitment. Director can be an inspiration in the work and determine the direction and goals of the organization. Therefore, the three-party (physician-pharmacist-director collaboration model can improve the quality of the relationship between the two professions, physician and pharmacist.

  7. Physician's practices and perspectives regarding tobacco cessation in a teaching hospital in Mysore City, Karnataka.

    Science.gov (United States)

    Saud, Mohammed; Madhu, B; Srinath, K M; Ashok, N C; Renuka, M

    2014-01-01

    Tobacco is a leading cause of disease and premature death. Most of the smokers visit a doctor for various health related ailments and thus such clinic visits provide many opportunities for interventions and professional tobacco cessation advice. The primary aim of the following study is to assess the physician practices, perspectives, resources, barriers and education relating to tobacco cessation and their perceived need for training for the same. The secondary aim is to compare the physician's cessation practices from patient's perspective. A descriptive study was conducted in a hospital attached to Medical College in Mysore city, Karnataka. Information about doctor's practices, perspectives and their perceived need for training in tobacco cessation were collected using pre-structured self-administered Questionnaire, which were distributed in person. Patient's practices and perspectives were assessed using a pre-structured Oral Questionnaire. Almost 95% of physicians said that they ask patients about their smoking status and 94% advise them to quit smoking, but only 50% assist the patient to quit smoking and only 28% arrange follow-up visits. Thus, they do not regularly provide assistance to help patients quit, even though 98% of the physicians believed that helping patients to quit was a part of their role. Only 18% and 35% of the physicians said that Undergraduate Medical Education and Post Graduate Medical Education respectively prepared them very well to participate in smoking cessation activities. Tobacco cessation requires repeated and regular assistance. Such assistance is not being provided to patients by attending doctors. Our medical education system is failing to impart the necessary skills to doctors, needed to help patients quit smoking. Reforms in education are needed so as to prepare the physician to effectively address this problem.

  8. Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses

    NARCIS (Netherlands)

    de Bie, J.; Cuperus-Bosma, J.M.; van der Jagt, M.A.; Gevers, J.K.M.; van der Wal, G.

    2005-01-01

    Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30%

  9. Physicians' Patient Load per DRG, the Consumption of Hospital Resources, and the Incentives of the DRG Prospective Payment System.

    Science.gov (United States)

    Munoz, Eric; And Others

    1990-01-01

    The relationship between numbers (high or low) of patients per diagnosis-related group (DRG) treated by individual physicians and hospital resource consumption of the patients at a large academic medical center was studied for the period 1985-87. The findings, although a result of many varied factors, suggest a relationship between the two…

  10. The Family Physician's Perceived Role in Preventing and Guiding Hospital Admissions at the End of Life: A Focus Group Study

    NARCIS (Netherlands)

    Reyniers, T.; Houttekier, D.; Pasman, H.R.; Stichele, R.V.; Cohen, J.; Deliens, L.

    2014-01-01

    CONCLUSIONS Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician’s role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or

  11. How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

    Science.gov (United States)

    Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

    2016-07-01

    To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

  12. Youth and young adults with cerebral palsy: their use of physician and hospital services.

    Science.gov (United States)

    Young, Nancy L; Gilbert, Thomas K; McCormick, Anna; Ayling-Campos, Anne; Boydell, Katherine; Law, Mary; Fehlings, Darcy L; Mukherjee, Shubhra; Wedge, John H; Williams, Jack I

    2007-06-01

    To examine patterns of health care utilization among youth and young adults who have cerebral palsy (CP) and to provide information to guide the development of health services for adults who have CP. This study analyzed health insurance data for outpatient physician visits and hospital admissions for a 4-year period. Six children's treatment centers in Ontario, Canada. The sample included 587 youth and 477 adults with CP identified from health records. Youths were 13 to 17 years of age, and adults were 23 to 32 years of age at the end of the data range. Not applicable. We computed the annual rates of outpatient physician visits and hospitalizations per 1000 persons and compared these with rates for the general population. Annual rates of outpatient physician visits were 6052 for youth and 6404 for adults with CP, 2.2 times and 1.9 times higher, respectively, than rates for age-matched peers (P<.01). Specialists provided 28.4% of youth visits but only 18.8% of adult visits. Annual hospital admission rates were 180 for youth and 98 for adults with CP, 4.3 times and 10.6 times higher, respectively, than rates for age-matched peers (P<.01). It appears that youth and adults with CP continue to have complex care needs and rely heavily on the health care system. Comprehensive services are essential to support their health as they move into youth and adulthood. However, there appear to be gaps in the adult health care system, such as limited access to specialist physicians.

  13. Feasibility and acceptability of a workers' health surveillance program for hospital physicians

    NARCIS (Netherlands)

    Ruitenburg, Martijn M.; Plat, Marie-Christine J.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2015-01-01

    A Workers' Health Surveillance (WHS) program is an occupational health strategy used to detect and address the health of individual workers to improve their ability to work. This study aims to investigate the feasibility and acceptability of a new job-specific WHS for hospital physicians. All

  14. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

    DEFF Research Database (Denmark)

    Kruger, Andreas J; Lockey, David; Kurola, Jouni

    2011-01-01

    -staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...... have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care....

  15. Predictors of regional Medicare expenditures for otolaryngology physician services.

    Science.gov (United States)

    Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis; Lango, Miriam N

    2017-06-01

    To describe geographic variation in spending and evaluate regional Medicare expenditures for otolaryngologist services with population- and beneficiary-related factors, physician supply, and hospital system factors. Cross-sectional study. The average regional expenditures for otolaryngology physician services were defined as the total work relative value units (wRVUs) collected by otolaryngologists in a hospital referral region (HRR) per thousand Medicare beneficiaries in the HRR. A multivariable linear regression model tested associations with regional sociodemographics (age, sex, race, income, education), the physician and hospital bed supply, and the presence of an otolaryngology residency program. In 2012, the mean Medicare expenditure for otolaryngology provider services across HRRs was 224 wRVUs per thousand Medicare beneficiaries (standard deviation [SD] 104), ranging from 31 to 604 wRVUs per thousand Medicare beneficiaries. In 2013, the average Medicare expenditures for each HRR was highly correlated with expenditures collected in 2012 (Pearson correlation coefficient .997, P = .0001). Regional Medicare expenditures were independently and positively associated with otolaryngology, medical specialist, and hospital bed supply in the region, and were negatively associated with the supply of primary care physicians and presence of an otolaryngology residency program after adjusting for other factors. The magnitude of associations with physician supply and hospital factors was stronger than any population or Medicare beneficiary factor. Wide variations in regional Medicare expenditures for otolaryngology physician services, highly stable over 2 years, were strongly associated with regional health system factors. Changes in health policy for otolaryngology care may require coordination with other physician specialties and integrated hospital systems. NA. Laryngoscope, 127:1312-1317, 2017. © 2016 The American Laryngological, Rhinological and Otological Society

  16. [Differences in practice among physicians staffing an emergency department in relation to years of experience].

    Science.gov (United States)

    Busca, Pablo; Inchaurza, Estibaliz; Illarramendi, Aiora; Urbina, Ohiana; González, Laura; Miró, Òscar

    2015-06-01

    To determine differences in certain variables reflecting clinical practice in a group of emergency physicians with varying levels of experience and to explore whether differences are associated with experience. Retrospective observational study of differences in variables reflecting emergency physicians' practice between 2005 and 2012. We studied work variables (months worked, patients treated, caseload distribution according to triage levels), patient management variables (consultation with other specialists, admissions, ambulance requests), diagnostic procedures ordered (simple radiographs, laboratory tests, ultrasound or computed tomography imaging), and time patients discharged home spent in the department (arrival to discharge). We explored relationships between these variables and the emergency physician's experience using linear regression analysis, followed by the construction of multivariable models to adjust for physician characteristics. Data for 50 emergency medicine physicians, in 291 years of work, were analyzed. The specialists' experience ranged from 1 to 22 years (mean [SD], 9.5 [5.8] years). They attended between 47 and 158 patients monthly (mean, 86 [19] patients). The physicians' experience was inversely and independently related to the mean number of patients attended monthly and the percentage of patients assigned a triage level of 1 or 2. Experience was directly and independently related to discharged patients' time spent in the emergency department and number of simple radiographs ordered. All associations were small (R2<0.010), however. Those variables continued to show statistically significant associations after increasingly complex modeling to adjust for the following physician variables: physician, age, sex, specialty, residency training in the same hospital). The practice of emergency physicians with more accumulated experience shows slight but significant differences from the practice of less experienced physicians.

  17. Physicians' perceptions of physician-nurse interactions and information needs in China.

    Science.gov (United States)

    Wen, Dong; Guan, Pengcheng; Zhang, Xingting; Lei, Jianbo

    2018-01-01

    Good communication between physicians and nurses is important for the understanding of disease status and treatment feedback; however, certain issues in Chinese hospitals could lead to suboptimal physician-nurse communication in clinical work. Convenience sampling was used to recruit participants. Questionnaires were sent to clinical physicians in three top tertiary Grade-A teaching hospitals in China and six hundred and seventeen physicians participated in the survey. (1) Common physician-nurse interactions were shift-change reports and provisional reports when needed, and interactions expected by physicians included face-to-face reports and communication via a phone or mobile device. (2) Most respondents believed that the need for information in physician-nurse interactions was high, information was moderately accurate and timely, and feedback regarding interaction time and satisfaction indicated that they were only average and required improvement. (3) Information needs in physician-nurse interactions differed significantly according to hospital category, role, workplace, and educational background (p < .05). There was a considerable need for information within physician-nurse interactions, and the level of satisfaction with the information obtained was average; requirements for the improvement of communication differed between physicians and nurses because of differences in their characteristics. Currently, the use of information technology in physician-nurse communication was less common but was highly expected by physicians.

  18. Consumer attitudes toward healthcare marketing practices: a comparison of hospitals vs. physicians.

    Science.gov (United States)

    Lim, J S; Zallocco, R

    1997-01-01

    This study investigates consumer attitudes toward the use of marketing practices by the health care industry. The survey results show significant differences in consumers' attitude toward the use and effects of various marketing practices by the two types of provider (hospital and physician). Theoretical and empirical implications are discussed.

  19. Physicians reading and writing practices: a cross-sectional study from Civil Hospital, Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Khaliq Muhammad

    2012-07-01

    Full Text Available Abstract Background To determine the behavior of physicians regarding medical literature reading and participation in research activities at one of the largest teaching hospitals in Pakistan. Method This descriptive, cross-sectional study was conducted by interviewing the house officers, residents and fellows of six major specialties (Medicine, Surgery, Pediatrics, Psychology, Obstetrics & Gynecology and Anesthesia in Civil Hospital, Karachi between August and December, 2011. The questionnaire elicited responses regarding the reading habits of physicians, preferred sources of information, their participation in research activities (publication & supervision and views regarding journal club. SPSS 17.0 was used for data entry and analysis. Result A total of 259 completely filled questionnaires were returned with a response rate of 85.19%. Mean age of the participants was 29.67 ± 7.65 years. Books were selected by 71.4% doctors as their preferred source of information, regardless of their clinical specialties. (p  Conclusion Urgent intervention is required to promote healthcare literature reading and writing practice in our physicians. Easy access to workplace computers with internet and subscription of paid journals will facilitate physicians. Lack of supervisors and busy schedule were reported to be important contributors for not participating in research. Addressing these issues will encourage doctors to participate more in research activities.

  20. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study

    NARCIS (Netherlands)

    Ruitenburg, Martijn M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2012-01-01

    Background: We studied the prevalence of common mental disorders among Dutch hospital physicians and investigated whether the presence of a mental disorder was associated with insufficient self-reported work ability. Methods: A questionnaire was sent to all (n = 958) hospital physicians of one

  1. Physician Acceptance of a Computerized Outpatient Medication System in a Teaching Hospital Group Practice

    OpenAIRE

    Blish, Christi; Proctor, Rita; Fletcher, Suzanne W.; O'Malley, Michael

    1983-01-01

    As part of a new automated ambulatory medical record, a computerized outpatient medication system was developed for a teaching hospital general medicine group practice. Seven months after its implementation, the system was evaluated to determine physician acceptance and approval. Practice physicians were surveyed, and 94% of the respondents approved of the system. Over 90% thought that the computerized system had improved the completeness and accuracy of medication information as well as thei...

  2. [Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission].

    Science.gov (United States)

    Bartiaux, M; Mols, P

    2017-01-01

    patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

  3. Mistrust of physicians in China: society, institution, and interaction as root causes.

    Science.gov (United States)

    Chan, Cheris Shun-Ching

    2018-03-01

    Based on two years' ethnographic research on doctor-patient relations in urban China, this paper examines the causes of patients' mistrust of physicians. I identify the major factors at the societal, institutional, and interpersonal levels that lead to patients' mistrust of physicians. First, I set the context by describing the extent of mistrust at the societal level. Then, I investigate the institutional sources of mistrust. I argue that the financing mechanism of public hospitals and physicians' income structures are the most crucial factors in inducing patients' mistrust. Hospitals' heavy reliance on self-finance has basically caused public hospitals to run like private hospitals, resulting in blatant conflicts of interest between hospitals and patients. Related to this is physicians' reliance on bonuses and commissions as part of their regular incomes, which has inevitably resulted in overtreatment and, hence, mistrust from the patients. At the interpersonal level, I describe how individual physicians' attitudes toward and interaction with patients may also affect patients' sense of trust or mistrust in physicians. In conclusion, I discuss the ethical implications of the mistrust problem, and suggest changes at the institutional and interpersonal levels to mitigate the problem. © 2017 John Wiley & Sons Ltd.

  4. Hospital Nurses' and Physicians' Use of Information Sources during their Production of Discharge Summaries: A Cross-Sectional Study

    OpenAIRE

    Hellesø, Ragnhild; Sogstad, Maren Kristine Raknes

    2014-01-01

    Hospital nurses' and physicians' production and exchange of accurate information between levels of care are crucial for ensuring safe and seamless care for patients in transition. We report on a study in which we explored hospital providers' use of information sources when they prepared discharge information for colleges in the community health-care sector. In this cross-sectional study, 510 nurses and 236 physicians responded through a questionnaire. Our findings show that nurses and physici...

  5. Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

    NARCIS (Netherlands)

    Jong, J.D. de; Westert, G.P.; Lagoe, R.; Groenewegen, P.P.

    2006-01-01

    OBJECTIVE: To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. DATA SOURCES: Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS).

  6. Perceptions of effective and ineffective nurse-physician communication in hospitals.

    Science.gov (United States)

    Robinson, F Patrick; Gorman, Geraldine; Slimmer, Lynda W; Yudkowsky, Rachel

    2010-01-01

    Nurse-physician communication affects patient safety. Such communication has been well studied using a variety of survey and observational methods; however, missing from the literature is an investigation of what constitutes effective and ineffective interprofessional communication from the perspective of the professionals involved. The purpose of this study was to explore nurse and physician perceptions of effective and ineffective communication between the two professions. Using focus group methodology, we asked nurses and physicians with at least 5 years' acute care hospital experience to reflect on effective and ineffective interprofessional communication and to provide examples. Three focus groups were held with 6 participants each (total sample 18). Sessions were audio recorded and transcribed verbatim. Transcripts were coded into categories of effective and ineffective communication. The following themes were found. For effective communication: clarity and precision of message that relies on verification, collaborative problem solving, calm and supportive demeanor under stress, maintenance of mutual respect, and authentic understanding of the unique role. For ineffective communication: making someone less than, dependence on electronic systems, and linguistic and cultural barriers. These themes may be useful in designing learning activities to promote effective interprofessional communication.

  7. Physician profiling. An analysis of inpatient practice patterns in Florida and Oregon.

    Science.gov (United States)

    Welch, H G; Miller, M E; Welch, W P

    1994-03-03

    Physician profiling is a method of cost control that focuses on patterns of care instead of on specific clinical decisions. It is one cost-control method that takes into account physicians' desire to curb the intrusion of administrative mechanisms into the clinical encounter. To provide a concrete example of profiling, we analyzed the inpatient practice patterns of physicians in Florida and Oregon. Data for 1991 from Medicare's National Claims History File were used to profile 12,720 attending physicians in Florida and 2589 in Oregon. For each attending physician, we determined the total relative value of all physicians' services delivered during each patient's hospital stay. Relative value was measured in relative-value units (RVUs), according to the resource-based relative-value scale used by Medicare in determining payments to physicians. The mean number of RVUs per admission was then adjusted for the physician's case mix according to the patients' assigned diagnosis-related groups. The influence of the physician's specialty and of selected types of services (such as imaging and endoscopy) was also examined. Florida physicians used markedly more resources, on average, than their colleagues in Oregon (46 vs. 30 case-mix-adjusted RVUs per admission). The difference was apparent for all specialties and all types of service. To illustrate the profiling data potentially available to the medical staffs of individual hospitals, we examined specific data on individual attending physicians and for various types of service for three hospitals' staffs. Despite similar overall profiles that fell below the national mean, each staff had a different practice pattern and would require different efforts to improve efficiency. In an effort to encourage further debate, we have described one method of physician profiling. Profiling data help identify and characterize differences in practice style to which individual physicians or hospital staffs can respond. Because profiling is

  8. How report cards on physicians, physician groups, and hospitals can have greater impact on consumer choices.

    Science.gov (United States)

    Sinaiko, Anna D; Eastman, Diana; Rosenthal, Meredith B

    2012-03-01

    Public report cards with quality and cost information on physicians, physician groups, and hospital providers have proliferated in recent years. However, many of these report cards are difficult for consumers to interpret and have had little impact on the provider choices consumers are making. To gain a more focused understanding of why these reports cards have not been more successful and what improvements could be made, we interviewed experts and surveyed registrants at the March 2011 AHRQ National Summit on Public Reporting for Consumers in Health Care. We found broad agreement that public reporting has been disconnected from consumer decisions about providers because of weaknesses in report card content, design, and accessibility. Policy makers have an opportunity to change the landscape of public reporting by taking advantage of advances in measurement, data collection, and information technology to deliver a more consumer-centered report card. Overcoming the constraint of limited public funding, and achieving the acceptance of providers, is critical to realizing future success.

  9. Relationships of multitasking, physicians' strain, and performance: an observational study in ward physicians.

    Science.gov (United States)

    Weigl, Matthias; Müller, Andreas; Sevdalis, Nick; Angerer, Peter

    2013-03-01

    Simultaneous task performance ("multitasking") is common in hospital physicians' work and is implicated as a major determinant for enhanced strain and detrimental performance. The aim was to determine the impact of multitasking by hospital physicians on their self reported strain and performance. A prospective observational time-and-motion study in a Community Hospital was conducted. Twenty-seven hospital physicians (surgical and internal specialties) were observed in 40 full-shift observations. Observed physicians reported twice on their self-monitored strain and performance during the observation time. Associations of observed multitasking events and subsequent strain and performance appraisals were calculated. About 21% of the working time physicians were engaged in simultaneous activities. The average time spent in multitasking activities correlated significantly with subsequently reported strain (r = 0.27, P = 0.018). The number of instances of multitasking activities correlated with self-monitored performance to a marginally significant level (r = 0.19, P = 0.098). Physicians who engage in multitasking activities tend to self-report better performance but at the cost of enhanced psychophysical strain. Hence, physicians do not perceive their own multitasking activities as a source for deficient performance, for example, medical errors. Readjustment of workload, improved organization of work for hospital physicians, and training programs to improve physicians' skills in dealing with multiple clinical demands, prioritization, and efficient task allocation may be useful avenues to explore to reduce the potentially negative impact of simultaneous task performance in clinical settings.

  10. Physician job satisfaction in Saudi Arabia: insights from a tertiary hospital survey.

    Science.gov (United States)

    Aldrees, Turki; Al-Eissa, Sami; Badri, Motasim; Aljuhayman, Ahmed; Zamakhshary, Mohammed

    2015-01-01

    Job satisfaction refers to the extent to which people like or dislike their job. Job satisfaction varies across professions. Few studies have explored this issue among physicians in Saudi Arabia. The objective of this study is to determine the level and factors associated with job satisfaction among Saudi and non-Saudi physicians. In this cross-sectional study conducted in a major tertiary hospital in Riyadh, a 5-point Likert scale structured questionnaire was used to collect data on a wide range of socio-demographic, practice environment characteristics and level and consequences of job satisfaction from practicing physicians (consultants or residents) across different medical specialties. Logistic regression models were fitted to determine factors associated with job satisfaction. Of 344 participants, 300 (87.2%) were Saudis, 252 (73%) males, 255 (74%) married, 188 (54.7%) consultants and age [median (IQR)] was 32 (27-42.7) years. Overall, 104 (30%) respondents were dissatisfied with their jobs. Intensive care physicians were the most dissatisfied physicians (50%). In a multiple logistic regression model, income satisfaction (odds ratio [OR]=0.448 95% CI 0.278-0.723, P job satisfaction identified in this study should be addressed in governmental strategic planning aimed at improving the healthcare system and patient care.

  11. Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.

    Science.gov (United States)

    Streit, Sven; Baumann, Philippe; Barth, Jürgen; Mattle, Heinrich P; Arnold, Marcel; Bassetti, Claudio L; Meli, Damian N; Fischer, Urs

    2015-01-01

    Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients. Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care. Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

  12. Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.

    Directory of Open Access Journals (Sweden)

    Sven Streit

    Full Text Available Transient ischemic attacks (TIA are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs and hospital physicians (HPs knew about stroke risk after TIA, and to measure their referral rates.We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients.Of the 1545 physicians, 40% (614 returned the survey. Of these, 75% (457 overestimated stroke risk within 24 hours, and 40% (245 overestimated risk within 3 months after TIA. Only 9% (53 underestimated stroke risk within 24 hours and 26% (158 underestimated risk within 3 months; 78% (473 of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543 would rigorously investigate the cause of a TIA, but only 38% (229 would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care.Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

  13. Physician identification and patient satisfaction in the emergency department: are they related?

    Science.gov (United States)

    Mercer, Mary P; Hernandez-Boussard, Tina; Mahadevan, Swaminatha V; Strehlow, Matthew C

    2014-05-01

    Patient satisfaction has become a quality indicator tracked closely by hospitals and emergency departments (EDs). Unfortunately, the primary factors driving patient satisfaction remain poorly studied. It has been suggested that correct physician identification impacts patient satisfaction in hospitalized patients, however, the limited studies that exist have demonstrated mixed results. In this study, we sought to identify factors associated with improved satisfaction among ED patients, and specifically, to test whether improving physician identification by patients would lead to increased satisfaction. We performed a pre- and postintervention, survey-based study of patients at the end of their ED visits. We compared patient satisfaction scores as well as patients' abilities to correctly identify their physicians over two separate 1-week periods: prior to and after introducing a multimedia presentation of the attending physicians into the waiting room. A total of 486 patients (25% of all ED visits) were enrolled in the study. In the combined study population, overall patient satisfaction was higher among patients who correctly identified their physicians than among those who could not identify their physicians (combined mean satisfaction score of 8.1 vs. 7.2; odds ratio [OR] 1.07). Overall satisfaction was also higher among parents or guardians of pediatric patients than among adult patients (satisfaction score of 8.4 vs. 7.4; OR 1.07), and among patients who experienced a shorter door-to-doctor time (satisfaction score of 8.2 for shorter waiting time vs. 5.6 for longer waiting time; OR 1.15). Ambulance patients showed decreased satisfaction over some satisfaction parameters, including physician courtesy and knowledge. No direct relationship was demonstrated between the study intervention (multimedia presentation) and improved patient satisfaction or physician identification. Improved patient satisfaction was found to be positively correlated with correct physician

  14. Physician leadership is essential to the survival of teaching hospitals.

    Science.gov (United States)

    Schwartz, R W; Pogge, C

    2000-06-01

    Academic medical centers (AMCs) face severe financial constraints because they must now compete directly with private providers that focus exclusively on cost-effective healthcare delivery. Educational and research capacities developed at AMCs have been supported by government and third party payers, but government support is diminishing. Physicians are ill-equipped to respond to market pressures. Analyses of cultural change and restructuring in corporate giants such as Greyhound, IBM and FedEx are relevant to teaching hospitals. To succeed, organizations must flatten hierarchy, empower staff, train leaders, and mobilize intellectual capital. Effective leadership is essential. Physicians must educate themselves on forces impacting the AMC, understand changes needed in the structure and processes of AMC governance and acquire competencies for leadership and management if AMCs are to survive and thrive. Surgeons should acquire competencies that will enable them to become leaders in the process of AMC transformation.

  15. Achieving Adherence to Evidence-Based Practices: Are Health IT and Hospital-Physician Integration Complementary or Substitutive Strategies?

    Science.gov (United States)

    Everson, Jordan; Lee, Shoou-Yih Daniel; Adler-Milstein, Julia

    2016-12-01

    In response to evolving policies and conditions, hospitals have increased health information technology (HIT) adoption and strived to improve hospital-physician integration. While evidence suggests that both HIT and integration confer independent benefits, when combined, they may provide complementary means to achieve high performance or overlap to offset each other's contribution. We explore this relationship in the context of hospital adherence to evidence-based practices (EBPs). Using the American Hospital Association's Annual and IT Supplement surveys, and Centers for Medicare and Medicaid Services's Hospital Compare, we estimate the independent relationships and interactions between HIT and hospital-physician integration with respect to EBP adherence. HIT adoption and tight (but not loose) integration are independently associated with greater adherence to EBPs. The interaction between HIT adoption and tight integration is negative, consistent with an offsetting association between HIT adoption and integration in their relationship to EBP adherence. This finding reveals the need to be aware of potential substitutive effects from simultaneous pursuit of multiple approaches to performance improvement. © The Author(s) 2016.

  16. “It’s like texting at the dinner table”: A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals

    Directory of Open Access Journals (Sweden)

    Kimberly D Pelland

    2017-06-01

    Full Text Available Background: Electronic health records (EHRs may reduce medical errors and improve care, but can complicate clinical encounters. Objective: To describe hospital-based physicians’ perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians’ perceptions Methods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. Results: The survey’s response rate was 68.3% and 2,236 (87.1% respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. Conclusion: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.

  17. Comparing assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool.

    Science.gov (United States)

    Aydin Er, Rahime; Sehiralti, Mine

    2014-07-01

    To compare assessments of the decision-making competencies of psychiatric inpatients as provided by physicians, nurses, relatives and an assessment tool. This study was carried out at the psychiatry clinic of Kocaeli University Hospital from June 2007 to February 2008. The decision-making competence of the 83 patients who participated in the study was assessed by physicians, nurses, relatives and MacCAT-T. Of the 83 patients, the relatives of 73.8% of them, including the parents of 47.7%, were interviewed during the study. A moderately good consistency between the competency assessments of the nurses versus those of the physicians, but a poor consistency between the assessments of the physicians and nurses versus those of the patients' relatives, was determined. The differences in the competency assessment obtained with the MacCAT-T versus the evaluations of the physicians, nurses and patients' relatives were statistically significant. Our findings demonstrate those physicians, nurses and the patients' relatives have difficulty in identifying patients lacking decision-making competence. Therefore, an objective competence assessment tool should be used along with the assessments of physicians and nurses, both of whom can provide clinical data, as well as those of relatives, who can offer insights into the patient's moral values and expectations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Work-related fear and the threats of fear among emergency department nursing staff and physicians in Finland.

    Science.gov (United States)

    Mikkola, Riitta; Huhtala, Heini; Paavilainen, Eija

    2017-10-01

    To describe fear, the threats causing fear and the occurrence of fear among emergency department nursing staff and physicians. The emergency department is a challenging workplace where the staff is often confronted by factors that cause fear. A cross-sectional study. A survey was conducted in 16 hospitals (n = 544). Nurses, practical nurses, orderlies and physicians from those hospitals participated in the survey. The survey questionnaire was based on the analysis of interviews of 30 nurses from one university hospital and one central hospital. The results of the interviews were analysed using the inductive content analysis method. The analysis of the survey was performed using statistical methods, such as frequencies, cross-tabulation and principal component analysis. The results showed that nearly all of the emergency department personnel had experienced work-related fear. Generally, the fear had been momentary. According to the survey results, fear was most often caused by medication errors, the resuscitation of a child, a catastrophic accident, urgent or violent situations or patients armed with weapons. Threats that caused fear included insecurity, danger in the work environment, threat of loss of one's health and threat of the consequences of one's mistakes and actions. The staff of emergency departments often encountered factors or situations that caused fear. The main threats causing fear that were raised by the respondents were insecurity and danger in the work environment. The data obtained from this study can be utilised in identifying and describing work-related fear and threats of fear among emergency department nursing staff and physicians. Based on the information herein, it will be possible to develop methods to prevent situations that cause fear in emergency departments. © 2016 John Wiley & Sons Ltd.

  19. Improving patient satisfaction through physician education, feedback, and incentives.

    Science.gov (United States)

    Banka, Gaurav; Edgington, Sarah; Kyulo, Namgyal; Padilla, Tony; Mosley, Virgie; Afsarmanesh, Nasim; Fonarow, Gregg C; Ong, Michael K

    2015-08-01

    Patient satisfaction has been associated with improved outcomes and become a focus of reimbursement. Evaluate an intervention to improve patient satisfaction. Nonrandomized, pre-post study that took place from 2011 to 2012. Large tertiary academic medical center. Internal medicine (IM) resident physicians, non-IM resident physicians, and adult patients of the resident physicians. IM resident physicians were provided with patient satisfaction education through a conference, real-time individualized patient satisfaction score feedback, monthly recognition, and incentives for high patient-satisfaction scores. Patient satisfaction on physician-related and overall satisfaction questions on the HCAHPS survey. We conducted a difference-in-differences regression analysis comparing IM and non-IM patient responses, adjusting for differences in patient characteristics. In our regression analysis, the percentage of patients who responded positively to all 3 physician-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions increased by 8.1% in the IM and 1.5% in the control cohorts (absolute difference 6.6%, P = 0.04). The percentage of patients who would definitely recommend this hospital to friends and family increased by 7.1% in the IM and 1.5% in the control cohorts (absolute difference 5.6%, P = 0.02). The national average for the HCAHPS outcomes studied improved by no more than 3.1%. This study was nonrandomized and was conducted at a single site. To our knowledge, this is the first intervention associated with a significant improvement in HCAHPS scores. This may serve as a model to increase patient satisfaction, hospital revenue, and train resident physicians. © 2015 Society of Hospital Medicine.

  20. How Patients and Relatives Experience a Visit from a Consulting Physician in the Euthanasia Procedure: A Study among Relatives and Physicians

    Science.gov (United States)

    Jansen-van der Weide, Marijke C.; Onwuteaka-Philipsen, Bregje D.; van der Heide, Agnes; van der Wal, Gerrit

    2009-01-01

    This study investigated the impact of a visit from a consulting physician on the patient and the relatives during the euthanasia procedure in The Netherlands. Data on experiences with the consultant's visit were collected from 86 relatives and 3,614 general practitioners, who described their most recent request for euthanasia or physician-assisted…

  1. Burnout among physicians and nursing staff working in the emergency hospital of Tanta University, Egypt.

    Science.gov (United States)

    Abdo, S A M; El-Sallamy, R M; El-Sherbiny, A A M; Kabbash, I A

    2016-03-15

    Little is known about professional burnout among health-care workers in Egypt. The current study aimed to reveal the extent of burnout among physicians and nursing staff working in the emergency hospital of Tanta University and to identify some of its determinants. A cross-sectional study was carried out on all physicians (n = 266) and a systematic random sample of nurses (n = 284). Burnout was assessed using the Maslach Burnout Inventory and its subscales. Most of the participants (66.0%)had a moderate level of burnout and 24.9% of them had high burnout. Multivariate analysis of variables affecting burnout showed that age, sex, frequency of exposure to work-related violence, years of experience, work burden, supervision and work activities were significant predictors of burnout among the respondents. The authors recommend health education interventions during pre-employment training programmes for prevention of burnout syndrome and periodic screening for early detection and management of burnout.

  2. Differences within the groups of physicians and managers in Dutch hospitals providing leads for intergroup cooperation : Running head: group differences in hospitals

    NARCIS (Netherlands)

    van Harten, Willem H.

    2010-01-01

    Background: Effective cooperation between physicians and managers is difficult to achieve but is an important factor in successfully implementing improvement initiatives in hospitals. Intergroup literature suggests that large differences between groups hinder effective cooperation. - Purposes:

  3. Management of work-related stress by Finnish occupational physicians.

    Science.gov (United States)

    Kinnunen-Amoroso, M; Liira, J

    2013-07-01

    Occupational stress is a serious threat to the well-being of employees and organizations and may cause ill-health and loss of productivity. Determining the methods that occupational health (OH) services and employers use to manage work-related stress can help to detect both barriers and facilitating factors for effective stress management. To examine stress management methods used by OH physicians in Finland. Anonymous, self-administered e-mail questionnaire to Finnish OH physicians. A total of 222 OH physicians responded. Neither OH services nor their client organizations used standardized tools to assess or manage work-related stress. Work-related stress was assessed using patient interviews. Physicians reported that the main method used to manage occupational stress was supporting the individual employee. Half of the physicians attempted to involve workplaces in stress management by asking their patients to contact their supervisors regarding stress issues. In order to tackle work-related stress consistently and effectively employers and OH services should have agreed standardized protocols for managing stress in the workplace.

  4. Workplace physical violence among hospital nurses and physicians in underserved areas in Jordan.

    Science.gov (United States)

    AbuAlRub, Raeda Fawzi; Al Khawaldeh, Abdullah Talal

    2014-07-01

    To: (1) examine the incidence, frequency and contributing factors to workplace violence among nurses and physicians in underserved areas in Jordan, and (2) identify the existing policies and the management modalities to tackle workplace violence. Workplace violence is a major problem in healthcare organisations. An understanding of the nature of violence is essential to implementing successful management. A descriptive exploratory research design. The questionnaire that was developed in 2003 by the International Labor Office, the International Council of Nurses, the World Health Organization, and the Public Services International was used to collect data from a convenience sample of 521 Jordanian physicians and nurses (396 nurses, 125 physicians) who worked in hospitals located in underserved areas. Around 15% of the participants were exposed to physical violence. The factors that contributed to workplace violence were related to absence of policies, inadequate staffing and lack of communication skills. Only 16·9% of participants indicated that there were specific policies available for dealing with physical workplace violence. Strengthening security and providing training were some of the important factors indicated by participants for decreasing violence in the workplace. Workplace violence is a problem in underserved areas that needs attention from administrators. Most participants were very dissatisfied with the way the administrators dealt with the incidents. Instituting firm policies against perpetrators and developing protective violence guidelines to support healthcare staff in managing workplace violence are paramount to tackle the problem of workplace violence. © 2013 John Wiley & Sons Ltd.

  5. Hospital-Based Physicians' Intubation Decisions and Associated Mental Models when Managing a Critically and Terminally Ill Older Patient.

    Science.gov (United States)

    Haliko, Shannon; Downs, Julie; Mohan, Deepika; Arnold, Robert; Barnato, Amber E

    2018-04-01

    Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences. We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant. Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter. We used an "expert" model to code the interviews. We then used Kruskal-Wallis tests to compare the weighted mental model themes of physicians who provided preference-concordant treatment with those who provided preference-discordant treatment. Sixty-six (90%) physicians provided preference-concordant treatment and 7 (10%) provided preference-discordant treatment (i.e., they intubated the patient). Physicians who intubated the patient were more likely to emphasize the reversible and emergent nature of the patient situation (z = -2.111, P = 0.035), their own comfort (z = -2.764, P = 0.006), and rarely focused on explicit patient preferences (z = 2.380, P = 0.017). Post-decisional interviewing with audio/video prompting may induce hindsight bias. The expert model has not yet been validated and may not be exhaustive. The small sample size limits generalizability and power. Hospital-based physicians providing preference-discordant used a different mental model for decision making for a critically and terminally ill simulated case. These differences may offer targets for future interventions to promote preference-concordant care for seriously ill patients.

  6. Measurement equivalence of patient safety climate in Chinese hospitals: can we compare across physicians and nurses?

    Science.gov (United States)

    Zhu, Junya

    2018-06-11

    Self-report instruments have been widely used to better understand variations in patient safety climate between physicians and nurses. Research is needed to determine whether differences in patient safety climate reflect true differences in the underlying concepts. This is known as measurement equivalence, which is a prerequisite for meaningful group comparisons. This study aims to examine the degree of measurement equivalence of the responses to a patient safety climate survey of Chinese hospitals and to demonstrate how the measurement equivalence method can be applied to self-report climate surveys for patient safety research. Using data from the Chinese Hospital Survey of Patient Safety Climate from six Chinese hospitals in 2011, we constructed two groups: physicians and nurses (346 per group). We used multiple-group confirmatory factor analyses to examine progressively more stringent restrictions for measurement equivalence. We identified weak factorial equivalence across the two groups. Strong factorial equivalence was found for Organizational Learning, Unit Management Support for Safety, Adequacy of Safety Arrangements, Institutional Commitment to Safety, Error Reporting and Teamwork. Strong factorial equivalence, however, was not found for Safety System, Communication and Peer Support and Staffing. Nevertheless, further analyses suggested that nonequivalence did not meaningfully affect the conclusions regarding physician-nurse differences in patient safety climate. Our results provide evidence of at least partial equivalence of the survey responses between nurses and physicians, supporting mean comparisons of its constructs between the two groups. The measurement equivalence approach is essential to ensure that conclusions about group differences are valid.

  7. Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses: a questionnaire survey

    NARCIS (Netherlands)

    de Bie, J.; Cuperus-Bosma, J.M.; van der Jagt, M.A.; Gevers, J.K.M.; van der Wal, G.

    2005-01-01

    Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30%

  8. Welfare, wellness, and job satisfaction of Chinese physicians: A national survey of public tertiary hospitals in China.

    Science.gov (United States)

    Sun, Jing; Ma, Jing; Hu, Guangyu; Zhao, Qi; Yuan, Changzheng; Si, Wen; Zhang, Xinqing; Liu, Yuanli

    2017-07-01

    Little national data are available on Chinese physicians' welfare, wellness, and job satisfaction. We conducted a self-administered smartphone-based national survey in early 2016 of 17 945 physicians from 136 tertiary hospitals across 31 provinces in China. In addition to collecting the physicians' basic information, we also measured 5 domains (the ethical and working environments, welfare, wellness, and job satisfaction). Half of the physicians reported a hospital-based annual income of less than RMB 72 000 ($10 300), and 60.31% of them did not think that the current medical pricing system reflects physicians' value. More than half (58.64%) of them did not have or did not know about medical malpractice insurance. These physicians worked long hours (an average of 10 h) and slept short hours (average 6 h). Only 35.78% of them thought that they were in good health, and 51.03% were in good mental health. Approximately, a quarter of them had helped to pay medical bills for patients who could not afford care, and 1 in 7 has been penalised for seeing patients who generated bad debts. Only 33.42% of them thought that their occupation receives social recognition and respect, and 70.98% would not encourage their children to pursue a medical career. The top 3 factors that may influence physician job satisfaction as chosen by the physicians were as follows: (1) the income distribution policy (45.92%), (2) working environment safety (25.86%), and (3) public trust and respect for their job (16.10%). In conclusion, we found that Chinese physicians bear heavy physical, mental, and financial stress, and many of them lack confidence that they receive trust and respect from society. Copyright © 2017 John Wiley & Sons, Ltd.

  9. Nasal Carriage of Uncommon Coagulase-Negative Staphylococci in Nurses and Physicians of Tehran University Hospitals

    Directory of Open Access Journals (Sweden)

    Elaheh Salimi

    2016-05-01

    Full Text Available Coagulase-negative staphylococci (CoNS have been identified as a major cause of nosocomial infections. Nasal carriage of CoNS in nurses and physicians is known to be an important risk factor for potential hospital infections. This study was carried out to investigate the prevalence of nasal carriage of uncommon coagulase-negative staphylococci among nurse and physician staffs of Tehran University Hospitals. A total of 116 CoNS were isolated from anterior nares of the study participants working in different wards of the hospitals. Thirteen uncommon CoNS were identified using phenotypic and biochemical methods, were subsequently confirmed by API kits. Staphylococcus xylosus, Staphylococcus haemolyticus, and Staphylococcus capitis species accounted for 53.85%, 30.77%, and 15.38% from the isolates, respectively. Six isolates (46.15% were found to be resistant to methicillin. In conclusion, screening of healthcare workers for uncommon CoNS colonization along with identification and testing for susceptibility of cultured isolates is of paramount importance in strengthening effective nosocomial infection control and prevention measures.

  10. How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?

    Directory of Open Access Journals (Sweden)

    Martijn M. Ruitenburg

    2016-03-01

    Conclusion: The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.

  11. Customer convergence: patients, physicians, and employees share in the experience and evaluation of healthcare quality.

    Science.gov (United States)

    Clark, Paul Alexander; Wolosin, Robert J; Gavran, Goran

    2006-01-01

    This article explores the interrelationships between three categories of service quality in healthcare delivery organizations: patient, employee, and physician satisfaction. Using the largest and most representative national databases available, the study compares the evaluations of hospital care by more than 2 million patients, 150,000 employees, and 40,000 physicians. The results confirm the relationship connecting employees' satisfaction and loyalty to their patients' satisfaction and loyalty. Patients' satisfaction and loyalty were also strongly associated with medical staff physicians' evaluations of overall satisfaction and loyalty to the hospital. Similarly, hospital employees' satisfaction and loyalty were related to the medical staff physicians' satisfaction with and loyalty to the hospital. Based upon the strength of the interrelationships, individual measures and subscales can serve as leverage points for improving linked outcomes. Patients, physicians, and employees, the three co-creators of health, agree on the evaluation of the quality of that service experience. The results demonstrate that promoting patient-centeredness, enhancing medical staff relations, and improving the satisfaction and loyalty of employees are not necessarily three separate activities in competition for hospital resources and marketing leadership attention.

  12. Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

    Directory of Open Access Journals (Sweden)

    Michelle von Babo

    Full Text Available Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland.In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed.560 physicians of 71 hospitals (64% responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women. 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients.This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

  13. CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital.

    Science.gov (United States)

    Kazemi, Alireza; Ellenius, Johan; Tofighi, Shahram; Salehi, Aref; Eghbalian, Fatemeh; Fors, Uno G

    2009-03-01

    In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems

  14. The resource-based relative value scale and physician reimbursement policy.

    Science.gov (United States)

    Laugesen, Miriam J

    2014-11-01

    Most physicians are unfamiliar with the details of the Resource-Based Relative Value Scale (RBRVS) and how changes in the RBRVS influence Medicare and private reimbursement rates. Physicians in a wide variety of settings may benefit from understanding the RBRVS, including physicians who are employees, because many organizations use relative value units as productivity measures. Despite the complexity of the RBRVS, its logic and ideal are simple: In theory, the resource usage (comprising physician work, practice expense, and liability insurance premium costs) for one service is relative to the resource usage of all others. Ensuring relativity when new services are introduced or existing services are changed is, therefore, critical. Since the inception of the RBRVS, the American Medical Association's Relative Value Scale Update Committee (RUC) has made recommendations to the Centers for Medicare & Medicaid Services on changes to relative value units. The RUC's core focus is to develop estimates of physician work, but work estimates also partly determine practice expense payments. Critics have attributed various health-care system problems, including declining and growing gaps between primary care and specialist incomes, to the RUC's role in the RBRVS update process. There are persistent concerns regarding the quality of data used in the process and the potential for services to be overvalued. The Affordable Care Act addresses some of these concerns by increasing payments to primary care physicians, requiring reevaluation of the data underlying work relative value units, and reviewing misvalued codes.

  15. Nurse practitioners and physician assistants: preparing new providers for hospital medicine at the mayo clinic.

    Science.gov (United States)

    Spychalla, Megan T; Heathman, Joanne H; Pearson, Katherine A; Herber, Andrew J; Newman, James S

    2014-01-01

    Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support. This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN. In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine. The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.

  16. Perceived Nurse-Physician Communication in Patient Care and Associated Factors in Public Hospitals of Jimma Zone, South West Ethiopia: Cross Sectional Study.

    Directory of Open Access Journals (Sweden)

    Fikadu Balcha Hailu

    Full Text Available Nurse-physician communication has been shown to have a significant impact on the job satisfaction and retention of staff. In areas where it has been studied, communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death and medical malpractice claims.The objective of this study is to determine perception of nurses and physicians towards nurse-physician communication in patient care and associated factors in public hospitals of Jimma zone, southwest Ethiopia.Institution based cross-sectional survey was conducted from March 10 to April 16, 2014 among 341 nurses and 168 physicians working in public hospitals in Jimma zone. Data was collected using a pre-tested self-administered questionnaire; entered into EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS version 16.0 for analysis. Factor analysis was carried out. Descriptive statistics, independent sample t-test, linear regression and one way analysis of variance were used. Variables with P-value < 0.05 were considered as statistically significant.The response rate of the study was 91.55%. The mean perceived nurse-physician communication scores were 50.88±19.7% for perceived professional respect and satisfaction, and 48.52±19.7% for perceived openness and sharing of patient information on nurse-physician communication. Age, salary and organizational factors were statistically significant predictors for perceived respect and satisfaction. Whereas sex, working hospital, work attitude individual factors and organizational factors were significant predictors of perceived openness and sharing of patient information in nurse-physician communication during patient care.Perceived level of nurse-physician communication mean score was low among nurses than physicians and it is attention seeking gap. Hence, the finding of our study suggests the need for developing and implementing nurse-physician

  17. Vertical Integration of Hospitals and Physicians: Economic Theory and Empirical Evidence on Spending and Quality.

    Science.gov (United States)

    Post, Brady; Buchmueller, Tom; Ryan, Andrew M

    2017-08-01

    Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.

  18. Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State?

    Science.gov (United States)

    Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A; O'Shaughnessy, Patrick M

    2017-07-01

    It is unclear whether publicly reported benchmarks correlate with quality of physicians and institutions. We investigated the association of patient satisfaction measures from a public reporting platform with performance of neurosurgeons in New York State. This cohort study comprised patients undergoing neurosurgical operations from 2009 to 2013 who were registered in the Statewide Planning and Research Cooperative System database. The cohort was merged with publicly available data from the Centers for Medicare and Medicaid Services Hospital Compare website. Propensity-adjusted regression analysis was used to investigate the association of patient satisfaction metrics with neurosurgeon quality, as measured by the neurosurgeon's individual rate of mortality and average length of stay. During the study period, 166,365 patients underwent neurosurgical procedures. Using propensity-adjusted multivariable regression analysis, we demonstrated that undergoing neurosurgical operations in hospitals with a greater percentage of patient-assigned "high" scores was associated with higher chance of being treated by a physician with superior performance in terms of mortality (odds ratio 1.90, 95% confidence interval 1.86-1.95), and a higher chance of being treated by a physician with superior performance in terms of length of stay (odds ratio 1.24, 95% confidence interval 1.21-1.27). Similar associations were identified for hospitals with a higher percentage of patients who claimed they would recommend these institutions to others. Merging a comprehensive all-payer cohort of neurosurgery patients in New York State with data from the Hospital Compare website, we observed an association of superior hospital-level patient satisfaction measures with objective performance of individual neurosurgeons in the corresponding hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Physician Appraisals: Key Challenges

    Directory of Open Access Journals (Sweden)

    Klich Jacek

    2017-06-01

    Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

  20. Utilization of Total Joint Arthroplasty in Physician-Owned Specialty Hospitals vs Acute Care Facilities.

    Science.gov (United States)

    Chen, Antonia F; Pflug, Emily; O'Brien, Daniel; Maltenfort, Mitchell G; Parvizi, Javad

    2017-07-01

    The recent emergence of physician-owned specialty hospitals has sparked controversy about overutilization. Thus, the purpose of this study was to compare utilization patterns of total joint arthroplasty (TJA) between physician-specialty hospitals (PSHs) and acute care hospitals (ACHs). A retrospective study was conducted from January 2010 to August 2014 comparing primary TJA patients between a PSH and an ACH; 103 PSH patients were matched to 103 ACH patients by age, gender, BMI, and ASA classification with similar case distribution between facilities. All surgeons in the study operated at both hospitals and were shareholders of the PSH. Information on nonoperative treatments, and timing to the initial appointment, consent, and surgery were analyzed using univariate analysis. Nonoperative treatments before surgery were similar between hospitals (P = 1.00). The time from the initial appointment to consent was longer for PSH (P = .0001). However, the time from consent to the date of surgery (P = .04) and the timing from symptoms to initial appointment (P = .006) was shorter for PSH. The time from initial appointment to the day of surgery was similar between groups (P = .20). Patients were more likely to be consented for surgery on their first clinic visit when undergoing surgery at ACH (87 of 103, 84.4%) compared to PSH (61 of 103; 59.2%; P total knee arthroplasty (P = .001) and total hip arthroplasty patients (P = .001) at PSH. Facility ownership in PSH resulted in similar conservative treatment before TJA. The time to surgical consent after the initial appointment was longer PSH, whereas the time from consent to the date of surgery was shorter at the PSH. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Children, care, career - a cross-sectional study on the risk of burnout among German hospital physicians at different career stages.

    Science.gov (United States)

    Richter, Astrid; Kostova, Petya; Harth, Volker; Wegner, Ralf

    2014-01-01

    With the increasing number of female medical students physicians' need for work-life balanced hospital jobs rises at all career stages. The Working Time Act (Arbeitszeitgesetz, ArbZG), an implementation of the European Working Time Directive into German law in 2004, should have improved the general conditions for creating flexible work. Nevertheless, the vast majority of female physicians still report an incompatibility of work and family. So far, little is known about mothers working on leading positions in the medical field. The presented study focuses on gender differences in the level of emotional exhaustion between child-rearing junior and senior physicians and different predictors of burnout. Three years after the ArbZT-enactment, 994 physicians from the listed hospital physicians in the Medical Register of the city of Hamburg participated in the cross-sectional study and completed a 60-item questionnaire (return rate of 46,5%). The questionnaire included a 22-item version of the German translation of the Maslach Burnout Inventory whereat emotional exhaustion was interpreted as the crucial predictor of burnout. Results of an univariate covariance analysis and regression analyses are reported. In the level of emotional exhaustion no gender differences were found between junior and senior physicians with children in the overall analysis. Support by the superior was the only overall predictor of burnout. Female senior physicians having children presented the highest risk of burnout. Only in this group parenting contributed significantly to the risk of burnout. Support by the superior and the relationship to colleagues are generally important predictors of burnout among hospital physicians. Parenthood only gets a crucial influence on psychomental health for female senior physicians. Still conservative role models are common in this group, thus dealing with the triple burden of work, leadership responsibility and child rearing seems to be a special female

  2. [Labor law issues in hospitals by structural changes and changes in hospital ownership].

    Science.gov (United States)

    Meyer, Peter

    2003-11-01

    The present article deals with the potential impact of structural changes and changes in hospital control or ownership on the employment contracts of the physicians concerned. While taking the applicable jurisdiction into consideration, the author examines the options of assigning new responsibilities or decreasing compensation opportunities, amending or even terminating employment contracts, outsourcing hospital-related services, or allowing physicians in the future to provide these services at their own risk. Furthermore, the article outlines the change in employer in various "change of control" scenarios such as in the case of hospital privatisation.

  3. Physician self-referral and physician-owned specialty facilities.

    Science.gov (United States)

    Casalino, Lawrence P

    2008-06-01

    Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

  4. Impact of physician specialty on quality care for patients hospitalized with decompensated cirrhosis.

    Directory of Open Access Journals (Sweden)

    Nicholas Lim

    Full Text Available Decompensated cirrhosis is a common precipitant for hospitalization, and there is limited information concerning factors that influence the delivery of quality care in cirrhotic inpatients. We sought to determine the relation between physician specialty and inpatient quality care for decompensated cirrhosis.We reviewed 247 hospital admissions for decompensated cirrhosis, managed by hospitalists or intensivists, between 2009 and 2013. The primary outcome was quality care delivery, defined as adherence to all evidence-based specialty society practice guidelines pertaining to each specific complication of cirrhosis. Secondary outcomes included new complications, length-of-stay, and in-hospital death.Overall, 147 admissions (59.5% received quality care. Quality care was given more commonly by intensivists, compared with hospitalists (71.7% vs. 53.1%, P = .006, and specifically for gastrointestinal bleeding (72% vs. 45.8%, P = .03 and hepatic encephalopathy (100% vs. 63%, P = .005. Involvement of gastroenterology consultation was also more common in admissions in which quality care was administered (68.7% vs. 54.0%, P = .023. Timely diagnostic paracentesis was associated with reduced new complications in admissions for refractory ascites (9.5% vs. 46.6%, P = .02, and reduced length-of-stay in admissions for spontaneous bacterial peritonitis (5 days vs. 13 days, P = .02.Adherence to quality indicators for decompensated cirrhosis is suboptimal among hospitalized patients. Although quality care adherence appears to be higher among cirrhotic patients managed by intensivists than by hospitalists, opportunities for improvement exist in both groups. Rational and cost-effective strategies should be sought to achieve this end.

  5. French hospital nurses' opinion about euthanasia and physician-assisted suicide: a national phone survey.

    Science.gov (United States)

    Bendiane, M K; Bouhnik, A-D; Galinier, A; Favre, R; Obadia, Y; Peretti-Watel, P

    2009-04-01

    Hospital nurses are frequently the first care givers to receive a patient's request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses' opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. A phone survey conducted among a random national sample of 1502 French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call "good" euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia.

  6. The physician/hospital joint venture. Developing a win/win strategy for success. Part I: The first step: developing the environment.

    Science.gov (United States)

    Shorr, A B

    1987-02-01

    This four part series, "The Physician/Hospital Joint Venture: Developing a Win/Win Strategy," will examine the philosophical basis of marketing to physicians, the options for the organization in formulating a strategy for joint venture development, structuring and negotiating the deal, and finally how to build the physician loyalty and commitment essential for the joint venture's continued success. In this first article, the author emphasizes the organization's need to develop a strategic plan that includes a program for attracting physicians. It also points out the need for sensitivity to physicians' concerns and provides examples of successes and failures.

  7. The changing power equation in hospitals.

    Science.gov (United States)

    Rayburn, J M; Rayburn, L G

    1997-01-01

    This research traces the origins, development, and reasons for change in the power equation in the U.S. hospitals between physicians, administrators and accountants. The paper contains three major sections: a review of the literature concerning authority, power, influence, and institutional theory; a review of the development of the power of professions, especially physicians, accounting and healthcare administrators, and the power equilibrium of a hospital; and, a discussion of the social policy implications of the power struggle. The basis for physicians' power derives from their legal ability to act on which others are dependent, such as choosing which hospital to admit patients, order tests and procedures for their patients. The Federal Government's prospective payment system and the hospitals' related case-mix accounting systems appear to influence the power structure in hospitals by redistributing that power. The basis of the accountants' power base is control of financial information. Accountants have a definite potential for influencing which departments receive financial resources and for what purpose. This moves hospital accountants into the power equation. The basis of the hospital administrators' power is their formal authority in the organization. Regardless of what actions federal government agencies, hospital accountants, or hospital administrators take, physicians are expected to remain the dominant factor in the power equation. Without major environmental changes to gain control of physician services, only insignificant results in cost containment will occur.

  8. Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan.

    Science.gov (United States)

    Hsu, Min-Huei; Yeh, Yu-Ting; Chen, Chien-Yuan; Liu, Chien-Hsiang; Liu, Chien-Tsai

    2011-03-01

    Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one

  9. Early weaning and hospitalization with alcohol-related diagnoses in adult life

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Mortensen, Erik Lykke; Reinisch, June M

    2006-01-01

    OBJECTIVE: This study attempted to determine whether lack of breast-feeding or a short duration of breast-feeding during infancy is associated with an elevated risk of hospitalization with alcohol-related diagnoses in adult life. METHOD: The study was a prospective longitudinal birth cohort design...... conducted in a sample of 6,562 men and women, all of whom were born in Copenhagen, Denmark, between October 1959 and December 1961. The sample was divided into two categories based on duration of breast-feeding, as assessed by a physician interview with mothers at a 1-year examination. Psychiatric...... hospitalizations with alcohol-related diagnoses according to ICD-8 or ICD-10 were identified in the Danish Psychiatric Central Register in 1999. Nine potential confounders were included as covariates: gender of the cohort member, maternal age, parental social status, maternal prenatal smoking, unwanted pregnancy...

  10. Physicians Mutual Aid Group: A Response to AIDS-Related Burnout.

    Science.gov (United States)

    Garside, Bruce

    1993-01-01

    Describes origins and functioning of physician's mutual aid group for physicians providing primary care to people with Acquired Immune Deficiency Syndrome (AIDS). Offers suggestions related to overcoming resistance physicians might have to participating in such a group and reviews modalities that were helpful in facilitating participants' ability…

  11. Access, use and preferences of information and communication technologies by physicians in a general hospital in Peru

    OpenAIRE

    Vásquez-Silva, Luis; Facultad de Medicina. Universidad Peruana Cayetano Heredia. Lima, Perú. Hospital Nacional Cayetano Heredia. Lima, Perú.; Ticse, Ray; Facultad de Medicina. Universidad Peruana Cayetano Heredia. Lima, Perú. Hospital Nacional Cayetano Heredia. Lima, Perú.; Alfaro-Carballido, Luz; Hospital Nacional Cayetano Heredia. Lima, Perú.; Guerra-Castañon, Felix; Facultad de Medicina. Universidad Peruana Cayetano Heredia. Lima, Perú. Hospital Nacional Cayetano Heredia. Lima, Perú.

    2015-01-01

    We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% havemobile Internet. Differences were evident in the...

  12. Physicians' perceptions, expectations, and experience with pharmacists at Hamad Medical Corporation in Qatar.

    Science.gov (United States)

    Zaidan, Manal; Singh, Rajvir; Wazaify, Mayyada; Tahaineh, Linda

    2011-04-08

    The purpose of this study was to investigate the physicians' perceptions, and expectations of their experiences with the pharmacists at Hamad Medical Corporation (HMC) in Qatar. A cross-sectional study was conducted at HMC between January and March 2006 using a validated questionnaire. The self-administered questionnaire was distributed to 500 physicians who were working at HMC comprising Hamad General Hospital, Women's Hospital, Rumaila Hospital, Al-Amal Hospital, Al Khor Hospital, and primary health centers. The questionnaire was composed of four parts, investigating the physicians' expectations, experiences, and perceptions of the pharmacists. A total of 205 questionnaires were completed (response rate 41%). A total of 183 physicians (89%) expected the pharmacist to educate patients about safe and appropriate use of drugs, whereas 118 (57%) expected the pharmacist to be available for health-care team consultation during bedside rounds. The indices of physicians showing how comfortable they were with pharmacists, and their expectations of pharmacists, were 61% and 65%, respectively, whereas the index on experience of physicians with pharmacists was lower (15%). Physicians were comfortable with pharmacists and had high expectations of pharmacists in performing their duties. However, physicians reported a poor experience with pharmacists, who infrequently informed them about the effectiveness of alternative drugs, patients experiencing problems with prescribed medications, and who took personal responsibility to resolve any drug-related problem.

  13. An Investigation About Attitude of Clinical Physicians in the Implementation of Telemedicine Technology in TUMS Hospitals 2003-2004

    Directory of Open Access Journals (Sweden)

    H Dargahi

    2005-05-01

    Full Text Available Background: This research have presented focuses upon the cultural side of managerial coordination and control as manifested in Telemedicine Technology. Specifically, the research seeks to analyze and determines the attitude of clinical physicians about the role of specific dimensions of organizational culture and organizational structure may have upon effective managerial coordination and control in Telemedicine Technology in TUMS hospitals. Materials and methods: We assessed the attitude of 82 clinical physicians in five randomly selected TUMS teaching hospitals in a mixed method of pooling Quantitative and Qualitative data using unstructured interview technique. Results: For successful telemedicine utilization, most of clinical physicians believed that we need organic organizations that have involved leadership, open and free communication of mistakes and success, desire to experiment with new ideas, support for continuing education, support for new things, clear rules to follow and acknowledge performance goals. Conclusion: The data indicate that organizational is most important to utilize successfur telemedicine technology.

  14. Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians

    NARCIS (Netherlands)

    Eich, Christoph; Russo, Sebastian G.; Heuer, Jan F.; Timmermann, Arnd; Gentkow, Uta; Quintel, Michael; Roessler, Markus

    Background: In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the

  15. Predictors of job satisfaction and burnout among tuberculosis management nurses and physicians.

    Science.gov (United States)

    Seo, Hae-Suk; Kim, Hyunjoong; Hwang, Se-Min; Hong, Soo Hyun; Lee, In-Young

    2016-01-01

    This study examined job satisfaction, empowerment, job stress, and burnout among tuberculosis management nurses and physicians in public healthcare institutions. This was a cross-sectional study analyzing survey data collected from 249 nurses and 57 physicians in 105 public health centers, three public tuberculosis hospitals, and one tertiary hospital. The survey questionnaire comprised general characteristics, work-related characteristics, and four index scales (job satisfaction, empowerment, job stress, and burnout). The two-sample t-test was used to estimate the mean differences in the four index scales. Multiple regression analysis was used to determine whether general and work-related characteristics affected the four index scales. The job satisfaction and empowerment scores of the nurses were lower than those of the physicians. Except for the tuberculosis-specialized hospitals alone, the average job satisfaction scores of nurses were higher than those of physicians. Moreover, the nurses reported more job stress and burnout than did the physicians in tuberculosis departments in public healthcare institutions in Korea; in particular, the burnout reported by nurses was significantly higher than that reported by physicians at the National Medical Center. Marital status, nursing position, number of coworkers, the average number of days of overtime work per month, self-rated health, and hospital type were associated with the four index scales. Overall, nurses were more vulnerable to job stress and burnout than physicians. Reducing the workload of nurses by ensuring the presence of sufficient nursing staff and equipment, as well as by equipping facilities to prevent tuberculosis infections, should be considered priorities.

  16. Physicians' Job Satisfaction.

    African Journals Online (AJOL)

    AmL

    doctors and retention of the existing doctors, in addition to the ... an employee's well-being Examples of job resources are job ..... increase physician job satisfaction for ensuring the .... both pay and benefits physicians at private hospitals.

  17. [Work engagement of hospital physicians: do social capital and personal traits matter?].

    Science.gov (United States)

    Susanne Lehner, Birgit; Kowalski, Christoph; Wirtz, Markus; Ansmann, Lena; Driller, Elke; Ommen, Oliver; Oksanen, Tuula; Pfaff, Holger

    2013-03-01

    Work engagement has been proven to be a viable indicator of physical and mental well-being at work. Research findings have shown a link between work engagement and both individual and organizational resources. The aim of the present study is to test the hypothesized relationships between personal traits (Big-5), the quality of the social work environment (social capital) and work engagement among hospital (n=35) physicians (n=387) in North-Rhine-Westphalia, Germany. Structural equation modeling (SEM), combining confirmatory factor analysis (CFA) and path analysis, was employed to conduct the statistical analyses. The results of the SEM indicated that social capital and neuroticism were significantly associated with work engagement. The relationship between agreeableness and work engagement was fully mediated by social capital. Findings suggest that social capital plays a key role in promoting work engagement of physicians. © Georg Thieme Verlag KG Stuttgart · New York.

  18. An evaluation of adherence to the patient's rights charter among patients and physicians at the emergency department of Imam Khomeini Hospital, Tehran

    Directory of Open Access Journals (Sweden)

    Seyyed Hassan Emami Razavi

    2006-03-01

    Full Text Available It is the cherished goal of the health care providers to observe the patient rights. An official order to install the patient rights charter in all crowded places of hospitals motivated us to evaluate the patient rights both from the patients' and resident points of view. "nThis is a descriptive survey with cross-sectional method. The research was conducted to examine the patients and residents awareness of the contents of "Patients' Rights Charter" in emergency department of Imam Khomeini hospital in Tehran and their views on the adherence of the cares to the articles of the charter. 140 patients and 70 residents were chosen by simple randomized method by Cochrane formula and the data was gathered by questionnaires. "n57.9% of patients were not aware of this announcement. 78% of patients believed that patients' rights is being carried out relatively. 88.6% of residents believed that they complied with the rights of patients. The patients were relatively satisfied with the nursing cares, medical services and hospital equipments (69% were satisfied with availability of physicians in necessary situations, 47% satisfied with the nursing cares and 93.6% satisfied with the hospital equipments."nTwo years after installation of the charter, patients and residents awareness of installation were low. According to the patient views, patients' rights were relatively adhered. Unawareness of patients of their rights may limit their expectations from physicians and if they become aware of the contents of charter, their satisfaction from current situation may alter.

  19. Assessing Hospital Physicians' Acceptance of Clinical Information Systems: A Review of the Relevant Literature

    Directory of Open Access Journals (Sweden)

    Bram Pynoo

    2013-06-01

    Full Text Available In view of the tremendous potential benefits of clinical information systems (CIS for the quality of patient care; it is hard to understand why not every CIS is embraced by its targeted users, the physicians. The aim of this study is to propose a framework for assessing hospital physicians' CIS-acceptance that can serve as a guidance for future research into this area. Hereto, a review of the relevant literature was performed in the ISI Web-of-Science database. Eleven studies were withheld from an initial dataset of 797 articles. Results show that just as in business settings, there are four core groups of variables that influence physicians' acceptance of a CIS: its usefulness and ease of use, social norms, and factors in the working environment that facilitate use of the CIS (such as providing computers/workstations, compatibility between the new and existing system.... We also identified some additional variables as predictors of CIS-acceptance.

  20. Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters.

    Science.gov (United States)

    Adams, Kristen; Cimino, Jenica E W; Arnold, Robert M; Anderson, Wendy G

    2012-10-01

    To describe hospital-based physicians' responses to patients' verbal expressions of negative emotion and identify patterns of further communication associated with different responses. Qualitative analysis of physician-patient admission encounters audio-recorded between August 2008 and March 2009 at two hospitals within a university system. A codebook was iteratively developed to identify patients' verbal expressions of negative emotion. We categorized physicians' responses by their immediate effect on further discussion of emotion - focused away (away), focused neither toward nor away (neutral), and focused toward (toward) - and examined further communication patterns following each response type. In 79 patients' encounters with 27 physicians, the median expression of negative emotion was 1, range 0-14. Physician responses were 25% away, 43% neutral, and 32% toward. Neutral and toward responses elicited patient perspectives, concerns, social and spiritual issues, and goals for care. Toward responses demonstrated physicians' support, contributing to physician-patient alignment and agreement about treatment. Responding to expressions of negative emotion neutrally or with statements that focus toward emotion elicits clinically relevant information and is associated with positive physician-patient relationship and care outcomes. Providers should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Physicians' and Nurses' Perceptions of and Attitudes Toward Incident Reporting in Palestinian Hospitals.

    Science.gov (United States)

    Rashed, Anan; Hamdan, Motasem

    2015-06-22

    Underreporting of incidents that happen in health care services undermines the ability of the systems to improve patient safety. This study assessed the attitudes of physicians and nurses toward incident reporting and the factors influencing reporting in Palestinian hospitals. It also examined clinicians' views about the preferred features of incident reporting system. Cross-sectional self-administered survey of 475 participants, 152 physicians and 323 nurses, from 11 public hospitals in the West Bank; response rate, 81.3%. There was a low level of event reporting among participants in the past year (40.3%). Adjusted for sex and age, physicians were 2.1 times more likely to report incidents than nurses (95% confidence interval, 1.32-3.417; P = 0.002). Perceived main barriers for reporting were grouped under lack of proper structure for reporting, prevalence of blame, and punitive environment. The clinicians indicated fear of administrative sanctions, social and legal liability, and of their competence being questioned (P > 0.05). Getting help for patients, learning from mistakes, and ethical obligation were equally indicated motivators for reporting (P > 0.05). Meanwhile, clinicians prefer formal reporting (77.8%) of all type of errors (65.5%), disclosure of reporters (52.7%), using reports to improve patient safety (80.3%), and willingness to report to immediate supervisors (57.6%). Clinicians acknowledge the importance of reporting incidents; however, prevalence of punitive culture and inadequate reporting systems are key barriers. Improving feedback about reported errors, simplifying procedures, providing clear guidelines on what and who should report, and avoiding blame are essential to enhance reporting. Moreover, health care organizations should consider the opinions of the clinicians in developing reporting systems.

  2. Strategy of health information seeking among physicians, medical residents, and students after introducing digital library and information technology in teaching hospitals of Iran.

    Science.gov (United States)

    kahouei, Mehdi; Alaei, Safollah; Shariat Panahi, Sohaila Sadat Ghazavi; Zadeh, Jamileh Mahdi

    2015-05-01

    It is important for physicians, medical students and health care organizations of developing countries to use reliable clinical information in order to deliver the best practice. Therefore, health sector of Iran endeavored to encourage physicians and medical students to integrate research findings into practice since 2005. Several educational interventions in the areas of information technology and databases were performed. Digital library was introduced in the teaching hospitals. The purpose of this study was to investigate whether these interventions increased the use of evidence-based health information resources among physicians, medical residents and students. This descriptive study involved 315 physicians, assistants and medical students in affiliated hospitals of Semnan University of medical sciences in 2013. A total 52.9% of physicians and 79.5% of medical residents and students always used patient data. 81.3% of physicians and 67.1% of medical residents and students reported using their own experiences, 26.5% of physicians and 16.9% of medical residents and students always used databases such as PubMed and MEDLINE for patient care. Our results revealed that in spite of providing educational and technical infrastructures for accomplishment of research utilization in medical education, the study subjects often identified and used what they regarded as reliable and relevant information from sources that do not truly represent the best evidence that is available. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

  3. Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

    Science.gov (United States)

    von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin

    2018-01-01

    Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

  4. Physician's emerging roles relating to trends in health information technology.

    Science.gov (United States)

    David Johnson, J

    2014-08-12

    Objective: To determine the new roles that physicians will adopt in the near future to adjust to accelerating trends from managed care to outcome-based practice to health care reform to health information technology to the evolving role of health consumers. Methods: Trends and related developments concerning the changing roles of physicians based on prior literature reviews. Results: Six possible roles, traditional, gatekeeper, coach, navigator, informatician and one voice among many, are discussed in terms of physician's centrality, patient autonomy, decision-making and uncertainty, information seeking, satisfaction and outcomes, particularly those related to compliance. Conclusion: A greater understanding of these emerging roles could lead to more efficacious outcomes in our ever changing, increasingly complex medical system. Patients often have little understanding of emerging trends that lead to the development of specialized roles such as hospitalist and navigators and, relatedly, the evolving roles of physicians.

  5. Case study of physician leaders in quality and patient safety, and the development of a physician leadership network.

    Science.gov (United States)

    Hayes, Chris; Yousefi, Vandad; Wallington, Tamara; Ginzburg, Amir

    2010-01-01

    There is increasing recognition of the need for physician leadership in quality and patient safety, and emerging evidence that physician leadership contributes to improved care. Hospitals are beginning to establish physician leader positions; however, there is little guidance on how to define these roles and the strategies physician leaders can use toward improving care. This case study examines the roles of four physician leaders, describes their contribution to the design and implementation of hospital quality and patient safety agendas and discusses the creation of a physician network to support these activities. The positions were established between July 2006 and April 2009. All are corporate roles with varying reporting and accountability structures. The physician leads are involved in strategic planning, identifying and leading quality and safety initiatives, physician engagement and culture change. All have significantly contributed to the implementation of hospital improvement activities and are seen as influential among their peers as resources and mentors for local project success. Despite their accomplishments, these physician leads have been challenged by ambiguous role descriptions and difficulty identifying effective improvement strategies. As such, an expanding physician network was created with the goal of sharing approaches and tools and creating new strategies. Physician leaders are an important factor in the improvement of safety and quality within hospitals. This case study provides a template for the creation of such positions and highlights the importance of networking as an effective strategy for improving local care and advancing professional development of physician leaders in quality and patient safety.

  6. Family physicians' attitude and interest toward participation in urban family physician program and related factors

    Directory of Open Access Journals (Sweden)

    Masoumeh Sadeghi

    2016-01-01

    Full Text Available Introduction: Every family physician has a key role in achieving the goals of the family physician program (FPP. Low satisfaction of physicians in certain areas of Iran and their low maintenance level in the program is quite challenging. The aims of the present study were; (1 to assess the attitude of rural/rural-urban family physicians about FPP and (2 to investigate their interest toward participation in urban FPP and (3 to explore the influencing factors. Methods: This cross-sectional study was performed on 137 family physicians who were working in rural/rural-urban FPP in Mashhad University of Medical Sciences (Iran. A self-designed valid and reliable questionnaire including demographic data and thirty questions on the participants' attitudes toward the FPP in Likert scale were used. Data were analyzed by multiple logistic regression models using SPSS software. Results: 49.3% of physicians were interested in continuing their cooperation in the urban-FPP. The mean total attitude score was 62.18 out of 100. The highest agreement and positive attitude of physicians were related to achievements of the program goals dimension. Multiple analyses showed that gender (odds ratio [OR] =5.5; male vs. female and employment status (OR = 16.7 and 10.9 for permanent employment and by contract compared to legal obligation, respectively were significantly associated with physicians' willingness toward participation in the urban-FPP. Conclusion: About half of the studied physicians were interested toward participation in the urban-FPP; Male physicians more than females and permanent employees more than others were willing and interested to participate in the urban-FPP.

  7. Measuring hospital medical staff organizational structure.

    Science.gov (United States)

    Shortell, S M; Getzen, T E

    1979-01-01

    Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance. PMID:511580

  8. Dynamics of change in local physician supply: an ecological perspective.

    Science.gov (United States)

    Jiang, H Joanna; Begun, James W

    2002-05-01

    The purpose of this study is to employ an ecological framework to identify factors that have an impact on change in local physician supply within the USA. A particular specialty type of patient care physicians in a local market is defined as a physician population. Four physician populations are identified: generalists, medical specialists, surgical specialists, and hospital-based specialists. Based on population ecology theory, the proposed framework explains the growth of a particular physician population by four mechanisms: the intrinsic properties of this physician population; the local market's carrying capacity, which is determined by three environmental dimensions (munificence, concentration, diversity); competition within the same physician population; and interdependence between different physician populations. Data at the level of Metropolitan Statistical Areas (MSAs) were compiled from the US Area Resources File, the American Hospital Association Annual Surveys of Hospitals, the American Medical Association Census of Medical Groups, the InterStudy National HMO Census, and the US County Business Patterns. Changes in the number and percentage of physicians in a particular specialty population from 1985 to 1994 were regressed, respectively, on 1985-94 changes in the explanatory variables as well as their levels in 1985. The results indicate that the population ecology framework is useful in explaining dynamics of change in the local physician workforce. Variables measuring the three environmental dimensions were found to have significant, and in some cases, differential effects on change in the size of different specialty populations. For example, both hospital consolidation and managed care penetration showed significant positive eflects on growth of the generalist population but suppressing effects on growth of the specialist population. The percentage of physicians in a particular specialty population in 1985 was negatively related to change in the size

  9. Practice arrangement and medicare physician payment in otolaryngology.

    Science.gov (United States)

    Cracchiolo, Jennifer; Ridge, John A; Egleston, Brian; Lango, Miriam

    2015-06-01

    Medicare Part B physician payment indicates a cost to Medicare beneficiaries for a physician service and connotes physician clinical productivity. The objective of this study was to determine whether there was an association between practice arrangement and Medicare physician payment. Cross-sectional study. Medicare provider utilization and payment data. Otolaryngologists from 1 metropolitan area were included as part of a pilot study. A generalized linear model was used to determine the effect of practice-specific variables including patient volumes on physician payment. Of 67 otolaryngologists included, 23 (34%) provided services through an independent practice, while others were employed by 1 of 3 local academic centers. Median payment was $58,895 per physician for the year, although some physicians received substantially higher payments. Reimbursements to faculty at 1 academic department were higher than to those at other institutions or to independent practitioners. After adjustments were made for patient volumes, physician subspecialty, and gender, payments to each faculty at Hospital C were 2 times higher than to those at Hospital A (relative ratio [RR] 2.03; 95% CI, 1.27-3.27; P = .003); 2 times higher than to faculty at Hospital B (RR 2.04; 95% CI, 1.4-2.7; P = .0001); and 1.6 times higher than to independent practitioners (RR 1.6; 95% CI, 1.04-2.7; P = .03). Payments to physicians in the other groups were not significantly different. Differences in reimbursement corresponded to an emphasis on procedures over office visits but not Medicare case mix adjustments for patient discharges from associated institutions. Variation in the cost of academic otolaryngology care may be subject in part to institutional factors. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  10. Electronic health record in the internal medicine clinic of a Brazilian university hospital: Expectations and satisfaction of physicians and patients.

    Science.gov (United States)

    Duarte, Jurandir Godoy; Azevedo, Raymundo Soares

    2017-06-01

    To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (pclinical setting should be preceded by careful planning to improve physician's adherence to the use of EHR. Patients do not seem to notice much difference to the

  11. Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia.

    Science.gov (United States)

    Mumenah, Sahar H; Al-Raddadi, Rajaa M

    2015-01-01

    The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH) are with their counterparts who work at some selected non-MOH hospitals. An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC), and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians' level of satisfaction and how it was affected by the difficulties was assessed. Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011) and radiologists (P building maintenance (P < 0.001). Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032). MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

  12. Who Do Hospital Physicians and Nurses Go to for Advice About Medications? A Social Network Analysis and Examination of Prescribing Error Rates.

    Science.gov (United States)

    Creswick, Nerida; Westbrook, Johanna Irene

    2015-09-01

    To measure the weekly medication advice-seeking networks of hospital staff, to compare patterns across professional groups, and to examine these in the context of prescribing error rates. A social network analysis was conducted. All 101 staff in 2 wards in a large, academic teaching hospital in Sydney, Australia, were surveyed (response rate, 90%) using a detailed social network questionnaire. The extent of weekly medication advice seeking was measured by density of connections, proportion of reciprocal relationships by reciprocity, number of colleagues to whom each person provided advice by in-degree, and perceptions of amount and impact of advice seeking between physicians and nurses. Data on prescribing error rates from the 2 wards were compared. Weekly medication advice-seeking networks were sparse (density: 7% ward A and 12% ward B). Information sharing across professional groups was modest, and rates of reciprocation of advice were low (9% ward A, 14% ward B). Pharmacists provided advice to most people, and junior physicians also played central roles. Senior physicians provided medication advice to few people. Many staff perceived that physicians rarely sought advice from nurses when prescribing, but almost all believed that an increase in communication between physicians and nurses about medications would improve patient safety. The medication networks in ward B had higher measures for density, reciprocation, and fewer senior physicians who were isolates. Ward B had a significantly lower rate of both procedural and clinical prescribing errors than ward A (0.63 clinical prescribing errors per admission [95%CI, 0.47-0.79] versus 1.81/ admission [95%CI, 1.49-2.13]). Medication advice-seeking networks among staff on hospital wards are limited. Hubs of advice provision include pharmacists, junior physicians, and senior nurses. Senior physicians are poorly integrated into medication advice networks. Strategies to improve the advice-giving networks between senior

  13. Are Australasian academic physicians an endangered species?

    Science.gov (United States)

    Wilson, A

    2007-11-01

    It has been stated that academic medicine is in a worldwide crisis. Is this decline in hospital academic practice a predictable consequence of modern clinical practice with its emphasis on community and outpatient-based services as well as a corporate health-care ethos or does it relate to innate problems in the training process and career structure for academic clinicians? A better understanding of the barriers to involvement in academic practice, including the effect of gender, the role and effect of overseas training, expectation of further research degrees and issues pertaining to the Australian academic workplace will facilitate recruitment and retention of the next generation of academic clinicians. Physician-scientists remain highly relevant as medical practice and education evolves in the 21st century. Hospital-based academics carry out a critical role in the ongoing mentoring of trainees and junior colleagues, whose training is still largely hospital based in most specialty programmes. Academic clinicians are uniquely placed to translate the rapid advances in medical biology into the clinical sphere, by guiding and carrying out translational research as well as leading clinical studies. Academic physicians also play key leadership in relations with government and industry, in professional groups and medical colleges. Thus, there is a strong case to assess the problems facing recruitment and retention of physician-scientists in academic practice and to develop workable solutions.

  14. Communication-related allegations against physicians caring for premature infants.

    Science.gov (United States)

    Nguyen, J; Muniraman, H; Cascione, M; Ramanathan, R

    2017-10-01

    Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

  15. Recruiting physicians without inviting trouble.

    Science.gov (United States)

    Hoch, L J

    1989-05-01

    Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review.

  16. Impact of vendor computerized physician order entry on patients with renal impairment in community hospitals.

    Science.gov (United States)

    Leung, Alexander A; Schiff, Gordon; Keohane, Carol; Amato, Mary; Simon, Steven R; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan; Zimlichman, Eyal; Seger, Diane L; Yoon, Catherine; Bates, David W

    2013-10-01

    Adverse drug events (ADEs) are common among hospitalized patients with renal impairment. To determine whether computerized physician order entry (CPOE) systems with clinical decision support capabilities reduce the frequency of renally related ADEs in hospitals. Quasi-experimental study of 1590 adult patients with renal impairment who were admitted to 5 community hospitals in Massachusetts from January 2005 to September 2010, preimplementation and postimplementation of CPOE. Varying levels of clinical decision support, ranging from basic CPOE only (sites 4 and 5), rudimentary clinical decision support (sites 1 and 2), and advanced clinical decision support (site 3). Primary outcome was the rate of preventable ADEs from nephrotoxic and/or renally cleared medications. Similarly, secondary outcomes were the rates of overall ADEs and potential ADEs. There was a 45% decrease in the rate of preventable ADEs following implementation (8.0/100 vs 4.4/100 admissions; P < 0.01), and the impact was related to the level of decision support. Basic CPOE was not associated with any significant benefit (4.6/100 vs 4.3/100 admissions; P = 0.87). There was a nonsignificant decrease in preventable ADEs with rudimentary clinical decision support (9.1/100 vs 6.4/100 admissions; P = 0.22). However, substantial reduction was seen with advanced clinical decision support (12.4/100 vs 0/100 admissions; P = 0.01). Despite these benefits, a significant increase in potential ADEs was found for all systems (55.5/100 vs 136.8/100 admissions; P < 0.01). Vendor-developed CPOE with advanced clinical decision support can reduce the occurrence of preventable ADEs but may be associated with an increase in potential ADEs. © 2013 Society of Hospital Medicine.

  17. Physician alignment strategies and real estate.

    Science.gov (United States)

    Czerniak, Thomas A

    2012-06-01

    When addressing locations of facilities after acquiring physician practices, hospitals should: Acknowledge the hospital's ambulatory plan is the driver rather than real estate assumed with the physician practices, Review the hospital ambulatory service plan for each submarket, Review the location of facilities within the service area and their proximity to one another, Sublease or sell existing facilities that are not appropriate, Ensure that the size and characteristics of each facility in the market are appropriate and consistent with the hospital's image.

  18. Junior physicians' workplace experiences in clinical fields in German-speaking Switzerland.

    Science.gov (United States)

    Buddeberg-Fischer, Barbara; Klaghofer, Richard; Abel, Thomas; Buddeberg, Claus

    2005-01-08

    To date, there have been several prospective cohort studies investigating the workplace experiences of junior physicians, but with limited focus on gender issues. The objective of the present study is to explore the workplace experiences of first-year residents according to gender, type of training hospital, and clinical field. Data reported are from the second assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2003, 497 residents (54.7% females, 45.3% males) assessed their workplace conditions, social support at work, and effort-reward imbalance. There are few, but relevant, gender related differences in workplace experiences, with female physicians experiencing less mentoring and higher over-commitment, yet more positive social relationships at work. In a multivariate model, significant differences in some workplace variables with regard to type of training hospital and/or clinical field are found: workplace conditions are rated worse in type "A" hospitals (university and cantonal hospitals) than in type "B"/"C"/"D" hospitals (regional hospitals and highly specialised units), and in surgical fields than in internal medicine. In "A" hospitals mentoring is assessed as better, but positive social relationships as worse. Both scales are rated worse in surgical fields than in internal medicine. The effort-reward imbalance (ERI) is rated significantly higher (unfavourable) in "A" hospitals than in "B"/"C"/"D" hospitals, regardless of gender and clinical field. Significantly more subjects with an ERI quotient above 1 (which is unfavourable) work in "A" hospitals, and in surgical fields regardless of hospital type. Of the total sample, 81 subjects (16.3%), 41 males and 40 females, show an ERI quotient above 1. The greater the workload, the worse the rating of workplace conditions, effort-reward imbalance, and over-commitment. Institutional determinants are crucial factors for the workplace experiences and first career steps of

  19. Evaluation of hospital information systems of the teaching hospitals affiliated to Shiraz University of Medical Sciences, based on the American College of Physicians Criteria

    Directory of Open Access Journals (Sweden)

    E Emami

    2014-01-01

    Full Text Available Introduction: Hospital information system (HIS is a computerized system used for management of hospital information as an electronic device and has an indispensible role in the field of qualified healthcare services. Nevertheless, compared to other industrial and commercial systems, this information system is lagged in using the information technology and applying the controlling standards for satisfying the customers. Therefore, the present study aimed to evaluate HIS, identify its strength and weak points, and improve it in the teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Method: The present descriptive, cross-sectional study was conducted in the 8 teaching hospitals of Shiraz University of Medical Sciences which used HIS in 2011. The study data were collected through interview and direct observation using the criteria of American Physician College check-list. Finally, SPSS statistical software was used to analyze the data through descriptive statistics. Results: The study results showed that laboratory and medical records had respectively the most %43.5 and the least %21.03 conformity to the criteria of American College of Physicians. Also, Faghihi and Zeinabiye hospitals respectively had the most %41.8 and the least %25.2 conformity to the American College of Physicians’ criteria. In pharmacy, data entrance mechanism and presentation of reports had complete conformity to the scales of American College of Physicians, while drug interactions showed no conformity. In laboratory, data entrance mechanism had complete conformity to the above-mentioned criteria and keeping the test history had %87.5 conformity. The possibility of receiving information from centers out of laboratory had no conformity to the desired criteria. In the radiology department, data entrance mechanism had complete conformity to the above-mentioned criteria and keeping the test history had %87.5 conformity. Besides, the possibility

  20. Burnout, job satisfaction, and medical malpractice among physicians.

    Science.gov (United States)

    Chen, Kuan-Yu; Yang, Che-Ming; Lien, Che-Hui; Chiou, Hung-Yi; Lin, Mau-Roung; Chang, Hui-Ru; Chiu, Wen-Ta

    2013-01-01

    Our objective was to estimate the incidence of recent burnout in a large sample of Taiwanese physicians and analyze associations with job related satisfaction and medical malpractice experience. We performed a cross-sectional survey. Physicians were asked to fill out a questionnaire that included demographic information, practice characteristics, burnout, medical malpractice experience, job satisfaction, and medical error experience. There are about 2% of total physicians. Physicians who were members of the Taiwan Society of Emergency Medicine, Taiwan Surgical Association, Taiwan Association of Obstetrics and Gynecology, The Taiwan Pediatric Association, and Taiwan Stroke Association, and physicians of two medical centers, three metropolitan hospitals, and two local community hospitals were recruited. There is high incidence of burnout among Taiwan physicians. In our research, Visiting staff (VS) and residents were more likely to have higher level of burnout of the emotional exhaustion (EE) and depersonalization (DP), and personal accomplishment (PA). There was no difference in burnout types in gender. Married had higher-level burnout in EE. Physicians who were 20~30 years old had higher burnout levels in EE, those 31~40 years old had higher burnout levels in DP, and PA. Physicians who worked in medical centers had a higher rate in EE, DP, and who worked in metropolitan had higher burnout in PA. With specialty-in-training, physicians had higher-level burnout in EE and DP, but lower burnout in PA. Physicians who worked 13-17hr continuously had higher-level burnout in EE. Those with ≥41 times/week of being on call had higher-level burnout in EE and DP. Physicians who had medical malpractice experience had higher-level burnout in EE, DP, and PA. Physicians who were not satisfied with physician-patient relationships had higher-level burnout than those who were satisfied. Physicians in Taiwan face both burnout and a high risk in medical malpractice. There is high

  1. Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.

    Science.gov (United States)

    Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W

    2013-07-01

    In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.

  2. Is working in culturally diverse working environment associated with physicians' work-related well-being? A cross-sectional survey study among Finnish physicians.

    Science.gov (United States)

    Aalto, Anna-Mari; Heponiemi, Tarja; Väänänen, Ari; Bergbom, Barbara; Sinervo, Timo; Elovainio, Marko

    2014-08-01

    International mobility of health care professionals is increasing, though little is known about how working in a culturally diverse team affects the native physicians' psychosocial work environment. We examined Finnish physicians' perceptions of work-related wellbeing according to whether they had foreign-born colleagues (FBCs) in their work unit. We also examined whether work-related resources moderate the potential association between work-related wellbeing and working alongside FBCs. A cross-sectional survey was conducted for a random sample of physicians in Finland in 2010 (3826 respondents, response rate 55%). Analyses were restricted to native Finnish physicians working in public health care. The results were analyzed by ANCOVA. In unadjusted analyses, having FBCs was related to poor team climate (pwork unit (p=0.007 for interaction between FBCs and procedural justice and pculturally diverse work units face challenges related to team climate and job satisfaction. The results also show that leadership plays an important role in culturally diverse work units. The potential challenges of culturally diverse teams for native physicians may be reduced by fair decision-making and by increasing physicians' job control. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Trust-based or performance-based management: a study of employment contracting in hospitals.

    Science.gov (United States)

    Pettersen, Inger Johanne

    2011-01-01

    Hospitals are frequently changing managerial practices due to numerous public sector reforms taking place. In general, these reforms include the making and monitoring of contracts that regulate relations between the hospitals and their professional staffs. The aim of this paper is to discuss some main characteristics of the contracts that regulate the perceived relations between physicians as employees and the public hospital as employer. The theoretical framework is based on a contract theory approach. The empirical data is based on survey data from full-time employed physicians in the medical and surgical divisions in one of the largest university hospitals in Norway. This study shows that perceived obligations and psychological contracts indicate high degree of relational contracts between the hospital and the physicians. These socio-cultural elements should be recognized as important mechanisms of coordination and communication when policy makers and hospital managers are designing hospital management control systems. Copyright © 2009 John Wiley & Sons, Ltd.

  4. Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives.

    Science.gov (United States)

    Snijdewind, Marianne C; van Tol, Donald G; Onwuteaka-Philipsen, Bregje D; Willems, Dick L

    2014-12-01

    The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known. To identify and categorize the characteristics of EAS requests that are more complex than others. We held in-depth interviews with 28 Dutch physicians about their perception of complex cases of EAS requests. We also interviewed 26 relatives of patients who had died by EAS. We used open coding and inductive analysis to identify various different aspects of the complexities described by the participants. Complexities can be categorized into relational difficulties-such as miscommunication, invisible suffering, and the absence of a process of growth toward EAS-and complexities that arise from unexpected situations, such as the capricious progress of a disease or the obligation to move the patient. The interviews showed that relatives of the patient influence the process toward EAS. First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  5. Changes in patient satisfaction related to hospital renovation: experience with a new clinical building.

    Science.gov (United States)

    Siddiqui, Zishan K; Zuccarelli, Rebecca; Durkin, Nowella; Wu, Albert W; Brotman, Daniel J

    2015-03-01

    There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction. To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility. Natural experiment utilizing a pre-post design with concurrent controls. Academic tertiary care hospital. We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls. Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities. The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores. The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical

  6. Physician perspectives on collaborative working relationships with team-based hospital pharmacists in the inpatient medicine setting.

    Science.gov (United States)

    Makowsky, Mark J; Madill, Helen M; Schindel, Theresa J; Tsuyuki, Ross T

    2013-04-01

    Collaborative care between physicians and pharmacists has the potential to improve the process of care and patient outcomes. Our objective was to determine whether team-based pharmacist care was associated with higher physician-rated collaborative working relationship scores than usual ward-based pharmacist care at the end of the COLLABORATE study, a 1 year, multicentre, controlled clinical trial, which associated pharmacist intervention with improved medication use and reduced hospital readmission rates. We conducted a cross-sectional survey of all team-based and usual care physicians (attending physicians and medical residents) who worked on the participating clinical teaching unit or primary healthcare teams during the study period. They were invited to complete an online version of the validated Physician-Pharmacist Collaboration Index (PPCI) survey at the end of the study. The main endpoint of interest was the mean total PPCI score. Only three (response rate 2%) of the usual care physicians responded and this prevented us from conducting pre-specified comparisons. A total of 23 team-based physicians completed the survey (36%) and reported a mean total PPCI score of 81.6 ± 8.6 out of a total of 92. Mean domain scores were highest for relationship initiation (14.0 ± 1.4 out of 15), and trustworthiness (38.9 ± 3.7 out of 42), followed by role specification (28.7 ± 4.3 out of 35). Pharmacists who are pursuing collaborative practice in inpatient settings may find the PPCI to be a meaningful tool to gauge the extent of collaborative working relationships with physician team members. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

  7. Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician.

    Directory of Open Access Journals (Sweden)

    Amitesh Agarwal

    Full Text Available To examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs and primary care physicians.We conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER visit, number of hospitalizations and 30-day readmission in 2010.A total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95%Confidence Interval [CI] 1.05-1.32, oxygen therapy (aOR = 1.25, 95% CI 1.12-1.40 and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23-1.56, but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71-0.98 and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI 1.07-1.48 than those cared for by physicians.Compared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and been referred to pulmonologist, however they had lower rates of vaccination probably due to lower age group. Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians, conversely there was no differences in hospitalization or readmission for COPD between MDs and APPs.

  8. Physician-management relationships at HCA: a case study.

    Science.gov (United States)

    Campbell, P; Kane, N M

    1990-01-01

    The questions of whether Hospital Corporation of America (HCA), a for-profit hospital company, fostered an environment detrimental to the physician-patient relationship during the period of implementation of the Medicare Prospective Payment System (PPS) was explored. The transition to PPS provided an opportunity to evaluate whether hospital ownership differences affected responses to a payment system which encouraged institutional intervention in the practice of medicine. A case study approach was used to observe the influence of the then largest for-profit hospital corporation upon physicians' medical practice in four owned hospitals. Findings indicated that HCA hospital managers were most directly influenced by the local competitive environment and their own personal agendas in responding to PPS incentives. Corporate influence actually softened payment system incentives to intervene in medical practice by providing a generous supply of capital, and by fostering a corporate culture conducive to cooperative relationships with physicians. Better public understanding of the determinants of hospital behavior is needed to preserve or enhance important social goals such as the physician-patient relationship; easily measurable characteristics such as ownership or bed size explain little about hospital behavior or motivation.

  9. Appealing to an important customer. Physicians should be the target of marketing.

    Science.gov (United States)

    Weiss, R

    1989-05-01

    Although many healthcare professionals are turning to the general public to increase market share and referrals, they should be directing their attention to physicians instead. One of the major challenges facing hospitals is determining physician needs. A survey may be necessary to identify physicians' perceptions, attitudes, values, expectations, market, and hospital loyalty. Another important research document is the physician profile, which includes each doctor by age, specialty, office location, admitting and outpatient referral activity, financial contribution, and referral and other affiliations. Surveying should not end with the physician. One of the best means of evaluating patient and physician satisfaction is by questioning physicians' office staff. To centralize physician services, a number of hospitals have established physician liaison programs, which bridge the gap between the hospital and the physician's office, heighten physician satisfaction, and increase referrals. Physician orientation is a key element of most outreach programs, providing an opportunity to develop relationships with new physicians. Other means of directly aiding physicians are physician referral services and practice enhancement and assistance.

  10. Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report

    Directory of Open Access Journals (Sweden)

    Karlsen Tom H

    2004-10-01

    Full Text Available Abstract Background Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS. This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. Methods We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. Results The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Conclusions Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

  11. Finnish physicians' stress related to information systems keeps increasing: a longitudinal three-wave survey study.

    Science.gov (United States)

    Heponiemi, Tarja; Hyppönen, Hannele; Vehko, Tuulikki; Kujala, Sari; Aalto, Anna-Mari; Vänskä, Jukka; Elovainio, Marko

    2017-10-17

    Poorly functioning, time-consuming, and inadequate information systems are among the most important work-related psychosocial factors causing stress in physicians. The present study examined the trend in the perceived stress that was related to information systems (SRIS) among Finnish physicians during a nine-year follow-up. In addition, we examined the associations of gender, age, employment sector, specialization status, leadership position, on-call burden, and time pressure with SRIS change and levels. A longitudinal design with three survey data collection waves (2006, 2010 and 2015) based on a random sample of Finnish physicians in 2006 was used. The study sample included 1095 physicians (62.3% women, mean age 54.4 years) who provided data on SRIS in every wave. GLM repeated measures analyses were used to examine the associations between independent variables and the SRIS trend during the years 2006, 2010, and 2015. SRIS increased during the study period. The estimated marginal mean of SRIS in 2006 was 2.80 (95% CI = 2.68-2.92) and the mean increase was 0.46 (95% CI = 0.30-0.61) points from 2006 to 2010 and 0.25 (95% CI = 0.11-0.39) points from 2010 to 2015. Moreover, our results show that the increase was most pronounced in primary care, whereas in hospitals SRIS did not increase between 2010 and 2015. SRIS increased more among those in a leadership position. On-call duties and high time-pressures were associated with higher SRIS levels during all waves. Changing, difficult, and poorly functioning information systems (IS) are a prominent source of stress among Finnish physicians and this perceived stress continues to increase. Organizations should implement arrangements to ease stress stemming from IS especially for those with a high workload and on-call or leadership duties. To decrease IS-related stress, it would be important to study in more detail the main IS factors that contribute to SRIS. Earlier studies indicate that the usability and stability

  12. Barriers to Medical Error Reporting for Physicians and Nurses.

    Science.gov (United States)

    Soydemir, Dilek; Seren Intepeler, Seyda; Mert, Hatice

    2017-10-01

    The purpose of the study was to determine what barriers to error reporting exist for physicians and nurses. The study, of descriptive qualitative design, was conducted with physicians and nurses working at a training and research hospital. In-depth interviews were held with eight physicians and 15 nurses, a total of 23 participants. Physicians and nurses do not choose to report medical errors that they experience or witness. When barriers to error reporting were examined, it was seen that there were four main themes involved: fear, the attitude of administration, barriers related to the system, and the employees' perceptions of error. It is important in terms of preventing medical errors to identify the barriers that keep physicians and nurses from reporting errors.

  13. Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates.

    Science.gov (United States)

    Kocher, Mininder S; Dichtel, Laura; Kasser, James R; Gebhardt, Mark C; Katz, Jeffery N

    2008-02-01

    Specialty board certification status has become the de facto standard of competency by which the profession and the public recognize physician specialists. However, the relationship between orthopedic board certification and physician performance has not been established. Rates of medical malpractice claims, hospital disciplinary actions, and state medical board disciplinary actions were compared between 1309 board-certified (BC) and 154 non-board-certified (NBC) orthopedic surgeons in 3 states. There was no significant difference between BC and NBC surgeons in medical malpractice claim proportions (BC, 19.1% NBC, 16.9% P = .586) or in hospital disciplinary action proportions (BC, 0.9% NBC, 0.8% P = 1.000). There was a significantly higher proportion of state medical board disciplinary action for NBC surgeons (BC, 7.6% NBC, 13.0% P = .028). An association between board certification status and physician performance is necessary to validate its status as the de facto standard of competency. In this study, BC surgeons had lower rates of state medical board disciplinary action.

  14. The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients.

    NARCIS (Netherlands)

    Sloots, Joanne M; Barton, Christopher A; Buckman, Julie; Bassett, Katherine L.; van der Palen, Job; Frith, Peter A.; Effing, Tanja

    2017-01-01

    We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT

  15. Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients.

    Science.gov (United States)

    Wang, Jong-Yi; Ho, Hsiao-Yun; Chen, Jen-De; Chai, Sinkuo; Tai, Chih-Jaan; Chen, Yung-Fu

    2015-07-12

    In this era of ubiquitous information, patient record exchange among hospitals still has technological and individual barriers including resistance to information sharing. Most research on user attitudes has been limited to one type of user or aspect. Because few analyses of attitudes toward electronic patient records (EPRs) have been conducted, understanding the attitudes among different users in multiple aspects is crucial to user acceptance. This proof-of-concept study investigated the attitudes of users toward the inter-hospital EPR exchange system implemented nationwide and focused on discrepant behavioral intentions among three user groups. The system was designed by combining a Health Level 7-based protocol, object-relational mapping, and other medical informatics techniques to ensure interoperability in realizing patient-centered practices. After implementation, three user-specific questionnaires for physicians, medical record staff, and patients were administered, with a 70 % response rate. The instrument showed favorable convergent construct validity and internal consistency reliability. Two dependent variables were applied: the attitudes toward privacy and support. Independent variables comprised personal characteristics, work characteristics, human aspects, and technology aspects. Major statistical methods included exploratory factor analysis and general linear model. The results from 379 respondents indicated that the patients highly agreed with privacy protection by their consent and support for EPRs, whereas the physicians remained conservative toward both. Medical record staff was ranked in the middle among the three groups. The three user groups demonstrated discrepant intentions toward privacy protection and support. Experience of computer use, level of concerns, usefulness of functions, and specifically, reason to use electronic medical records and number of outpatient visits were significantly associated with the perceptions. Overall, four

  16. [Recommendations for problem solving in integrative postgraduate medical training of physicians at anthroposophic hospitals in Germany and Switzerland].

    Science.gov (United States)

    Eberhard, Sabine; Weinzirl, Johannes; Orlow, Pascale; Berger, Bettina; Heusser, Peter

    2014-01-01

    In the context of the first-time evaluation of the quality and problems of integrative postgraduate medical training (PGMT) at German and Swiss anthroposophic hospitals, all 240 trainees and all 214 trainers were asked to propose options for problem solutions. The study included a cross-sectional questionnaire survey with sections for further comments. The data were evaluated with qualitative content analysis (Mayring). 56 (51.8%) out of 108 responding trainees and 54 (54%) out of 100 responding trainers had given potential solutions. Both groups were analyzed together. On internal level, recommendations comprised re-orientation on a leadership basis, i.e. elevation of PGMT to a core element of hospital policy in anthroposophic medicine (AM), as well as better personnel policy; trainers with more professional and teaching competency in AM; structured and extended continual education program; coordination of PGMT with ward and hospital organization; and work load reduction for physicians through process optimization and resource planning. Externally, the recommendations embraced financial support; external training programs; networking of anthroposophic hospitals in PGMT; implementation of a common competence center for anthroposophic PGMT; conventional and anthroposophic PGMT curriculums; and improvement of science base and public discourse of AM. The proposed options for problem solving in PGMT at anthroposophic hospitals emerge from concrete problem perceptions of the trainers and trainees. They can serve as a basis for concrete improvements of PGMT in AM that could be implemented professionally and in an international context. The preconditions for this are given through the already existing establishment of AM at universities and through the good international connections of anthroposophic hospitals and anthroposophic physicians' associations.

  17. Effects of Physician Volume on Readmission and Mortality in Elderly Patients with Heart Failure: Nationwide Cohort Study.

    Science.gov (United States)

    Lee, Joo Eun; Park, Eun Cheol; Jang, Suk Yong; Lee, Sang Ah; Choy, Yoon Soo; Kim, Tae Hyun

    2018-03-01

    Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality. We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002-2013. Subjects comprised 2345 inpatients (age: >65 years) admitted to acute-care hospitals for heart failure. A multivariate Cox regression was used. Of the 2345 patients hospitalized with heart failure, 812 inpatients (34.6%) were readmitted within 30 days and 190 (8.1%) had died within a year. Heart-failure patients treated at hospitals with low physician volumes had higher readmission and mortality rates than high physician volumes [30-day readmission: hazard ratio (HR)=1.291, 95% confidence interval (CI)=1.020-1.633; 1-year mortality: HR=2.168, 95% CI=1.415-3.321]. Patients admitted to hospitals with low or middle bed and physician volume had higher 30-day readmission and 1-year mortality rates than those admitted to hospitals with high volume (30-day readmission: HR=2.812, 95% CI=1.561-5.066 for middle-volume beds & low-volume physicians, 1-year mortality: HR=8.638, 95% CI=2.072-36.02 for middle-volume beds & low-volume physicians). Physician volume is related to lower readmission and mortality for heart failure. Of interest, 30-day readmission and 1-year mortality were significantly associated with the combined effects of physician and institution bed volume. © Copyright: Yonsei University College of Medicine 2018

  18. Physician's information about alcohol problems at hospitalisation of alcohol misusers

    DEFF Research Database (Denmark)

    Nielsen, S D; Gluud, C

    1992-01-01

    Information was gathered on recognition and treatment of alcohol problems in the primary and secondary health sectors, the latter represented by a department of hepatology. The general practitioner finds in most cases (18/26, 69%) that it is relevant to advise about a patient's alcohol misuse...... on admission forms when the patient previously has been discharged from another department with this diagnosis. However, if the patient has not previously been hospitalised due to alcohol misuse, information on the diagnosis is only rarely (30/114, 26%) available. This difference is highly significant (P = 0.......0001). The case-recording hospital physician at admission recognises 73% of alcohol misusers who are admitted with a non-alcohol-related diagnosis. When the patient had been evaluated by both the admitting physician and the case-recording hospital physician, information on the alcohol problem occurred...

  19. Attitudes of Nurses and Physicians About Clinical Autopsy in Neonatal and Adult Hospital Care: A Survey in Sweden.

    Science.gov (United States)

    Mjörnheim, Berit; Rosendahl, Anders; Eriksson, Lennart C; Takman, Christina

    2015-01-01

    The rate of autopsies has dropped to low levels in Western countries. The aim of this study was to describe the experiences and attitudes of registered nurses (RNs) and physicians (MD) toward clinical autopsies in neonatal and adult hospital care in Sweden. RNs and MDs in neonatal and adult care specialized clinics at a university-affiliated hospital in Sweden were surveyed. Survey responses were tallied, and free-text comments were assessed with qualitative content analysis. Three hundred thirty-six surveys were distributed; the response rate was 35%. Most RNs and 14% of the MDs had limited or no experience participating in an autopsy. Notably, few RNs and approximately one third of the MDs were familiar with the autopsy processes and the treatment of the deceased person's body after an autopsy. More than one third of RNs had experience with talking to relatives regarding autopsy. Most agreed that an autopsy could be supportive for relatives during the grieving process and beneficial for the quality of healthcare. Most MDs (70%) thought that autopsies should be performed more frequently. Qualitative results emphasized that RNs and MDs thought that autopsy information supported the grieving process of relatives-especially parents who had lost a child. The survey data confirm belief in the value of clinical autopsies in neonatal and adult hospital care. RNs and MDs should receive training about the autopsy process and procedures for obtaining consent for an autopsy. RNs are in a position to support the decision making of relatives about providing consent for autopsy and have an opportunity to take a more active role in the autopsy process.

  20. Knowledge, attitudes, representations and declared practices of nurses and physicians about obesity in a university hospital: training is essential.

    Science.gov (United States)

    Bucher Della Torre, S; Courvoisier, D S; Saldarriaga, A; Martin, X E; Farpour-Lambert, N J

    2018-04-01

    In the context of a worldwide obesity epidemic, healthcare providers play a key role in obesity management. Knowledge of current guidelines and attitudes to prevent stigmatization are especially important. This study aimed to assess knowledge, attitudes, beliefs, perception of opportunity for intervention, declared practices and need for training and material of nurses and physicians about obesity in a Swiss University Hospital. A total of 834 physicians and nurses filled an online survey. The questionnaire was based on literature, exploratory interviews and expert committee review. It was pre-tested with 15 physicians and nurses. Participants declared a low level of negative attitudes towards individuals living with obesity. However, the results highlighted a lack of knowledge to diagnose obesity in adults and children, as well as confidence and training to care of patients with obesity. One-third of providers did not know how to calculate body mass index. Half of providers felt it was part of their role to take care of patients with obesity, even if 55% of them had the feeling that they did not have adequate training. Nurses and physicians working in a university hospital showed a low level of negative attitudes but a lack of knowledge and skills on obesity management. Training should be improved in this population to insure adequate and coherent messages and equal access to evidence-based treatment for patients living with obesity. © 2018 World Obesity Federation.

  1. Variation in Primary Cesarean Delivery Rates by Individual Physician within a Single Hospital Laborist Model

    Science.gov (United States)

    METZ, Torri D.; ALLSHOUSE, Amanda A.; GILBERT, Sara A Babcock; DOYLE, Reina; TONG, Angie; CAREY, J. Christopher

    2016-01-01

    Background Laborist practice models are associated with lower cesarean delivery rates than individual private practice models in several studies; however, this effect is not uniform. Further exploration of laborist models may help us better understand the observed reduction in cesarean delivery rates in some hospitals with implementation of a laborist model. Objective Our objective was to evaluate the degree of variation in primary cesarean delivery rates by individual laborists within a single institution employing a laborist model. In addition, we sought to evaluate whether differences in cesarean delivery rates resulted in different maternal or short-term neonatal outcomes. Study Design At this teaching institution, one laborist (either a generalist or maternal-fetal medicine attending physician) is directly responsible for labor and delivery management during each shift. No patients are followed in a private practice model nor are physicians incentivized to perform deliveries. We retrospectively identified all laborists who delivered nulliparous, term women with cephalic singletons at this institution from 2007-14. Overall and individual primary cesarean delivery rates were reported as percentages with exact Pearson 95% CI. Laborists were grouped by tertile as having low, medium or high cesarean delivery rates. Characteristics of the women delivered, indications for cesarean delivery, and short-term neonatal outcomes were compared between these groups. A binomial regression model of cesarean delivery was estimated, where the relative rates of each laborist compared to the lowest-unadjusted laborist rate were calculated; a second model was estimated to adjust for patient-level maternal characteristics. Results Twenty laborists delivered 2,224 nulliparous, term women with cephalic singletons. The overall cesarean delivery rate was 24.1% (95% CI 21.4-26.8). In an unadjusted binomial model, the overall effect of individual laborist was significant (pcesarean

  2. Dealing with symptoms and issues of hospitalized patients with cancer in indonesia: the role of families, nurses, and physicians.

    Science.gov (United States)

    Effendy, Christantie; Vissers, Kris; Tejawinata, Sunaryadi; Vernooij-Dassen, Myrra; Engels, Yvonne

    2015-06-01

    Patients with cancer often face physical, psychological, social, spiritual, and emotional symptoms. Our aim was to study symptoms and issues of hospitalized patients with cancer in Indonesia, a country with strong family ties, and how family members, nurses, and physicians deal with them. In 2011, 150 hospitalized cancer patients in 3 general hospitals in Indonesia were invited to fill in a questionnaire, which was based on the validated Problems and Needs of Palliative Care (short version) questionnaire. Descriptive statistics were performed. Of 119 patients (79%) who completed the questionnaire, 85% stated that their symptoms and issues were addressed. According to these patients, financial (56%), autonomy (36%), and psychosocial (34%) issues were most often addressed by the family alone. Physical symptoms (52%) and spiritual issues (33%) were addressed mainly by a combination of family, nurses, and physicians. Hospitalized patients with cancer in Indonesia felt that most of their symptoms and issues had been addressed, and the family was highly involved. The strong family ties in Indonesian culture may have contributed to this family role. More research is needed to clarify how this influences patient outcome, quality of care, and quality of life of both the patients and their families, along with the degree of partnership between families and professionals. This information might help answer the question what advantages and disadvantages the family role in caring for a hospitalized patient with cancer generates for the patient, the family, and professional caregivers. © 2014 World Institute of Pain.

  3. Radiation decontamination unit for the community hospital.

    Science.gov (United States)

    Waldron, R L; Danielson, R A; Shultz, H E; Eckert, D E; Hendricks, K O

    1981-05-01

    "Freestanding" radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstruction. Because of the development of nuclear power plants in relatively remote areas and widespread transportation of radioactive materials it is important for hospitals and physicians to be prepared to handle radiation accident victims. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Ridge Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. It is important that the team leader be knowledgeable in radiation accident management and have personnel trained in radiation accident management as members of this team. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important. Periodic drills are necessary for this mobilization and the smooth operation of the unit.

  4. Healthcare technology: physician collaboration in reducing the surgical cost.

    Science.gov (United States)

    Olson, Steven A; Obremskey, William T; Bozic, Kevin J

    2013-06-01

    The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

  5. Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden.

    Science.gov (United States)

    Armuand, G M; Nilsson, J; Rodriguez-Wallberg, K A; Malmros, J; Arvidson, J; Lampic, C; Wettergren, L

    2017-10-01

    The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions. A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility. More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17). Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology. © 2017 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

  6. Physician Networks and Ambulatory Care-sensitive Admissions.

    Science.gov (United States)

    Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Nyweide, David J; Iwashyna, Theodore J; Sun, Xuming; Mendelsohn, Jayme; Moody, James

    2015-06-01

    Research on the quality and cost of care traditionally focuses on individual physicians or medical groups. Social network theory suggests that the care a patient receives also depends on the network of physicians with whom a patient's physician is connected. The objectives of the study are: (1) identify physician networks; (2) determine whether the rate of ambulatory care-sensitive hospital admissions (ACSAs) varies across networks--even different networks at the same hospital; and (3) determine the relationship between ACSA rates and network characteristics. We identified networks by applying network detection algorithms to Medicare 2008 claims for 987,000 beneficiaries in 5 states. We estimated a fixed-effects model to determine the relationship between networks and ACSAs and a multivariable model to determine the relationship between network characteristics and ACSAs. We identified 417 networks. Mean size: 129 physicians; range, 26-963. In the fixed-effects model, ACSA rates varied significantly across networks: there was a 46% difference in rates between networks at the 25th and 75th performance percentiles. At 95% of hospitals with admissions from 2 networks, the networks had significantly different ACSA rates; the mean difference was 36% of the mean ACSA rate. Networks with a higher percentage of primary-care physicians and networks in which patients received care from a larger number of physicians had higher ACSA rates. Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care.

  7. Locum physicians' professional ethos: a qualitative interview study from Germany.

    Science.gov (United States)

    Salloch, Sabine; Apitzsch, Birgit; Wilkesmann, Maximiliane; Ruiner, Caroline

    2018-05-08

    In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals. In this first qualitative study on German locum physicians, the locums' own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups' perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians' role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society? The study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor-patient contact and the sustainability of hiring locums as a remedy in times of staff shortage. Further qualitative and quantitative research on locum physicians' professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector.

  8. Can We Do That Here? Establishing the Scope of Surgical Practice at a New Safety-Net Community Hospital Through a Transparent, Collaborative Review of Physician Privileges.

    Science.gov (United States)

    O'Neill, Sean M; Seresinghe, Sarah; Sharma, Arun; Russell, Tara A; Crawford, L'Orangerie; Frencher, Stanley K

    2018-01-01

    Stewarding of physician privileges wisely is imperative, but no guidelines exist for how to incorporate system-level factors in privileging decisions. A newly opened, safety-net community hospital tailored the scope of surgical practice through review of physician privileges. Martin Luther King, Jr. Community Hospital is a public-private partnership, safety-net institution in South Los Angeles that opened in July 2015. It has 131 beds, including a 28-bed emergency department, a 20-bed ICU, and 5 operating rooms. Staff privileging decisions were initially based only on physicians' training and experience, but this resulted in several cases that tested the boundaries of what a small community hospital was prepared to handle. A collaborative, transparent process to review physician privileges was developed. This began with physician-only review of procedure lists, followed by a larger, multidisciplinary group to assess system-level factors. Specific questions were used to guide discussion, and unanimous approval from all stakeholders was required to include a procedure. An initial list of 558 procedures across 11 specialties was reduced to 321 (57.5%). No new cases that fall outside these new boundaries have arisen. An inclusive process was crucial for obtaining buy-in and establishing cultural norms. Arranging transfer agreements remains a significant challenge. Accumulation of institutional experience continues through regular performance reviews. As this hospital's capabilities mature, a blueprint has been established for expanding surgical scope of practice based explicitly on system-level factors. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  9. Are specialist physicians missing out on the e-Health boat?

    Science.gov (United States)

    Osborn, M; Day, R; Westbrook, J

    2009-10-01

    Nationally health systems are making increasing investments in the use of clinical information systems. Little is known about current computer use by specialist physicians, particularly outside the hospital setting. To identify the extent and reasons physician Fellows of the Royal Australasian College of Physicians (RACP) use computers in their work. A self-administered survey was emailed from the RACP to all practising physicians in 2007 that were living in Australia and New Zealand who had consented to email contact with the College. The survey was sent to a total of 7445 eligible physicians, 2328 physicians responded (31.3% response rate), but only 1266 responses (21.0%) were able to be analysed. Most 97.5% had access to computers at work and 96.5% used home computers for work purposes. Physicians in public hospitals (72.6%) were more likely to use computers for work (65.6%) than those in private hospitals (12.6%) or consulting rooms (27.3%). Overall physicians working in public hospitals used a wider range of applications with 70.5% using their computers for searching the internet, 53.7% for receiving results and 52.7% used their computers to engage in specific educational activities. Physicians working from their consulting rooms (33.6%) were more likely to use electronic prescribing (11%) compared with physicians working in public hospitals (5.7%). Fellows have not incorporated computers into their consulting rooms over which they have control. This is in contrast to general practitioners who have embraced computers after the provision of various incentives. The rate of use of computers by physicians for electronic prescribing in consulting rooms (11%) is very low in comparison with general practitioners (98%). One reason may be that physicians work in multiple locations whereas general practitioners are more likely to work from one location.

  10. Development of a tripolar model of technology acceptance: Hospital-based physicians' perspective on EHR.

    Science.gov (United States)

    Beglaryan, Mher; Petrosyan, Varduhi; Bunker, Edward

    2017-06-01

    In health care, information technologies (IT) hold a promise to harness an ever-increasing flow of health related information and bring significant benefits including improved quality of care, efficiency, and cost containment. One of the main tools for collecting and utilizing health data is the Electronic Health Record (EHR). EHRs implementation can face numerous barriers to acceptance including attitudes and perceptions of potential users, required effort attributed to their implementation and usage, and resistance to change. Various theories explicate different aspects of technology deployment, implementation, and acceptance. One of the common theories is the Technology Acceptance Model (TAM), which helps to study the implementation of different healthcare IT applications. The objectives of this study are: to understand the barriers of EHR implementation from the perspective of physicians; to identify major determinants of physicians' acceptance of technology; and develop a model that explains better how EHRs (and technologies in general) are accepted by physicians. The proposed model derives from a cross-sectional survey of physicians selected through multi-stage cluster sampling from the hospitals of Yerevan, Armenia. The study team designed the survey instrument based on a literature review on barriers of EHR implementation. The analysis employed exploratory structural equation modeling (ESEM) with a robust weighted least squares (WLSMV) estimator for categorical indicators. The analysis progressed in two steps: appraisal of the measurement model and testing of the structural model. The derived model identifies the following factors as direct determinants of behavioral intention to use a novel technology: projected collective usefulness; personal innovativeness; patient influence; and resistance to change. Other factors (e.g., organizational change, professional relationships, administrative monitoring, organizational support and computer anxiety) exert their

  11. Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan

    Science.gov (United States)

    Chou, Li-Ping; Li, Chung-Yi; Hu, Susan C

    2014-01-01

    Objectives To explore the prevalence and associated factors of burnout among five different medical professions in a regional teaching hospital. Design Cross-sectional study. Setting Hospital-based survey. Participants A total of 1329 medical professionals were recruited in a regional hospital with a response rate of 89%. These voluntary participants included 101 physicians, 68 physician assistants, 570 nurses, 216 medical technicians and 374 administrative staff. Primary and secondary outcome measures Demographic data included gender, age, level of education and marital status, and work situations, such as position, work hours and work shifts, were obtained from an electronic questionnaire. Job strain and burnout were measured by two validated questionnaires, the Chinese version of the Job Content Questionnaire and the Copenhagen Burnout Inventory. Results Among the five medical professions, the prevalence of high work-related burnout from highest to lowest was nurses (66%), physician assistants (61.8%), physicians (38.6%), administrative staff (36.1%) and medical technicians (31.9%), respectively. Hierarchical regression analysis indicated that job strain, overcommitment and low social support explained the most variance (32.6%) of burnout. Conclusions Physician assistant is an emerging high burnout group; its severity is similar to that of nurses and far more than that of physicians, administrative staff and medical technicians. These findings may contribute to the development of feasible strategies to reduce the stress which results in the burnout currently plaguing most hospitals in Taiwan. PMID:24568961

  12. Physician practice participation in accountable care organizations: the emergence of the unicorn.

    Science.gov (United States)

    Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R

    2014-10-01

    To provide the first nationally based information on physician practice involvement in ACOs. Primary data from the third National Survey of Physician Organizations (January 2012-May 2013). We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. © Health Research and Educational Trust.

  13. Dealing with symptoms and issues of hospitalized patients with cancer in indonesia: the role of families, nurses, and physicians

    NARCIS (Netherlands)

    Effendy, C.; Vissers, K.; Tejawinata, S.; Vernooij-Dassen, M.J.F.J.; Engels, Y.M.

    2015-01-01

    OBJECTIVE: Patients with cancer often face physical, psychological, social, spiritual, and emotional symptoms. Our aim was to study symptoms and issues of hospitalized patients with cancer in Indonesia, a country with strong family ties, and how family members, nurses, and physicians deal with them.

  14. Direct medical cost of influenza-related hospitalizations among severe acute respiratory infections cases in three provinces in China.

    Directory of Open Access Journals (Sweden)

    Lei Zhou

    Full Text Available BACKGROUND: Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. METHODS: Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital's Hospital Information System (HIS and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range and median (interquartile range [IQR] costs were calculated and compared among children (≤15 years, adults (16-64 years and elderly (≥65 years groups. Factors influencing cost were analyzed. RESULTS: A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range direct medical cost was $1,797 ($80-$27,545 for all hospitalizations, and the median (IQR direct medical cost was $231 ($164, $854 ($890, and $2,263 ($7,803 for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. CONCLUSION: Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies.

  15. Scientific activity and working hours of physicians in university hospitals: results from the Innsbruck and Salzburg physician lifestyle assessment (TISPLA).

    Science.gov (United States)

    Steger, Bernhard; Colvin, Hans Peter; Rieder, Josef

    2009-01-01

    Controllable lifestyle has become an important factor influencing career decision-making among physicians. In academic medicine, doctors are required to combine both patient care and research in their daily routine. Insufficient release of clinicians for research during contracted work hours may lead to increased weekly working hours in academic medical centers and deter medical graduates from academia. We tested for an association between numbers of scientific publications and an increased hourly workload among physicians. This was a cross-sectional online survey among all salaried physicians working in the university hospitals of Innsbruck and Salzburg, Austria. The main outcome measures were the self-reported total number of scientific papers published in peer-reviewed medical journals over the past two years and self-reported working hours. Of 590 returned surveys, 393 were fully completed and included in the study. The sample was stratified into three groups according to scientific output in the past two years: Group A, >/= 6 publications; Group B, 1-5 publications; Group C, no publications. Men were more likely than women to have a scientific publication: in Group A there was a male predominance of 75%, whereas in Group C only 48% were men (P = 0.0034). A total of 59% (n = 232) of all participants had not published a scientific article in the past two years (Group C) and worked a mean of 58.3 +/- 12 h/week. Physicians in Group B (n = 113) had published 2.4 +/- 1.4 papers and worked 62.8 +/- 12.9 h/week; those in Group A (n = 48) had published 11.5 +/- 6.6 papers and worked 73 +/- 13.1 h/week (P work time but for 60% of overtime hours, reflecting the fact that research was mainly performed during overtime. Research activity among clinicians in academic medical centers is associated with significantly increased overtime hours. Measures need to be taken to allow medical graduates an academic career at reasonable impairment of personal lifestyle.

  16. Are hospitals also for relatives?

    DEFF Research Database (Denmark)

    Nissen, Nina Konstantin; Madsen, Mette; Kjøller, Mette

    2008-01-01

    at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark. METHODS: We surveyed activities offered by Danish hospitals to the relatives of cardiac patients. Data were obtained from an Internet-based survey...... and 50 of 55 invited hospital departments participated. RESULTS: Almost all departments offer activities to relatives of cardiac patients, but only one-quarter have activities specifically aimed at supporting relatives. Large departments offer activities for relatives more often than smaller departments....... Participation rates for relatives are generally low, and the departments experience numerous barriers in providing activities for relatives of heart patients. CONCLUSIONS: Danish hospitals focus very little on relatives of cardiac patients, and this seems to be due to several factors, including lack...

  17. Assessment of abuse-related injuries: a comparative study of forensic physicians, emergency room physicians, emergency room nurses and medical students.

    Science.gov (United States)

    Reijnders, Udo J L; Giannakopoulos, Georgios F; de Bruin, Kim H

    2008-01-01

    A comparative study was made investigating whether emergency room physicians, emergency room nurses, forensic physicians, and interns are competent in describing, recognising and determining the possible cause of injuries. The injury assessment scores varied from good--adequate--fail and remained blank in various participant groups. Forensic physicians scored significantly better than emergency room staff and interns in the assessment of abuse-related injuries. There were almost no differences noted between emergency room physicians and emergency room nurses. For the functional group with more or less than 4 to 6 years of experience, no significant differences were noted for scoring good in all 5 cases. The fact that forensic physicians scored better than the emergency room staff is probably explained by the fact that almost all practicing forensic physicians have been officially qualified. Training in this field for all professionals involved in such assessment should be mandatory.

  18. More than half the families of mobile intensive care unit patients experience inadequate communication with physicians.

    Science.gov (United States)

    Debaty, Guillaume; Ageron, François-Xavier; Minguet, Laetitia; Courtiol, Guillaume; Escallier, Christophe; Henniche, Adeline; Maignan, Maxime; Briot, Raphaël; Carpentier, Françoise; Savary, Dominique; Labarere, José; Danel, Vincent

    2015-07-01

    This study aimed to assess comprehension by family members of the patient's severity in the prehospital setting. We conducted a cross-sectional study in four mobile intensive care units (ICUs, medicalized ambulances) in France from June to October 2012. Nurses collected data on patients, patient's relatives, and mobile ICU physicians. For each patient, one relative and one physician independently rated the patient's severity using a simplified version of the Clinical Classification of Out-of-Hospital Emergency Patients scale (CCMS). Relatives were also asked to assess their interview with the physician. The primary outcome was agreement between the relative's and physician's ratings of the patient's severity. Data were available for 184 patients, their relatives, and mobile ICU physicians. Full and partial agreement between relatives and physicians regarding the patient's severity was found for 79 (43%) and 121 (66%) cases, respectively [weighted kappa = 0.32 (95% confidence interval, CI, 0.23-0.42)]. Relatives overestimated the patient's severity assessed by the physician [6 (5-8) vs. 4 (3-7), p communicated by mobile ICU physicians.

  19. [Burnout in physicians].

    Science.gov (United States)

    Kurzthaler, Ilsemarie; Kemmler, Georg; Fleischhacker, W Wolfgang

    2017-06-01

    Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

  20. Cancer patients' reluctance to discuss psychological distress with their physicians was not associated with underrecognition of depression by physicians: a preliminary study.

    Science.gov (United States)

    Okuyama, Toru; Endo, Chiharu; Seto, Takashi; Kato, Masashi; Seki, Nobuhiko; Akechi, Tatsuo; Furukawa, Toshiaki A; Eguchi, Kenji; Hosaka, Takashi

    2009-06-01

    To investigate the association between cancer patients' reluctance for emotional disclosure to their physician and underrecognition of depression by physicians. Randomly selected ambulatory patients with lung cancer were evaluated by the Hospital Depression and Anxiety Scale (HADS), and those with scores over the validated cutoff value for adjustment disorder or major depressive disorder were included in this analysis. The data set included the responses to the 13-item questionnaire to assess four possible concerns of patients in relation to emotional disclosure to the treating physician ("no perceived need to disclose emotions," "fear of the negative impact of emotional disclosure," "negative attitude toward emotional disclosure," "hesitation to disturb the physician with emotional disclosure"). The attending physicians rated the severity of depression in each patient using 3-point Likert scales (0 [absent] to 2 [clinical]). Depression was considered to be underrecognized when the patients had a HADS score above the cutoff value, but in whom the depression rating by the attending physician was 0. The HADS score was over the cutoff value in the 60 patients. The mean age was 65.1 +/- 10.0, and 82% had advanced cancer (Stage IIIb or IV or recurrence). Depression was underrecognized in 44 (73%) patients. None of the four factors related to reluctance for emotional disclosure was associated with the underrecognition of depression by the physicians. None of the demographic or cancer-related variables were associated with depression underrecognition by physicians. The results did not support the assumption that patients' reluctance for emotional disclosure is associated with the underrecognition of depression by physicians.

  1. Aspects of physicians' attitudes towards the rational use of drugs at a training and research hospital: a survey study.

    Science.gov (United States)

    Filiz Basaran, Nesrin; Akici, Ahmet

    2013-08-01

    The rational use of drugs (RUD) is primarily the responsibility of physicians. The aim of this study was to investigate whether physicians are aware of RUD principles and how they apply them in daily medical practice. A total 136 physicians working at the Kartal Training and Research Hospital in Istanbul were enrolled in the study between February and March 2012. A face-to-face interview was conducted with physicians to assess their knowledge and attitude regarding RUD. A large majority of the physicians declared that consultation time was insufficient (84 %). The data obtained from the survey indicate that 54 % of the enrolled physicians monitored the therapeutic outcome and that 27 % found the information given to the patient to be sufficient. Participating physicians stated that the less known characteristics of the drugs they prescribed were drug interactions, traceability in market, and price. The most preferred reference source was Vademecum (a drug guideline prepared by the private sector). Two major factors contributing to prescribing patterns were "self study" and "observation of teachers" at clinical training. There was a significant difference between internists-surgeons and residents-specialists in the number of prescribed drugs per prescription (p change in managerial practices within the healthcare system. The other, more essential explanation is education; consequently, serious consideration should be given to including effective clinical pharmacotherapy training and RUD courses in the medical education curriculum.

  2. Repeated, Close Physician Coronary Artery Bypass Grafting Teams Associated with Greater Teamwork.

    Science.gov (United States)

    Everson, Jordan; Funk, Russell J; Kaufman, Samuel R; Owen-Smith, Jason; Nallamothu, Brahmajee K; Pagani, Francis D; Hollingsworth, John M

    2018-04-01

    To determine whether observed patterns of physician interaction around shared patients are associated with higher levels of teamwork as perceived by physicians. Michigan Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) procedures at 24 hospitals in the state between 2008 and 2011. We assessed hospital teamwork using the teamwork climate scale in the Safety Attitudes Questionnaire. After aggregating across CABG discharges at these hospitals, we mapped the physician referral networks (including both surgeons and nonsurgeons) that served them and measured three network properties: (1) reinforcement, (2) clustering, and (3) density. We then used multilevel regression models to identify associations between network properties and teamwork at the hospitals on which the networks were anchored. In hospitals where physicians repeatedly cared for patients with the same colleagues, physicians perceived better teamwork (β-reinforcement = 3.28, p = .003). When physicians who worked together also had other colleagues in common, the reported teamwork was stronger (β clustering = 1.71, p = .001). Reported teamwork did not change when physicians worked with a higher proportion of other physicians at the hospital (β density = -0.58, p = .64). In networks with higher levels of reinforcement and clustering, physicians perceive stronger teamwork, perhaps because the strong ties between them create a shared understanding; however, sharing patients with more physicians overall (i.e., density) did not lead to stronger teamwork. Clinical and organizational leaders may consider designing the structure of clinical teams to increase interactions with known colleagues and repeated interactions between providers. © Health Research and Educational Trust.

  3. Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Sahar H Mumenah

    2015-01-01

    Full Text Available Aim: The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH are with their counterparts who work at some selected non-MOH hospitals. Methods: An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC, and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians′ level of satisfaction and how it was affected by the difficulties was assessed. Results: Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011 and radiologists (P < 0.001, absence of the internet and computer access (P < 0.001, unavailability of laboratory services (P = 0.004, reagents (P = 0.001, X-ray equipment (P = 0.027, ultrasound equipment (P < 0.001, an electronic medical records system (P < 0.001, insufficient laboratory tests (P = 0.0001, and poor building maintenance (P < 0.001. Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032. Conclusion: MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

  4. How do NHS general hospitals in England deal with patients with alcohol-related problems? A questionnaire survey.

    Science.gov (United States)

    Owens, Lynn; Gilmore, Ian T; Pirmohamed, Munir

    2005-01-01

    Alcohol-related disease represents a major burden on hospitals. However, it is unclear whether hospitals have developed the necessary expertise and guidelines to deal with this burden. The aim of this survey was to determine what measures general hospital NHS Trusts in England had in place to deal with alcohol-related problems, including the employment of dedicated alcohol specialist nurses. Two postal surveys of all NHS general hospital Trusts in England, the first in 2000 (n = 138; 54% response rate) and the second in 2003 after the publication of the Royal College of Physicians (RCP) report on alcohol in secondary care (n = 164; 75% response rate). Between the two surveys, there was a significant increase (P = 0.005) in the number of dedicated alcohol nurses employed by general hospital trusts; however, the numbers remain low (n = 21). Additionally, the availability of prescribing guidelines for the management of alcohol withdrawal increased significantly (P = 0.0001). The survey indicates that most general hospitals do not have appropriate services in place to deal with such patients. Although there is a need and willingness to develop alcohol services in general hospitals, which is one of the key recommendations of the RCP report, the lack of funding is going to act as a major barrier.

  5. [Quality of involuntary hospital administration in Switzerland].

    Science.gov (United States)

    Jäger, Matthias; Ospelt, Isabelle; Kawohl, Wolfram; Theodoridou, Anastasia; Rössler, Wulf; Hoff, Paul

    2014-05-21

    This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted. Retrospective investigation of medical records of involuntary inpatients at the University Hospital of Psychiatry in Zurich during a period of six months (N=489). Considerable deficits concerning formal and particularly content-related aspects of the certificates were found. Psychiatrists issued certificates of the highest quality followed by emergency physicians, hospital doctors and general practitioners. Patients differed with respect to several sociodemographic and clinical variables. The quality of certificates directing involuntary hospital admission has to be improved considering the impact on the individual concerned. The consequences of the new legislation on the quality of the admission practices should be inquired in order to improve professional training on the issue.

  6. Do hospital physicians really want to go digital? Acceptance of a picture archiving and communication system in a university hospital; Moechten Krankenhausaerzte wirklich auf digitale Systeme umsteigen? Die Akzeptanz gegenueber einem Bildarchivierungs- und Uebermittlungssystem in einer Universitaetsklinik

    Energy Technology Data Exchange (ETDEWEB)

    Duyck, P.; Pynoo, B.; Devolder, P.; Voet, T.; Adang, L.; Vercruysse, J. [Radiologie und medizinische Bildgebung, Universitaetsklinik Gent (Belgium)

    2008-07-15

    Purpose: radiology departments are making the transition from analog film to digital images by means of PACS (Picture Archiving and Communication System). It is critical for the hospital that its physicians adopt and accept the new digital work method regarding radiological information. The aim of this study is to investigate hospital physicians' acceptance of PACS using questionnaires pre- and post-implementation and to identify main influencing factors. Materials and methods: the study was conducted in an 1169 bed university hospital. The UTAUT (Unified Theory of Acceptance and Use of Technology) questionnaire was administered at two times: one month pre-implementation (T1) and 1.5 years post-implementation (T2) of PACS, targeting all hospital physicians with the exemption of radiologists. The UTAUT scales (Behavioral Intention BI; Facilitating Conditions FC; Effort Expectancy EE; Performance Expectancy PE; Anxiety ANX; Social Influence SI; System Use USE; Attitude toward technology ATT; Self-Efficacy SE) were used to assess questions regarding: (a) PACS' usefulness, (b) PACS' ease of learning/using, (c) PACS support availability, (d) the perceived pressure to use PACS, (e) physicians' attitude towards PACS and (f) physicians' intention to use and actual use of PACS. Results: at T1 scale ratings were positive toward the PACS implementation. The ratings on all scales with the exception of self-efficacy improved at T2. Regression analysis revealed that the key factor for intention to use PACS at T1 was the usefulness of PACS, while the availability and awareness of support was its most important predictor at T2. Overall, PE was the best predictor of BI, but all four UTAUT-determinants (PE, FC, EE and SI) were salient for its prediction. Variance explained in BI ranged from 31 to 37% while variance explained in USE was very low (3%). (orig.)

  7. Avoidable Technical and Clinical Denial Write-Off Management in Hospitals, Physician Offices, and Clinics.

    Science.gov (United States)

    Terra, Sandra Marlene; Byrne, Amanda

    2016-01-01

    This article reviews the various types of technical and clinical denials that are usually "written off" and proposes strategies to prevent this loss. For purposes of this writing, avoidable technical and clinical denial write-offs are defined as revenue lost from "first-pass" denials rejections. For example, a procedure that requires an authorization is performed without having had an authorization obtained. After appeals and attempts to recoup the revenue, often unsuccessful, the organization ultimately "writes off" the revenue as not collectable. The question to ask is: Are these claims really not collectable or can actionable steps be taken to conserve these dollars and improve the bottom line? Acute care hospitals, physician offices, and clinics. In today's environment, the need to manage costs is ubiquitous. Cost management is on the priority list of all savvy health care executives, even if margins are healthy, revenue is under pressure, and the magnitude of cost reduction needed is greater than what past efforts have achieved. As hospitals and physician clinics prioritize areas for improvement, reduction in lost revenue-especially avoidable lost revenue-should be at the top of the list. Attentively managing claim denial write-offs will significantly reduce lost revenue. There is significant interface between case management and the revenue cycle. Developing core competencies for reducing clinical and technical denials should be a critical imperative in overall cost management strategy. Case managers are well placed to prevent these unnecessary losses through accurate status determination and clinical documentation review. These clinical professionals can also provide insight into work flow and other processes inherent in the preauthorization process.

  8. [Physician-patient with AIDS-relationship, as a model of clinical relation within the framework of the social security institutions in Mexico].

    Science.gov (United States)

    Valdez-Martínez, Edith; Bedolla, Miguel; Rico, Rosalía

    2011-01-01

    To examine the nature and level of physician involvement during a clinical encounter with a patient with a chronic condition, such as AIDS, and to explore how it is understood and constructed by them. Qualitative design with participant observation and semi-structured interviews, with physicians and patients, conducted in hospitals of Social Security Institutions in Mexico City Data were analyzed using the constant comparative method developed in the grounded theory tradition. The emergent themes studied were the dynamics of the encounters, levels of participation of the physician, and attitudes of both participants. Irrespective of whether patients were seen for the first time, or subsequently, in outpatient consultation or in hospital, the physician focused on the solution of the biological problem and on the performance of a work commitment with the Institution. This study highlights the need to strengthen the incorporation of the ethics into daily clinical practice in order to transform a physician-patient relationship which is merely bureaucratic, focused on the solution of a biological problem and on the fulfillment of an institutional commitment, into a relationship which is truly professional and at the service of the patient.

  9. Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn

    Science.gov (United States)

    Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R

    2014-01-01

    Objective To provide the first nationally based information on physician practice involvement in ACOs. Data Sources/Study Setting Primary data from the third National Survey of Physician Organizations (January 2012–May 2013). Study Design We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. Data Collection/Extraction Methods We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. Principal Findings We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Conclusions Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. PMID:24628449

  10. An innovative approach to supporting hospitalist physicians towards academic success.

    Science.gov (United States)

    Howell, Eric; Kravet, Steven; Kisuule, Flora; Wright, Scott M

    2008-07-01

    Academic hospitalist physicians face significant challenges that may threaten their chances for successful and timely promotions, such as heavy clinical workloads, limited training in research, and relatively few experienced mentors in their field. The appreciable growth of hospital medicine groups in recent years, as has occurred at our institution, compounds the predicament by diluting the limited resources that are available to support these physicians. A needs assessment was followed by the development of specific objectives for the division and for individual members of the division related to academic success. The resulting 3-pronged strategy to support the academic success of our group was based on securing strong mentorship, investing requisite resources, and committing to recruit fellowship-trained new faculty. To date, the initiative has resulted in an increased number of peer-reviewed publication and grants, as well as national leadership roles for division members. Copyright 2008 Society of Hospital Medicine.

  11. The impact of provider consolidation on physician prices.

    Science.gov (United States)

    Carlin, Caroline S; Feldman, Roger; Dowd, Bryan

    2017-12-01

    When a clinic system is acquired by an integrated delivery system (IDS), the ownership change includes both vertical integration with the hospital(s), and horizontal integration with the IDS's previously owned or "legacy" clinics, causing increased market concentration in physician services. Although there is a robust literature on the impact of hospital market concentration, the literature on physician market concentration is sparse. The objective of this study is to determine the impact on physician prices when two IDSs acquired three multispecialty clinic systems in Minneapolis-St Paul, Minnesota at the end of 2007, using commercial claims data from a large health plan (2006-2011). Using a difference-in-differences model and nonacquired clinics as controls, we found that four years after the acquisitions (2011), average physician price indices in the acquired clinic systems were 32-47% higher than expected in absence of the acquisitions. Average physician prices in the IDS legacy clinics were 14-20% higher in 2011 than expected. Procedure-specific prices for common office visit and inpatient procedures also increased following the acquisitions. Copyright © 2017 John Wiley & Sons, Ltd.

  12. When authenticity matters most: Physicians' regulation of emotional display and patient satisfaction.

    Science.gov (United States)

    Yagil, Dana; Shnapper-Cohen, Moran

    2016-10-01

    The emotions expressed by physicians in medical encounters have significant impact on health outcomes and patient satisfaction. This study explored how physicians' regulation of displayed emotions affects patients' satisfaction, under low and high levels of patient distress and length of physician-patient acquaintance. Questionnaires were administered to 46 physicians and 230 of their patients (before and after the medical encounter) in outpatient clinics of two hospitals. Data were analyzed with hierarchical linear modeling which takes the nested data structure into account. We found a significant interaction effect of physician regulation of displayed emotions and patient distress on satisfaction: When distress was high, physician regulation of emotions was negatively related to patient satisfaction. The results also show a significant interaction effect of physician regulation of displayed emotions and length of physician-patient acquaintance: With a longer acquaintance, physician regulation of emotions was negatively related to patient satisfaction. The effect of the physicians' emotional display on patient satisfaction depends on contextual factors, such as patient distress and length of physician-patient acquaintance, which affect patients' emotional needs and expectations. When patients have high emotional involvement in the encounter it is suggested that physicians consider presenting genuine emotions to patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Radiation decontamination unit for the community hospital

    International Nuclear Information System (INIS)

    Waldron, R.L. II; Danielson, R.A.; Shultz, H.E.; Eckert, D.E.; Hendricks, K.O.

    1981-01-01

    Freestanding radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstrution. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Rige Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important

  14. Consumer product branding strategy and the marketing of physicians' services.

    Science.gov (United States)

    Friedrich, H; Witt, J

    1995-01-01

    Hospitals have traditionally maintained physician referral programs as a means of attracting physicians to their network of affiliated providers. The advent of managed care and impending healthcare reform has altered the relationship of hospitals and physicians. An exploratory study of marketing approaches used by twelve healthcare organizations representing twenty-five hospitals in a large city was conducted. Strategies encountered in the study ranged from practice acquisition to practice promotion. This study suggests that healthcare providers might adopt consumer product branding strategies to secure market-share, build brand equity, and improve profitability.

  15. Accuracy and congruence of patient and physician weight-related discussions: from Project CHAT (Communicating Health: Analyzing Talk)

    Science.gov (United States)

    Bodner, Michael E.; Dolor, Rowena J.; Óstbye, Truls; Lyna, Pauline; Alexander, Stewart C.; Tulsky, James A.; Pollak, Kathryn I.

    2014-01-01

    Objective Primary care providers should counsel overweight patients to lose weight. Rates of self-reported weight-related counseling vary, perhaps due to self-report bias. We assessed accuracy and congruence of weight-related discussions among patients, physicians, and audio-recorded encounters. Methods We audio recorded encounters between physicians (n=40) and their overweight/obese patients (n=461) at five community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. Results Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters contained weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%) but when weight was not discussed patients and physicians were more inaccurate and incongruent (patient 36%; physician 44%; 28% congruence). Physicians less comfortable discussing weight were more likely to misreport that weight was discussed [OR = 4.5 (95% CI=1.88–10.75, p<0.001)]. White physicians with African-American patients were more likely to report accurately no discussion about weight than White physicians with White patients OR=0.30 (95% CI=0.13–0.69, p<0.01). Conclusion Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed, but not when recordings indicated no weight discussions. Physician overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions. PMID:24390888

  16. The distribution and transitions of physicians in Japan: a 1974–2004 retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Kodama Tomoko

    2009-08-01

    Full Text Available Abstract Background In Japan, physicians freely choose their specialty and workplace, because to date there is no management system to ensure a balanced distribution of physicians. Physicians in Japan start their careers in hospitals, then become specialists, and then gradually leave hospitals to work in private clinics and take on primary care roles in their specialty fields. The present study aimed to analyse national trends in the distribution and career transitions of physicians among types of facilities and specialties over a 30-year period. Methods We obtained an electronic file containing physician registration data from the Survey of Physicians, Dentists and Pharmacists. Descriptive statistics and data on movement between facilities (hospitals and clinics for all physicians from 1974, 1984, 1994 and 2004 were analysed. Descriptive statistics for the groups of physicians who graduated in 1970, 1980 and 1990 were also analysed, and we examined these groups over time to evaluate their changes of occupation and specialty. Results The number of physicians per 100 000 population was 113 in 1974, and rose to 212 by 2004. The number of physicians working in hospitals increased more than threefold. In Japan, while almost all physicians choose hospital-based positions at the beginning of their career, around 20% of physicians withdrew from hospitals within 10 years, and this trend of leaving hospitals was similar among generations. Physicians who graduated in 1980 and registered in general surgery, cardiovascular surgery or paediatric surgery were 10 times more likely to change their specialty, compared with those who registered in internal medicine. More than half of the physicians who registered in 1970 had changed their specialties within a period of 30 years. Conclusion The government should focus primarily on changing the physician fee schedule, with careful consideration of the balance between office-based physicians and hospital

  17. [Empathy, inter-professional collaboration, and lifelong medical learning in Spanish and Latin-American physicians-in-training who start their postgraduate training in hospitals in Spain. Preliminary outcomes].

    Science.gov (United States)

    San-Martín, Montserrat; Roig-Carrera, Helena; Villalonga-Vadell, Rosa M; Benito-Sevillano, Carmen; Torres-Salinas, Miquel; Claret-Teruel, Gemma; Robles, Bernabé; Sans-Boix, Antonia; Alcorta-Garza, Adelina; Vivanco, Luis

    2017-01-01

    To identify similarities and differences in empathy, abilities toward inter-professional collaboration, and lifelong medical learning, between Spanish and Latin-American physicians-in-training who start their posgraduate training in teaching hospitals in Spain. Observational study using self-administered questionnaires. Five teaching hospitals in the province of Barcelona, Spain. Spanish and Latin-American physicians-in-training who started their first year of post-graduate medical training. Empathy was measured using the Jefferson scale of empathy. Abilities for inter-professional collaboration were measured using the Jefferson scale attitudes towards nurse-physician collaboration. Learning was measured using the Jefferson scale of medical lifelong learning scale. From a sample of 156 physicians-in-training, 110 from Spain and 40 from Latin America, the Spanish group showed the highest empathy (pempathy and inter-professional collaboration for the whole sample (r=+0.34; pempathy in the development of inter-professional collaboration abilities. In Latin-American physicians who start posgraduate training programs, lifelong learning abilities have a positive influence on the development of other professional competencies. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. Knowledge and Attitude of Physicians toward Prescribing Antibiotics and the Risk of Resistance in Two Reference Hospitals

    Directory of Open Access Journals (Sweden)

    Adel Alothman

    2016-01-01

    Full Text Available Introduction Antibiotics are essential and abundantly prescribed in hospitals because of their effectiveness and lifesaving benefits. However, the unnecessary use of antibiotics has been observed in earlier studies, and it has persisted through recent years as a major issue since it is one of the leading causes of antibiotic resistance. The increase in antibiotic resistance nowadays is one of the most critical concerns in global public health around the world. The objective of this study was to evaluate the knowledge and perceptions related to antibiotic prescription among physicians at our medical centers. Method A cross-sectional survey of non-infectious diseases specialized physicians. The study was conducted during 2015 at two tertiary care centers in Riyadh, Saudi Arabia. Result Of the 107 returned questionnaires, 93 were complete and valuable. Most respondents (82% perceived antibiotic resistance to be a critical problem globally, and 78% also think that it is a very important national problem. These attitudes did not differ across specialty or level of training. Widespread antibiotic use and inappropriate empirical choices were believed by 81% of the participants to be important general causes of resistance. Only half of respondents thought that antibiotic restriction is a useful intervention to decrease the antibiotic resistance. The physicians believed educational interventions are the most useful and effective way to improve prescription patterns and decrease antibiotic resistance. Complications due to infection with resistant organisms were acknowledged by almost all of the participants, with some differences in their estimations of how often it will occur. Conclusion Antimicrobial resistance, globally and nationally, is considered as a serious threat, and physicians in this survey acknowledged that. Among the most significant factors is antimicrobial misuse, either by overprescribing or providing inappropriate drugs with some

  19. Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives

    Directory of Open Access Journals (Sweden)

    DeMaria Lisa M

    2012-04-01

    Full Text Available Abstract Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM, obstetric nurses (ON and general physicians (GP. A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to

  20. Exploring Physicians' Dissatisfaction and Work-Related Stress: Development of the PhyDis Scale.

    Science.gov (United States)

    Pedrazza, Monica; Berlanda, Sabrina; Trifiletti, Elena; Bressan, Franco

    2016-01-01

    Research, all over the world, is starting to recognize the potential impact of physicians' dissatisfaction and burnout on their productivity, that is, on their intent to leave the job, on their work ability, on the amount of sick leave days, on their intent to continue practicing, and last but not least, on the quality of the services provided, which is an essential part of the general medical care system. It was interest of the provincial medical board's ethical committee to acquire information about physician's work-related stress and dissatisfaction. The research group was committed to define the indicators of dissatisfaction and work-related stressors. Focus groups were carried out, 21 stressful experience's indicators were identified; we developed an online questionnaire to assess the amount of perceived stress relating to each indicator at work (3070 physicians were contacted by e-mail); quantitative and qualitative data analysis were carried out. The grounded theory perspective was applied in order to assure the most reliable procedure to investigate the concepts' structure of "work-related stress." We tested the five dimensions' model of the stressful experience with a confirmatory factor analysis: Personal Costs; Decline in Public Image and Role Uncertainty; Physician's Responsibility toward hopelessly ill Patients; Relationship with Staff and Colleagues; Bureaucracy. We split the sample according to attachment style (secure and insecure -anxious and avoidant-). Results show the complex representation of physicians' dissatisfaction at work also with references to the variable of individual difference of attachment security/insecurity. The discriminant validity of the scale was tested. The original contribution of this paper lies on the one hand in the qualitative in depth inductive analysis of physicians' dissatisfaction starting from physicians' perception, on the other hand, it represents the first attempt to analyze the physicians' dissatisfaction with

  1. Depressive symptoms and workplace-violence-related risk factors among otorhinolaryngology nurses and physicians in Northern China: a cross-sectional study.

    Science.gov (United States)

    Fang, Huiying; Zhao, Xiaowen; Yang, Haicheng; Sun, Peihang; Li, Ying; Jiang, Kexin; Li, Peng; Jiao, Mingli; Liu, Ming; Qiao, Hong; Wu, Qunhong

    2018-01-27

    Workplace violence is relatively frequent among medical professionals who work in otorhinolaryngology units. This phenomenon reduces the quality of provided medical care and increases the incidence of depressive symptoms among physicians and nurses, seriously affecting their job satisfaction and work efficiency with a negative attitude towards providing treatment. Few existing studies have assessed workplace-violence-related factors associated with depressive symptoms among otorhinolaryngology physicians and nurses. We conducted a cross-sectional study in grade A tertiary hospitals of Heilongjiang province in Northern China, to evaluate the occurrence and level of depressive symptoms among otorhinolaryngology physicians and nurses and to analyse the relationship between them and workplace-violence-related risk factors and demographic variables. Of all our participating professionals, (379 otorhinolaryngologists and 273 nurses), 57.2% were found to have depressive symptoms, whereas, of the respondents who had suffered from physical violence, 71.25% had depressive symptoms. Professionals with less than 1 year of experience, as well as professionals who more frequently worked alone, were more likely to suffer from depressive symptoms than their colleagues. This research addresses an emerging issue of clinical practice, and its results differ from those of previous studies; specifically, it indicates that the frequency of depressive symptoms among otorhinolaryngology physicians and nurses may be influenced by physical violence, the number of coworkers they have for more than half of their working hours and other workplace-violence-related factors. To reduce the depressive symptoms caused by workplace violence and improve the quality of medical services, medical institutions should implement effective measures to prevent the occurrence of physical violence, strengthen team cooperation ability and increase peer support. © Article author(s) (or their employer(s) unless

  2. Accidents and Incidents Related to Intravenous Drug Administration: A Pre-Post Study Following Implementation of Smart Pumps in a Teaching Hospital.

    Science.gov (United States)

    Guérin, Aurélie; Tourel, Julien; Delage, Emmanuelle; Duval, Stéphanie; David, Marie-Johanne; Lebel, Denis; Bussières, Jean-François

    2015-08-01

    Smart pumps are expected to prevent and reduce medication errors. The implementation of smart pumps requires a significant effort and collaboration of physicians, nurses, pharmacists, and other stakeholders. The main objective of this study was to evaluate the impact of new smart pumps on reported drug-related accidents and incidents (AIs). This is a descriptive retrospective pre-post study conducted at a women's and pediatric hospital with 500 beds. A strong multidisciplinary team (nurse, pharmacist, pharmacy resident, physician, biomedical technician, information technology technician, patient safety officer, manager) was involved in the planning, implementation, and monitoring technology implementation. A total of 1045 smart pumps were implemented in 2011 in our hospital. The reported number of AIs related to intravenous drug administration (AIIV) before and after the implementation of 1045 smart pumps were collected. A total of 2911 AI events related to medications, devices, and equipment were self-reported by clinical staff in the pre-phase (Y0), 3523 in the post-phase (Y1), and 2788 in the post-phase (Y2). The total AIIV increased from 1432 in Y0 to 1834 in Y1 and decreased to 1389 in Y2. We observed no risk reduction associated with the implementation of smart pumps in a 500 bed mother-child hospital. Further studies are required to explore the details of the potential risk reduction associated with the use of smart pumps.

  3. Using the critical incident survey to assess hospital service quality.

    Science.gov (United States)

    Longo, B; Connor, G; Barnhart, T

    1993-01-01

    This survey was designed to determine "standards of excellence" in hospital services as defined by (a) former patients, (b) physicians, (c) hospital employees, and (d) corporate insurance subscribers. One hundred forty-seven (147) patients, 188 employees, and 20 corporate subscribers were interviewed by telephone, and 52 physicians were interviewed in their offices. The interview consisted of a single question: "Can you think of a time when, as a patient/employee/employer/physician, you had a particularly satisfying or dissatisfying experience with a local hospital?" Reported incidents were reviewed, and 239 "critical incidents" were identified. These incidents were classified into 12 descriptive categories relating to the underlying factors in the incident reports. Six focus groups were later held with participants segregated by the population pool they represented. These groups were asked to develop definitions of "excellence" in hospital service quality and standards for service which would "exceed expectations." The focus groups created 122 standards of excellence, which were classified into 43 categories. Overall, the largest percentages of corporate, physician, and employee critical incidents were classified as "Administrative Policy" issues. Patients most often reported "Nurturing" incidents as critical to their perceptions of hospital service quality.

  4. Validation of the Physician-Pharmacist Collaborative Index for physicians in Malaysia.

    Science.gov (United States)

    Sellappans, Renukha; Ng, Chirk Jenn; Lai, Pauline Siew Mei

    2015-12-01

    Establishing a collaborative working relationship between doctors and pharmacists is essential for the effective provision of pharmaceutical care. The Physician-Pharmacist Collaborative Index (PPCI) was developed to assess the professional exchanges between doctors and pharmacists. Two versions of the PPCI was developed: one for physicians and one for pharmacists. However, these instruments have not been validated in Malaysia. To determine the validity and reliability of the PPCI for physicians in Malaysia. An urban tertiary hospital in Malaysia. This prospective study was conducted from June to August 2014. Doctors were grouped as either a "collaborator" or a "non-collaborator". Collaborators were doctors who regularly worked with one particular clinical pharmacist in their ward, while non-collaborators were doctors who interacted with any random pharmacist who answered the general pharmacy telephone line whenever they required assistance on medication-related enquiries, as they did not have a clinical pharmacist in their ward. Collaborators were firstly identified by the clinical pharmacist he/she worked with, then invited to participate in this study through email, as it was difficult to locate and approach them personally. Non-collaborators were sampled conveniently by approaching them in person as these doctors could be easily sampled from any wards without a clinical pharmacist. The PPCI for physicians was administered at baseline and 2 weeks later. Validity (face validity, factor analysis and discriminative validity) and reliability (internal consistency and test-retest) of the PPCI for physicians. A total of 116 doctors (18 collaborators and 98 non-collaborators) were recruited. Confirmatory factor analysis confirmed that the PPCI for physicians was a 3-factor model. The correlation of the mean domain scores ranged from 0.711 to 0.787. "Collaborators" had significantly higher scores compared to "non-collaborators" (81.4 ± 10.1 vs. 69.3 ± 12.1, p Malaysia.

  5. Continuity of care with physicians and risk of subsequent hospitalization and end-stage renal disease in newly diagnosed type 2 diabetes mellitus patients.

    Science.gov (United States)

    Chang, Po-Ya; Chien, Li-Nien; Bai, Chyi-Huey; Lin, Yuh-Feng; Chiou, Hung-Yi

    2018-01-01

    Effective management for type 2 diabetes mellitus (DM) can slow the progression of kidney outcomes and reduce hospital admissions. Better continuity of care (COC) was found to improve patients' adherence and self-management. This study examined the associations between COC, hospitalization, and end-stage renal disease (ESRD) in DM patients. In the cohort study, data from 1996 to 2012 were retrieved from the Longitudinal Health Insurance Database, using inverse probability weighted analysis. A total of 26,063 patients with newly diagnosed type 2 DM who had been treated with antihyperglycemic agents were included. COC is to assess the extent to which a DM patient visited the same physician during the study period. This study categorized COC into 3 groups - low, intermediate, and high, - according to the distribution of scores in our sample. The number of ESRD patients in the high, intermediate, and low COC groups were 92 (22.33%), 130 (31.55%), and 190 (46.12%), respectively, and the mean follow-up periods for the 3 groups were 7.13, 7.12, and 7.27 years, respectively. After using inverse probability weighting, the intermediate and low COC groups were significantly associated with an increased risk of ESRD compared with the high COC group (adjusted hazard ratio (aHR) 1.36 [95% CI, 1.03-1.80] and aHR 1.76 [95% CI, 1.35-2.30], respectively). The intermediate and low COC groups were also significantly associated with the subsequent hospitalization compared with the high COC group (aHR 1.15 [95% CI, 0.99-1.33] and aHR 1.72 [95% CI, 1.50-1.97], respectively). COC is related to ESRD onset and subsequent hospitalization among patients with DM. This study suggested that when DM patients keep visiting the same physician for managing their diseases, the progression of renal disease can be prevented.

  6. An exploration of nurse-physician perceptions of collaborative behaviour.

    Science.gov (United States)

    Collette, Alice E; Wann, Kristen; Nevin, Meredith L; Rique, Karen; Tarrant, Grant; Hickey, Lorraine A; Stichler, Jaynelle F; Toole, Belinda M; Thomason, Tanna

    2017-07-01

    Interprofessional collaboration is a key element in providing safe, holistic patient care in the acute care setting. Trended data at a community hospital indicated opportunities for improvement in collaboration on micro, meso, and macro levels. The aim of this survey study was to assess the current state of collaboration between frontline nurses and physicians at a non-academic acute care hospital. A convenience sample of participants was recruited with a final respondent sample of 355 nurses and 82 physicians. The results indicated that physicians generally perceived greater collaboration than nurses. Physician ratings did not vary by primary practice area, whereas nurse ratings varied by clinical practice area. Nurse ratings were the lowest in the operating room and the highest in the emergency department. Text-based responses to an open-ended question were analysed by role and coded by two independent research teams. Emergent themes emphasised the importance of rounding, roles, respect, and communication. Despite recognition of the need for improved collaboration and relational behaviours, strategies to improve collaborative practice must be fostered at the meso level by organisational leaders and customised to address micro-level values. At the study site, findings have been used to address and improve collaboration towards the goal of becoming a high reliability organisation.

  7. To resuscitate or not to resuscitate: a logistic regression analysis of physician-related variables influencing the decision.

    Science.gov (United States)

    Einav, Sharon; Alon, Gady; Kaufman, Nechama; Braunstein, Rony; Carmel, Sara; Varon, Joseph; Hersch, Moshe

    2012-09-01

    To determine whether variables in physicians' backgrounds influenced their decision to forego resuscitating a patient they did not previously know. Questionnaire survey of a convenience sample of 204 physicians working in the departments of internal medicine, anaesthesiology and cardiology in 11 hospitals in Israel. Twenty per cent of the participants had elected to forego resuscitating a patient they did not previously know without additional consultation. Physicians who had more frequently elected to forego resuscitation had practised medicine for more than 5 years (p=0.013), estimated the number of resuscitations they had performed as being higher (p=0.009), and perceived their experience in resuscitation as sufficient (p=0.001). The variable that predicted the outcome of always performing resuscitation in the logistic regression model was less than 5 years of experience in medicine (OR 0.227, 95% CI 0.065 to 0.793; p=0.02). Physicians' level of experience may affect the probability of a patient's receiving resuscitation, whereas the physicians' personal beliefs and values did not seem to affect this outcome.

  8. Financial transparency and physicians: the physician leader's guide to sharing numbers.

    Science.gov (United States)

    Paskert, James P

    2014-01-01

    Review critical factors such as length of stay, case mix, financial statements, ratios and days cash on hand that physicians need to understand to adequately manage hospital patients and engage in the success of the organization.

  9. Physicians and administrators can work together.

    Science.gov (United States)

    Fuller, G W; Beaupre, E M

    1979-10-01

    This article describes the working relationship between the administration and medical staff of the Mid-Maine Medical Center which is comprised of two separate modern hospitals. The authors advocate the philosophy that "a hospital which harnesses the medical staff's considerable talent and expertise through sound organizational input will be a stronger institution." They explain that patient care is becoming increasingly complex and that management decisions impact heavily on the care provided. In 1973, the Medical Center changed from its traditional organizational form of having a full-time medical director and an administrator report to the board of directors, to a modified corporate model designed to increase physician involvement. In the new organization, the vice president of finance and a part-time chief of staff (acting as vice president for medical affairs) report to the president (former medical director) who, in turn, is responsible to the board of trustees. The authors attribute the success of the reorganization to the CEO's willingness to delegate and share authority, not to the CEO's physician background. Planning at the institution involves a committee of six physicians, four administrators, and one full-time planner. A budgeting committee of three physicians and three administrators is responsible for the review of the budget as well as for making recommendations for the executive board for the expected volume of services. It is concluded that there is no perfect way to run a hospital, but the involvement of doctors in hospital decisions is necessary.

  10. How to save distressed IDS-physician marriages: a case study.

    Science.gov (United States)

    Collins, H; Johnson, B A

    1998-04-01

    A hospital-driven IDS that encounters serious problems resulting from ownership of a physician practice should address those problems by focusing on three core areas: vision and leadership, effectiveness of operations, and physician compensation arrangements. If changes in these areas do not lead to improvements, the IDS may need to consider organizational restructuring. In one case study, a hospital-driven IDS faced the problem of owning a poorly performing MSO with a captive physician group. The IDS's governing board determined that the organization lacked effective communication with the physicians and that realization of the organization's vision would require greater physician involvement in organizational decision making. The organization is expected to undergo some corporate reorganization in which physicians will acquire an equity interest in the enterprise.

  11. Physician-related barriers to cancer pain management with opioid analgesics

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Sjøgren, Per; Møldrup, Claus

    2007-01-01

    OBJECTIVE: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics. METHODS: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full...... texts were not available in PUBMED were retrieved from the electronic databases of specific journals. RESULTS: Sixty-five relevant articles, published in the period from 1986 to 2006, were identified. Physicians' barriers to cancer pain management were studied in questionnaire surveys and in the reviews...

  12. Stoicism, the physician, and care of medical outliers

    Directory of Open Access Journals (Sweden)

    Papadimos Thomas J

    2004-12-01

    Full Text Available Abstract Background Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care. Discussion The Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses. Summary Practicing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit.

  13. The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients.

    Science.gov (United States)

    Barton, Christopher A; Bassett, Katherine L; Buckman, Julie; Effing, Tanja W; Frith, Peter A; van der Palen, Job; Sloots, Joanne M

    2017-02-01

    We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT algorithms. Two multivariate logistic regression models for infrequent (≤1/year) versus frequent (>1/year) future respiratory-related hospitalizations were defined: one with the adjusted CAT score that correlated best with future hospitalizations and one with the original CAT score. Patient characteristics related to future hospitalizations ( p ≤ 0.2) were also entered. Eighty-two COPD patients were included. The CAT algorithm derived from the nurse focus group was a borderline significant predictor of hospitalization risk (odds ratio (OR): 1.07; 95% confidence interval (CI): 1.00-1.14; p = 0.050) in a model that also included hospitalization frequency in the previous year (OR: 3.98; 95% CI: 1.30-12.16; p = 0.016) and anticholinergic risk score (OR: 3.08; 95% CI: 0.87-10.89; p = 0.081). Presence of ischemic heart disease and/or heart failure appeared 'protective' (OR: 0.17; 95% CI: 0.05-0.62; p = 0.007). The original CAT score was not significantly associated with hospitalization risk. In conclusion, as a predictor of respiratory-related hospitalizations, an adjusted CAT score was marginally significant (although the original CAT score was not). 'Previous respiratory-related hospitalizations' was the strongest factor in this equation.

  14. Burnout, Engagement, and Organizational Culture: Differences between Physicians and Nurses.

    Science.gov (United States)

    Mijakoski, Dragan; Karadzinska-Bislimovska, Jovanka; Basarovska, Vera; Montgomery, Anthony; Panagopoulou, Efharis; Stoleski, Sasho; Minov, Jordan

    2015-09-15

    Burnout results from a prolonged response to chronic emotional and interpersonal workplace stressors. The focus of research has been widened to job engagement. Purpose of the study was to examine associations between burnout, job engagement, work demands, and organisational culture (OC) and to demonstrate differences between physicians and nurses working in general hospital in Skopje, Republic of Macedonia. Maslach Burnout Inventory and Utrecht Work Engagement Scale were used for assessment of burnout and job engagement. Work demands and OC were measured with Hospital Experience Scale and Competing Values Framework, respectively. Higher scores of dedication, hierarchy OC, and organizational work demands were found in physicians. Nurses demonstrated higher scores of clan OC. Burnout negatively correlated with clan and market OC in physicians and nurses. Job engagement positively correlated with clan and market OC in nurses. Different work demands were related to different dimensions of burnout and/or job engagement. Our findings support job demands-resources (JD-R) model (Demerouti and Bakker). Data obtained can be used in implementation of specific organizational interventions in the hospital setting. Providing adequate JD-R interaction can lead to prevention of burnout in health professionals (HPs) and contribute positively to better job engagement in HPs and higher quality of patient care.

  15. 42 CFR 415.130 - Conditions for payment: Physician pathology services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment: Physician pathology... Physician Services to Beneficiaries in Providers § 415.130 Conditions for payment: Physician pathology... of physician pathology services to fee-for-service Medicare beneficiaries who were hospital...

  16. Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Herlitz Johan

    2010-08-01

    Full Text Available Abstract Background Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR, including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme. Methods Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses. Results In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians. The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test. Conclusions Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.

  17. Joint-venture proposals strengthen hospital-physician relationship.

    Science.gov (United States)

    Rovinsky, M

    2000-12-01

    By proposing the joint-venture development of an ambulatory surgery center and medical office space with a group practice, one hospital succeeded in enhancing its relationship with the practice and paved the way for future collaboration. Although the hospital's proposal to jointly develop an ambulatory surgery center was not accepted, the hospital was able to dissuade the group practice from developing a competing ambulatory surgery facility while increasing the group's trust in and loyalty to the hospital. As a result, the hospital potentially will benefit from increased inpatient admissions.

  18. [Work-related accidents, with biological materials, in health care workers in public hospitals in Brasilia, Brazil, 2002/2003].

    Science.gov (United States)

    Caixeta, Roberta de Betânia; Barbosa-Branco, Anadergh

    2005-01-01

    This study evaluates the knowledge and acceptance of biosafety measures by health care professionals in light of the potential risk of occupational transmission of HIV. The survey assessed 570 health care workers from 6 hospitals, randomly selected from all hospitals in the Federal District (Brasilia), Brazil. The sample corresponds to 15.0% of the all health professionals in the selected hospitals. These professionals answered a semi-structured questionnaire on knowledge of biosafety and universal precautions, risk of occupational HIV transmission, work-related accidents, use of personal protective equipment (PPE), and acceptance of chemoprophylaxis and HIV testing. The overall accident coefficient was 39.1. Dentists, physicians, and laboratory technicians were those who most frequently suffered such accidents. The accident coefficient was inversely proportional to the hospital capacity. The professionals' knowledge of biosafety concepts and the fact that written norms were displayed in their workstations did not positively affect the work accident coefficient.

  19. The Effects of Emotional Intelligence (EI Items Education on Job Related Stress in Physicians and Nurses who Work in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Kh Nooryan

    2011-12-01

    Full Text Available Background & Aim: Intensive care units (ICUs are recognized as stressful environments. The objective of this study was to determine the effects of emotional intelligence education items on job related stress on physicians and nurses who work in intensive care units at hospitals of Yerevan, Armenia. Methods: A interventional study design was implemented with 106 registered hospital physicians and nurses, who were widely distributed all the way through. Case group was taught about 15 E.I items. For data collection, the 20-question Berger situational (overt anxiety questionnaire, the 20-item personality (covert anxiety questionnaire, and the Bar-on emotional intelligence questionnaire with 133 questions were used. Statistical descriptive methods, chi-square (X2 and t-tests were used to analyze data. Results: The research achievements revealed that the average score of the case group`s situational anxiety was 46.59 before intervention, which decreased to 39.95 after the training of the items of emotional intelligence. The average score of situational anxiety of control group was 44.32 before intervention which increased to 44.76 after examination. There was a meaningful statistical difference between case and control group after education of emotional intelligence`s items (p=0.001. Conclusion: Results of the current study showed that physicians and nurses experience high level of stress. The ability to effectively deal with emotion intelligence and emotional information in the workplace assists employees in coping with occupational stress and should be developed in stress managing trainings.

  20. The perceptions of patient safety culture: A difference between physicians and nurses in Taiwan.

    Science.gov (United States)

    Huang, Chih-Hsuan; Wu, Hsin-Hung; Lee, Yii-Ching

    2018-04-01

    In order to pursue a better patient safety culture and provide a superior medical service for patients, this study aims to respectively investigate the perceptions of patient safety from the viewpoints of physicians and nurses in Taiwan. Little knowledge has clearly identified the difference of perceptions between physicians and nurses in patient safety culture. Understanding physicians and nurses' attitudes toward patient safety is a critical issue for healthcare organizations to improve medical quality. Confirmatory factor analysis (CFA) is used to verify the structure of data (e.g. reliability and validity), and Pearson's correlation analysis is conducted to demonstrate the relationships among seven patient safety culture dimensions. Research results illustrate that more teamwork is exhibited among team members, the more safety of a patient is committed. Perceptions of management and emotional exhaustion are important components that contribute to a better patient safety. More importantly, working conditions and stress recognition are found to be negatively related from the perceptions of nurses. Compared to physicians, nurses reported higher stress and challenges which result from multi-task working conditions in the hospital. This study focused on the contribution of a better patient safety culture from different viewpoints of physicians and nurses for healthcare organizations in Taiwan. A different attitudes toward patient safety is found between physicians and nurses. The results enable the hospital management to realize and design appropriate implications for hospital staffs to establish a better patient safety culture. Copyright © 2017. Published by Elsevier Inc.

  1. The business of pediatric hospital medicine.

    Science.gov (United States)

    Percelay, Jack M; Zipes, David G

    2014-07-01

    Pediatric hospital medicine (PHM) programs are mission driven, not margin driven. Very rarely do professional fee revenues exceed physician billing collections. In general, inpatient hospital care codes reimburse less than procedures, payer mix is poor, and pediatric inpatient care is inherently time-consuming. Using traditional accounting principles, almost all PHM programs will have a negative bottom line in the narrow sense of program costs and revenues generated. However, well-run PHM programs contribute positively to the bottom line of the system as a whole through the value-added services hospitalists provide and hospitalists' ability to improve overall system efficiency and productivity. This article provides an overview of the business of hospital medicine with emphasis on the basics of designing and maintaining a program that attends carefully to physician staffing (the major cost component of a program) and physician charges (the major revenue component of the program). Outside of these traditional calculations, resource stewardship is discussed as a way to reduce hospital costs in a capitated or diagnosis-related group reimbursement model and further improve profit-or at least limit losses. Shortening length of stay creates bed capacity for a program already running at capacity. The article concludes with a discussion of how hospitalists add value to the system by making other providers and other parts of the hospital more efficient and productive. Copyright 2014, SLACK Incorporated.

  2. The Characteristics of Personal Order Sets in a Computerized Physician Order Entry System at a Community Hospital

    OpenAIRE

    Thomas, Sean M.; Davis, Daniel C.

    2003-01-01

    Personal order sets (POS) have been touted as important for the success of a computerized physician order entry (CPOE) system1. However, POS may systematize practice variability and are difficult to centrally administer. Few studies have looked at the characteristics and use of POS in a community hospital. We examined how POS are used at the Queen’s Medical Center (QMC). POS are an important part of the success of the QMC CPOE, but have definite disadvantages.

  3. Effects of one-hour training course and spirometry on the ability of physicians to diagnose and treat chronic obstructive pulmonary disease.

    Science.gov (United States)

    Cai, Shan; Qin, Li; Tanoue, Lynn; Hu, Anmei; Jia, Xiujie; Luo, Hong; Chen, Yan; Chen, Ping; Peng, Hong

    2015-01-01

    In China, the prevalence of chronic obstructive pulmonary disease (COPD) in persons 40 years of age or older is estimated at 8.2%, but this is likely a substantial underestimate. Eight secondary hospitals which didn't have spirometries were chosen randomly in Hunan province of central south China. Physician subjects at these hospitals underwent a one-hour training course on the Chinese COPD guidelines. Physicians answered questionnaires assessing their knowledge of the guidelines before and after the training session. The mean correct scores of questionnaires were compared before and after training. Four out of the eight hospitals were given access to spirometry. Eligible patient subjects underwent spirometry testing prior to the physician visit. After seeing the patient, physicians were asked to answer a questionnaire relating to the diagnosis and severity of COPD. Physicians were then given the results of the spirometry, and asked to answer the same questionnaire. Physicians' responses before and after receiving the spirometry results were compared. 225 physicians participated in the training session. 207 questionnaires were completed. Mean scores (out of 100) before and after the training were 53.1 ± 21.7 and 93.3 ± 9.8, respectively. 18 physicians and 307 patient subjects participated in the spirometry intervention. Based on spirometric results, the prevalence of COPD was 38.8%. Physicians correctly identified the presence of COPD without spirometric data in 85 cases (76.6%); this increased to 117 cases (97.4%) once spirometric data were available. Without spirometric data, physicians incorrectly diagnosed COPD in 38 patients; this decreased to 6 patients once spirometric data were available. Spirometric data also improved the ability of physicians to correctly grade COPD severity. Simple educational training can substantially improve physicians' knowledge relating to COPD. Spirometry combined with education improves the ability of physicians to diagnose COPD

  4. Screening for hepatocellular carcinoma by Egyptian physicians

    Institute of Scientific and Technical Information of China (English)

    Sahar; M; Hassany; Ehab; F; Abdou; Moustafa; Mohamed; El; Taher; Afaf; Adel; Abdeltwab; Hubert; E; Blum

    2015-01-01

    AIM: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma(HCC). METHODS: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts:(1) personal information regarding the physician(name, age, specialty and type of health care setting); and(2) professional experience in the care of patients at risk for HCC development(screening, knowledge about the cause and natural course of liver diseases and HCC risk). RESULTS: Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus(HCV) genotype as risk factor for HCC development(P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis(P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health(MOH) doctors consider HCV infection as the leading cause of HCC in Egypt(P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening(P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo(P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation.CONCLUSION: In Egypt, physicians

  5. Characteristics of training and motivation of physicians working in emergency medicine

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    Gilson Soares Feitosa-Filho

    Full Text Available Summary Introduction: Emergency medicine is an area in which correct decisions often need to be made fast, thus requiring a well-prepared medical team. There is little information regarding the profile of physicians working at emergency departments in Brazil. Objective: To describe general characteristics of training and motivation of physicians working in the emergency departments of medium and large hospitals in Salvador, Brazil. Method: A cross-sectional study with standardized interviews applied to physicians who work in emergency units in 25 medium and large hospitals in Salvador. At least 75% of the professionals at each hospital were interviewed. One hospital refused to participate in the study. Results: A total of 659 physicians were interviewed, with a median age of 34 years (interquartile interval: 29-44 years, 329 (49.9% were female and 96 (14.6% were medical residents working at off hours. The percentage of physicians who had been trained with Basic Life Support, Advanced Cardiovascular Life Support and Advanced Trauma Life Support courses was 5.2, 18.4 and 11.0%, respectively, with a greater frequency of Advanced Cardiovascular Life Support training among younger individuals (23.6% versus 13.9%; p<0.001. Thirteen percent said they were completely satisfied with the activity, while 81.3% expressed a desire to stop working in emergency units in the next 15 years, mentioning stress levels as the main reason. Conclusion: The physicians interviewed had taken few emergency immersion courses. A low motivational level was registered in physicians who work in the emergency departments of medium and large hospitals in Salvador.

  6. Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses.

    Science.gov (United States)

    Esmaeilpour-Bandboni, Mohammad; Vaismoradi, Mojtaba; Salsali, Mahvash; Snelgrove, Sherrill; Sheldon, Lisa Kennedy

    2017-08-01

    Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

  7. Youth and young adults with spina bifida: their utilization of physician and hospital services.

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    Young, Nancy L; Anselmo, Lianne A; Burke, Tricia A; McCormick, Anna; Mukherjee, Shubhra

    2014-03-01

    To describe current patterns of health care utilization of youth and young adults who have spina bifida (SB) and provide evidence to guide the development of health care for this growing population. We conducted a secondary analysis of health services utilization data from the Canadian Institute for Health Information to determine the rates and patterns of health care utilization, because comprehensive health care has been recognized as critical to positive health outcomes. Participants were identified from 6 publicly funded children's treatment centers. Health records from youth (n=164; age range, 13.0-17.9y) and adults (n=120; age range, 23.0-32.9y) with SB contributed to this study. Not applicable. The rates of outpatient physician visits and hospital admissions for the youth and adult groups were calculated. The proportion with a "medical home" was also calculated. The annual rates of outpatient physician visits per 1000 persons were 8031 for youth and 8524 for adults with SB. These rates were approximately 2.9 and 2.2 times higher, respectively, than for their age-matched peers. On average, 12% of youth and 24% of adults with SB had a medical home. The annual rates of hospital admissions per 1000 persons were 329 for youth and 285 for adults with SB. Rates of admissions were 19.4 and 12.4 times higher, respectively, for these groups than for the general population. It appears that persons with SB are accessing health services more often than their age-matched peers, and few have a medical home. We recommend that seamless medical care be provided to all adults with SB, coordinated by a primary care provider, to facilitate comprehensive care. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Factors identified with higher levels of career satisfaction of physicians in Andalusia, Spain

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    Juan Nicolás Peña-Sánchez

    2014-09-01

    Full Text Available The satisfaction of physicians is a world-wide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i measure the career satisfaction of physicians; ii identify differences in the dimensions of career satisfaction; and iii test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain. Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians.

  9. The consumers' social media use in choosing physicians and hospitals: the case study of the province of Izmir.

    Science.gov (United States)

    Tengilimoglu, Dilaver; Sarp, Nilgün; Yar, Cemre Eda; Bektaş, Meral; Hidir, Mehmet Nil; Korkmaz, Esin

    2017-01-01

    Manifested as a reflection of the Internet technology progress, web 2.0 has transformed communication among people to different dimensions while increasing the social use of Internet. Thus, the concept of social media has entered our lives. Blogs, forums, Facebook, Twitter and YouTube applications are but few of the social media platforms with active users exceeding millions. As in many other subjects, these and others are also environments where people share information and their positive or negative experiential views with respect to healthcare issues and services. Hence, the social media communication and exchange of information are deemed influential on the process of receiving health services. In the present study that aims to determine social media use of individuals in their choice of physicians, dentists and hospitals, a survey, as a data collection instrument, has been carried out to 947 residents of the province of Izmir. Individuals participating in the study have stated that they have used social media in choosing a physician (41.9% of the participants), dentist (34.1% of the participants) and hospitals (41.7% of the participants). The study has revealed that individuals are affected by social media in their healthcare choices. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  10. Barriers in the management of cancer-related pain and strategies to overcome them: findings of a qualitative research involving physicians and nurses in Italy

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    Cesarina Prandi

    2015-03-01

    Full Text Available Introduction and aims. There are many barriers and obstacles that even today lead to an inadequate treatment of cancer-related pain. The aim is to describe the experiences of a group of Italian physicians and nurses as far as the nature of these barriers is concerned and the possible tools to be used to overcome them. Material and method. We run 5 focus groups with 42 healthcare professionals (11 physicians, 31 nurses working in 5 hospitals in Italy. The findings of the focus groups were analysed according to the “Content Analysis” method. Results. Five main items emerged: the importance of communication, the need for education regarding pain therapy, the ethnic/cultural/religious differences, the mutual trust and support within the working group, the daily challenges. Conclusion. In harmony with the most recent literature, physicians and nurses voice above all their need for an education more directly aimed at overcoming the prevailing barriers rooted in ignorance, prejudice and fears.

  11. Assessment of Turkish junior male physicians' exposure to mobbing behavior.

    Science.gov (United States)

    Sahin, Bayram; Cetin, Mehmet; Cimen, Mesut; Yildiran, Nuri

    2012-08-01

    To determine the extent of Turkish junior male physicians' exposure to mobbing behavior and its correlation with physicians' characteristics. The study included physicians recruited for compulsory military service in April 2009. No sampling method was used, questionnaires were delivered to all physicians, and 278 of 292 (95%) questionnaires were returned. We used Leymann Inventory of Psychological Terror including 45 items for data collection and structural equation model for data analysis. A total of 87.7% of physicians experienced mobbing behavior. Physicians who worked more than 40 hours a week, single physicians, physicians working in university hospitals and private hospitals, and physicians who did not have occupational commitment were more exposed to mobbing (PMobbing was not associated with specialty status, service period, age, and personality variables (P>0.05). All goodness-of- fit indices of the model were acceptable (χ(2)=1.449, normed fit index=0.955, Tucker Lewis index=0.980, comparative fit index=0.985, and root mean square error of approximation=0.040). Workplace mobbing is a critical problem for junior male physicians in Turkey. We suggest an introduction of a reporting system and education activities for physicians in high-risk groups.

  12. Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: a qualitative study.

    Science.gov (United States)

    So, Cynthia; Pierluissi, Edgar

    2012-04-01

    To describe expectations of, and perceived motivators and barriers to, in-hospital exercise of hospitalized older adults. Qualitative study using the framework theory. Public hospital general medical wards. Twenty-eight English- or Spanish-speaking inpatients aged 65 to 103. Semistructured interviews were conducted at the bedside. Questions explored attitudes and expectations regarding in-hospital exercise. Interviews were tape recorded and transcribed, and content analysis was performed to identify major themes. For most participants (71%), exercise in the hospital meant walking. Only 29% of participants expected to be exercising in the hospital, although three-quarters perceived it to be appropriate. Major themes included motivating factors and barriers to in-hospital exercise. Motivating factors included avoiding the negative effects of prolonged bed rest, promoting a sense of well-being, promoting functional recovery, and being asked to exercise. Barriers included symptoms related to one's illness, institutional barriers, and fear of injury. Most respondents (85%) felt that if the physician suggested exercise, it would influence their decision to do so, yet few (27%) reported that they had spoken to their physician about exercise. Hospitalized older adults have positive perceptions about in-hospital exercise, although they must overcome significant barriers to do so. Medical professionals have a strong influence over the exercise behavior of elderly adults in the hospital yet infrequently address the issue. Incorporating motivating factors and removing barriers may increase the effectiveness of in-hospital exercise programs. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  13. Effectiveness of pharmacovigilance: multifaceted educational intervention related to the knowledge, skills and attitudes of multidisciplinary hospital staff

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    Fabiana Rossi Varallo

    Full Text Available OBJECTIVES: Most educational interventions in pharmacovigilance are designed to encourage physicians to report adverse drug reactions. However, multidisciplinary teams may play an important role in reporting drug-related problems. This study assessed the impact of a multifaceted educational intervention in pharmacovigilance on the knowledge, skills and attitudes of hospital professionals. METHOD: This prospective, open-label, non-randomized study was performed in a medium-complexity hospital in São Paulo, Brazil. The intervention involved four activities: 1 an interactive lecture, 2 a practical class, 3 a pre-post questionnaire administered to professionals on a multidisciplinary team, and 4 educational material. The intervention’s impact on the professionals’ knowledge and skills was assessed using the World Health Organization’s definitions. The intervention’s effect on the professionals’ attitudes was analysed by the prevalence of adverse drug event reports (adverse drug reactions, medication errors, therapeutic failure and drug quality deviations and the relevance (seriousness and expectancy of the events. RESULTS: One hundred seventy-three professionals were enrolled. A 70-fold increase in the number of adverse drug event reports was observed during the 12 months post-intervention. The intervention improved the professionals’ form-completion skills (p<0.0001 and their knowledge of pharmacovigilance (p<0.0001. The intervention also contributed to detecting serious drug-induced events. The nursing staff reported medication errors, and pharmacists and physiotherapists recognized serious adverse drug reactions. Physicians communicated suspicions of therapeutic failure. CONCLUSIONS: A multidisciplinary approach to drug-safety assessments contributes to identifying new, relevant drug-related problems and improving the rate of adverse drug event reporting. This strategy may therefore be applied to improve risk communication in

  14. The Attitudes of Physicians, Nurses, Physical Therapists, and Midwives Toward Complementary Medicine for Chronic Pain: A Survey at an Academic Hospital.

    Science.gov (United States)

    Aveni, Eléonore; Bauer, Brent; Ramelet, Anne-Sylvie; Kottelat, Yolande; Decosterd, Isabelle; Finti, Guillaume; Ballabeni, Pierluigi; Bonvin, Eric; Rodondi, Pierre-Yves

    2016-01-01

    To assess the attitudes of physicians, nurses, physical therapists, and midwives toward complementary medicine (CM) at a Swiss academic hospital and toward its use for treating chronic pain. The cross-sectional survey took place from October to December 2013. An e-mail sent to 4925 healthcare professionals (1969 physicians, 2372 nurses, 145 physical therapists, and 111 midwives) working at Lausanne University Hospital, Switzerland, invited them to answer a web-based questionnaire. The questionnaire was answered by 1247 healthcare professionals (response rate: 25.3%). Of these, 96.1% strongly agreed or agreed that CM could be useful for the treatment of chronic pain, with more nurses (96.7%) and midwives (100%) than physicians (93.8%) agreeing that CM could be useful (P chronic pain. Respondents listed migraine (74.7%), tension headaches (70.6%), and low back pain (70.1%) as three main conditions for which they would refer patients for acupuncture. The three therapies with which respondents were the most unfamiliar were neuraltherapy (57.2%), mindfulness-based stress reduction (MBSR) (54.1%), and biofeedback (51.9%). Over half of respondents, 58.3%, had never referred a patient to a CM practitioner. A total of 84.3% of the respondents felt that they lacked the knowledge to inform their patients about CM. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Physicians' Psychosocial Work Conditions and Quality of Care: A Literature Review

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    Peter Angerer

    2015-05-01

    Full Text Available Background: Physician jobs are associated with adverse psychosocial work conditions. We summarize research on the relationship of physicians' psychosocial work conditions and quality of care. Method: A systematic literature search was conducted in MEDLINE and PsycINFO. All studies were classified into three categories of care quality outcomes: Associations between physicians' psychosocial work conditions and (1 the physician-patient-relationship, or (2 the care process and outcomes, or (3 medical errors were examined. Results: 12 publications met the inclusion criteria. Most studies relied on observational cross-sectional and controlled intervention designs. All studies provide at least partial support for physicians’ psychosocial work conditions being related to quality of care. Conclusions: This review found preliminary evidence that detrimental physicians’ psychosocial work conditions adversely influence patient care quality. Future research needs to apply strong designs to disentangle the indirect and direct effects of adverse psychosocial work conditions on physicians as well as on quality of care.Keywords: psychosocial work conditions, physicians, quality of care, physician-patient-relationship, hospital, errors, review, work stress, clinicians

  16. Shared governance: one way to engage employed physicians.

    Science.gov (United States)

    Sanford, Kathleen D

    2012-09-01

    To work better with employed physicians, finance leaders should: Understand classic management theories on what motivates employees. Learn from shared governance models with nurses at Magnet hospitals. Apply best practices in management to all employees, not just physicians.

  17. Attitudes of health care professionals, relatives of advanced cancer patients and public towards euthanasia and physician assisted suicide.

    Science.gov (United States)

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Panagiotou, Irene; Galanos, Antonis; Gouliamos, Athanasios

    2010-10-01

    Nowadays, euthanasia has the meaning of the direct administration of a lethal agent to the patient by another party with a merciful intent after patients' request. Physician assisted suicide refers to the patient intentionally and wilfully ending his or her own life with the assistance of a physician. The objectives of the manuscript were to investigate the opinions of Greek physicians, nurses, lay people and relatives of advanced cancer patients on euthanasia and physician assisted suicide. The final sample consisted of 215 physicians, 250 nurses, 218 relatives and 246 lay people. A survey questionnaire was used concerning issues such as euthanasia and physician assisted suicide. The survey instrument included 13 questions and described issues such as religious and spiritual beliefs, euthanasia, physician assisted suicide and decision-making situations. 43.3% physicians and 41.3% relatives would agree in advance that in case of heart and/or respiratory arrest there would not be an effort to revive a terminally ill cancer patient. 20.5% physicians had a request for euthanasia. Significant associations were found between physicians (9.3%), relatives (1.8%, p=0.001) and lay people (3.7%, p=0.020) on their opinions regarding withdrawing treatment. The majority of the participants were opposed to euthanasia and physician assisted suicide. However many would agree to the legalization of an advanced cancer patient's hastened death. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  18. Team physicians in college athletics.

    Science.gov (United States)

    Steiner, Mark E; Quigley, D Bradford; Wang, Frank; Balint, Christopher R; Boland, Arthur L

    2005-10-01

    There has been little documentation of what constitutes the clinical work of intercollegiate team physicians. Team physicians could be recruited based on the needs of athletes. A multidisciplinary team of physicians is necessary to treat college athletes. Most physician evaluations are for musculoskeletal injuries treated nonoperatively. Descriptive epidemiology study. For a 2-year period, a database was created that recorded information on team physician encounters with intercollegiate athletes at a major university. Data on imaging studies, hospitalizations, and surgeries were also recorded. The diagnoses for physician encounters with all undergraduates through the university's health service were also recorded. More initial athlete evaluations were for musculoskeletal diagnoses (73%) than for general medical diagnoses (27%) (P respiratory infections and dermatologic disorders, or multiple visits for concussions. Football accounted for 22% of all physician encounters, more than any other sport (P athletes did not require a greater number of physician encounters than did the general undergraduate pool of students on a per capita basis. Intercollegiate team physicians primarily treat musculoskeletal injuries that do not require surgery. General medical care is often single evaluations of common conditions and repeat evaluations for concussions.

  19. Work-related behaviour and experience patterns of physicians compared to other professions.

    Science.gov (United States)

    Voltmer, Edgar; Kieschke, Ulf; Spahn, Claudia

    2007-08-11

    To identify health risk factors and resources of physicians in comparison with other professions. Data of cross-sectional mail surveys conducted among German physicians (n = 344), teachers (n = 5169), policemen (n = 851), prison officers (n = 3653), and starting entrepreneurs (n = 632) were analysed regarding eleven health-relevant dimensions and four behaviour patterns examined by the questionnaire "Work-Related Behaviour and Experience Pattern (AVEM)". Only 17% of the physicians showed healthy behaviour and experience patterns. With 43%, they scored highest in terms of reduced working motivation. Together with the teachers, they also had the highest scores for resignation and burnout (27%). Satisfaction with life and work as well as social support showed medium scores. Starting entrepreneurs showed the healthiest patterns (45%), but also the highest risk pattern for overexertion (38%). It was possible to identify clear risk patterns for profession-related psychosocial symptoms and impairments. The high scores for reduced working motivation demonstrate the need for interventions to improve organisation of health care and individual coping strategies.

  20. Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Yanhong Gong

    Full Text Available Physicians' poor mental health not only hinders their professional performance and affects the quality of healthcare provided but also adversely affects patients' health outcomes. Few studies in China have evaluated the mental health of physicians. The purposes of this study are to quantify Chinese physicians' anxiety and depressive symptoms as well as evaluate associated risk factors.In our study, 2641 physicians working in public hospitals in Shenzhen in southern China were recruited and interviewed by using a structured questionnaire along with validated scales testing anxiety and depressive symptoms. Multivariable logistic regression models were used to identify risk factors for anxiety and depressive symptoms.An estimated 25.67% of physicians had anxiety symptoms, 28.13% had depressive symptoms, and 19.01% had both anxiety and depressive symptoms. More than 10% of the participants often experienced workplace violence and 63.17% sometimes encountered it. Among our study population, anxiety and depressive symptoms were associated with poor self-reported physical health, frequent workplace violence, lengthy working hours (more than 60 hours a week, frequent night shifts (twice or more per week, and lack of regular physical exercise.Our study demonstrates that anxiety and depressive symptoms are common among physicians in China, and the doctor-patient relationship issue is particularly stressful. Interventions implemented to minimize workload, improve doctor-patient relationships, and assist physicians in developing healthier lifestyles are essential to combat anxiety and depressive symptoms among physicians, which may improve their professional performance.

  1. Japanese hospitals--culture and competition: a study of ten hospitals.

    Science.gov (United States)

    Anbäcken, O

    1994-01-01

    Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies--specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc.

  2. A 37-year-old man trying to choose a high-quality hospital: review of hospital quality indicators.

    Science.gov (United States)

    Howell, Michael D

    2009-12-02

    Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.

  3. Workplace violence against physicians in Turkey's emergency departments: a cross-sectional survey.

    Science.gov (United States)

    Bayram, Başak; Çetin, Murat; Çolak Oray, Neşe; Can, İsmail Özgür

    2017-06-29

    We aimed to determine the prevalence of violence directed at emergency department (ED) physicians in Turkey and confirm the factors influencing such violence. Cross-sectional survey study. Country of Turkey. Physicians currently practising in EDs in Turkey. The prevalence of violence directed at physicians and factors that may influence it, such as physicians' personal characteristics, ED characteristics and physicians' opinions regarding the causes of and suggested methods of preventing violence. A total of 713 physicians participated. Of these, 78.1% reported being subjected to violence in the past year and 65.9% reported more than one such incident. Being subjected to violence was related to age (p=0.008), working in an ED with a high patient admission rate (p=0.018), current position (pviolence. The present safety precautions against violence do not appear to influence the prevalence of violence. Our results indicated that ED physicians' experience of violence is related to personal characteristics such as age and level of expertise, and hospital and ED characteristics such as high patient admission rates. Presently, no measures taken to reduce this violence have been proven effective. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. The physician-administrator as patient: distinctive aspects of medical care.

    Science.gov (United States)

    Cappell, Mitchell S

    2011-01-01

    This article examines distinctive aspects of medical care experienced by a 55-year-old hospitalized for quintuple coronary artery bypass surgery who was also a senior physician-administrator (chief of gastroenterology) at the same hospital. The article describes eight distinctive aspects of administrator-physicians as patients, including special patient treatment; exalted patient expectations by hospital personnel; patient suppression of emotions; patient denial; self-doctoring; job stress contributing to disease; self-sacrifice to achieve better health; and rational medical decisions when not under stress. Health-care workers should recognize how these distinctive aspects of medical care and behavior affect administrator-physicians as patients, in order to mitigate their negative effects, potentiate their positive effects, and optimize the care of these patients.

  5. A Study of the Educationally Influential Physician.

    Science.gov (United States)

    Kaufman, David M.; Ryan, Kurt; Hodder, Ian

    1999-01-01

    A survey of 172 family doctors found that they approached educationally influential (EI) physicians they knew through their hospitals; only 20% used e-mail and 40% the Internet for medical information; EI physicians helped extend their knowledge and validate innovations found in the literature; and health care reform was negatively affecting…

  6. "If you cannot tolerate that risk, you should never become a physician": a qualitative study about existential experiences among physicians.

    Science.gov (United States)

    Aase, M; Nordrehaug, J E; Malterud, K

    2008-11-01

    Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues. To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians (including three women), aged 33-66 years, residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner. Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients' lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position. Physicians' vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity.

  7. Hospital emergency on-call coverage: is there a doctor in the house?

    Science.gov (United States)

    O'Malley, Ann S; Draper, Debra A; Felland, Laurie E

    2007-11-01

    The nation's community hospitals face increasing problems obtaining emergency on-call coverage from specialist physicians, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. The diminished willingness of specialist physicians to provide on-call coverage is occurring as hospital emergency departments confront an ever-increasing demand for services. Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to non-hospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns. Hospital strategies to secure on-call coverage include enforcing hospital medical staff bylaws that require physicians to take call, contracting with physicians to provide coverage, paying physicians stipends, and employing physicians. Nonetheless, many hospitals continue to struggle with inadequate on-call coverage, which threatens patients' timely access to high-quality emergency care and may raise health care costs.

  8. Physicians' and Pharmacists' Experience and Expectations of the ...

    African Journals Online (AJOL)

    Purpose: To investigate physicians' and pharmacists' experience and expectations of the roles of pharmacists in hospital setting in Macau for the development of physician-pharmacist collaborative working relationship (CWR). Methods: A survey was conducted to address the research questions. The study population ...

  9. Work-related behavior and experience patterns of entrepreneurs compared to teachers and physicians.

    Science.gov (United States)

    Voltmer, Edgar; Spahn, Claudia; Schaarschmidt, Uwe; Kieschke, Ulf

    2011-06-01

    This study examined the status of health-related behavior and experience patterns of entrepreneurs in comparison with teachers and physicians to identify specific health risks and resources. Entrepreneurs (n = 632), teachers (n = 5,196), and physicians (n = 549) were surveyed in a cross-sectional design. The questionnaire Work-related Behavior and Experience Patterns (AVEM) was used for all professions and, in addition, two scales (health prevention and self-confidence) from the Checklist for Entrepreneurs in the sample of entrepreneurs. The largest proportion of the entrepreneurs (45%) presented with a healthy pattern (compared with 18.4% teachers and 18.3% physicians). Thirty-eight percent of entrepreneurs showed a risk pattern of overexertion and stress, followed by teachers (28.9%) and physicians (20.6%). Unambitious or burnout patterns were seen in only 9.3/8.2% of entrepreneurs, respectively, and 25.3/27.3% of teachers, and 39.6/21.5% of physicians. While the distribution of patterns in teachers and physicians differed significantly between genders, a gender difference was not found among entrepreneurs. Entrepreneurs with the risk pattern of overexertion scored significantly (P successful enterprise depends, in part, on the health of the entrepreneur. The large proportion of entrepreneurs with the healthy pattern irrespective of gender may support the notion that self-selection effects of healthy individuals in this special career might be important. At the same time, a large proportion was at risk for overexertion and might benefit from measures to cope with professional demands and stress and promote a healthy behavior pattern.

  10. The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction.

    Science.gov (United States)

    Lin, Blossom Yen-Ju; Hsu, Chung-Ping C; Juan, Chi-Wen; Lin, Cheng-Chieh; Lin, Hung-Jung; Chen, Jih-Chang

    2011-01-01

    The role of the leader of a medical unit has evolved over time to expand from simply a medical role to a more managerial one. This study aimed to explore how the behavior of a hospital-based emergency department's (ED's) leader might be related to ED unit performance and ED employees' work satisfaction. One hundred and twelve hospital-based EDs in Taiwan were studied: 10 in medical centers, 32 in regional hospitals, and 70 in district hospitals. Three instruments were designed to assess leader behaviors, unit performance and employee satisfaction in these hospital-based EDs. A mail survey revealed that task-oriented leader behavior was positively related to ED unit performance. Both task- and employee-oriented leader behaviors were found to be positively related to ED nurses' work satisfaction. However, leader behaviors were not shown to be related to ED physicians' work satisfaction at a statistically significant level. Some ED organizational characteristics, however, namely departmentalization and hospital accreditation level, were found to be related to ED physicians' work satisfaction. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. Communication with the seriously ill: physicians' attitudes in Saudi Arabia.

    Science.gov (United States)

    Mobeireek, A F; al-Kassimi, F A; al-Majid, S A; al-Shimemry, A

    1996-10-01

    To study some ethical problems created by accession of a previously nomadic and traditional society to modern invasive medicine, by assessment of physicians' attitudes towards sharing information and decision-making with patients in the setting of a serious illness. Self-completion questionnaire administered in 1993. Riyadh, Jeddah, and Buraidah, three of the largest cities in Saudi Arabia. Senior and junior physicians from departments of internal medicine and critical care in six hospitals in the above cities. A total of 249 physicians participated in the study. Less than half (47%) indicated they provided information on diagnosis and prognosis of serious illnesses all the time. Physicians who were more senior and those who spoke Arabic fared better than other groups. The majority (75%) preferred to discuss information with close relatives rather than patients, even when the patients were mentally competent. Most of the physicians (72%) felt patients had the right to refuse a specific treatment modality, and 68% denied patients the right to demand such a treatment if considered futile. Further analysis showed that physicians' attitudes varied along a spectrum from passive (25%) to paternalistic (21%) with the largest group (47%) in a balanced position. In traditional societies where physicians are regarded as figures of authority and family ties are important, there is a considerable shift of access to information and decision-making from patients to their physicians and relatives in a manner that threatens patients' autonomy. Ethical principles, wider availability of invasive medical technology and a rise in public awareness dictate an attitude change.

  12. Physician job satisfaction and working conditions in Japan.

    Science.gov (United States)

    Wada, Koji; Arimatsu, Mayuri; Higashi, Toshiaki; Yoshikawa, Toru; Oda, Susumu; Taniguchi, Hatsumi; Kawashima, Masatoshi; Aizawa, Yoshiharu

    2009-01-01

    The aim of this study was to determine factors of working conditions associated with job satisfaction among physicians in Japan. We sent a questionnaire to all the physicians who graduated from a medical school in Japan. Physicians who were satisfied with their job were determined as those who selected "very satisfied" and "satisfied" in response to the question: "Overall, are you satisfied with your job?" Working conditions were determined from 10 different aspects: income fairness, hospital resources, career satisfaction, difficulty in patient care, lack of personal time, administrative work, workload, and relationships with physician colleagues, staff and patients. Logistic regression analysis was used to explore the association between working conditions and job satisfaction. Among the respondents, 209 (55.4%) men and 62 (61.4%) women were determined to be satisfied with their job. Job satisfaction was associated with income fairness for both men (corrected odds ratio 1.31, 95% confidence interval 1.09 to 1.47) and women (1.35, 1.05 to 1.53). For men, job satisfaction was associated with good hospital resources (1.45, 1.29 to 1.57), high career satisfaction (1.41, 1.23 to 1.57), good relationships with physician colleagues (1.33, 1.12 to 1.49), and good relationships with hospital staff (1.28, 1.07 to 1.45). For women, job satisfaction was associated with good relationships with patients (1.41, 1.07 to 1.56). Certain working conditions were important factors for job satisfaction among physicians. These factors should be discussed for improving working conditions.

  13. Organizational commitment of military physicians.

    Science.gov (United States)

    Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay

    2009-09-01

    An individual's loyalty or bond to his or her employing organization, referred to as organizational commitment, influences various organizational outcomes such as employee motivation, job satisfaction, performance, accomplishment of organizational goals, employee turnover, and absenteeism. Therefore, as in other sectors, employee commitment is crucial also in the healthcare market. This study investigates the effects of organizational factors and personal characteristics on organizational commitment of military physicians using structural equation modeling (SEM) on a self-report, cross-sectional survey that consisted of 635 physicians working in the 2 biggest military hospitals in Turkey. The results of this study indicate that professional commitment and organizational incentives contribute positively to organizational commitment, whereas conflict with organizational goals makes a significantly negative contribution to it. These results might help develop strategies to increase employee commitment, especially in healthcare organizations, because job-related factors have been found to possess greater impact on organizational commitment than personal characteristics.

  14. Hospital survival strategies for the 1980s.

    Science.gov (United States)

    Bonney, R S

    1983-09-01

    Survival strategies for hospitals and hospital pharmacy departments are presented, and one hospital's development into a health-services system is described. Financial and competitive pressures are forcing institutions to develop new strategies for survival. The primary institutional strategy is diversification--both horizontal and vertical. Diversification can assist in the hospital's growth, increase its asset and revenue bases, and lead to the development of a health-care delivery system. Marketing to physicians and developing information systems are also critical strategies under a prospective payment system. Institutions will need to know the cost of providing care for specific diagnosis-related groups. Strategies must be employed to develop incentives to reduce inpatient acute-care services and to increase productivity. Physicians should be involved in all of the institutional strategies. Strategies for the pharmacy department are basically the same. Pharmacy departments should develop programs to reduce drug use (especially antibiotic use) and information systems that show the actual cost of providing services by diagnosis. The major corporate restructuring and diversification efforts of one hospital are described. The future of hospitals and pharmacy departments will depend on the successful application of the strategies discussed.

  15. Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

    Science.gov (United States)

    Lako, Christiaan J; Rosenau, Pauline

    2009-03-01

    In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician's opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician's advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient's confidence in physician referral and advice.

  16. Physicians in health care management: 2. Managing performance: who, what, how and when?

    OpenAIRE

    Lemieux-Charles, L

    1994-01-01

    Physicians are becoming more involved in performance management as hospitals restructure to increase effectiveness. Although physicians are not hospital employees, they are subject to performance appraisals because the hospitals are accountable to patients and the community for the quality of hospital services. The performance of a health care professional may be appraised by the appropriate departmental manager, by other professionals in a team or program or by peers, based on prior agreemen...

  17. Better Usability and Technical Stability Could Lead to Better Work-Related Well-Being among Physicians.

    Science.gov (United States)

    Vainiomäki, Suvi; Aalto, Anna-Mari; Lääveri, Tinja; Sinervo, Timo; Elovainio, Marko; Mäntyselkä, Pekka; Hyppönen, Hannele

    2017-10-01

    Background and Objective Finnish physicians have been increasingly dissatisfied with poor usability of the electronic patient record (EPR) systems, which they have identified as an overload factor in their work. Our aim is to specify which factors in EPRs are associated with work-related well-being of physicians. Methods A web-based questionnaire was sent to Finnish physicians younger than 65 years; the responses (n = 3,781) represent one-fourth of these. This was a repetition of a survey in 2010, where this questionnaire was used for the first time. In addition to statements assessing usability, there were questions measuring time pressure and job control. The relation between usability and work well-being was investigated with hierarchical multivariate regression analyses: With time pressure and job control as dependent variables, EPR usability assessments and physicians' background information were used as independent variables. Results In the multivariate analyses, technical problems that are often experienced in the EPR were related to higher time pressure and lower job control. Active participation in the development of the EPR system was related to stronger time pressure and stronger job control. In addition, use of several systems daily and the experience of time-consuming documentation of patient information for statistical purposes (billing, national registries, and reporting) were related to higher time pressure, while those with longer experience with the EPR system and those experiencing easy-to-read nursing records reported higher job control. Conclusion To relieve time pressure and increase sense of job control experienced by physicians, usability, integrations, and stability of the EPR systems should be improved: fewer login procedures, easier readability of nursing records, and decreased need for separate documentation for statistical purposes. Physician participation in the EPR development would increase the feeling of job control, but

  18. Relation Between Demographic Factors And Hospitalization In ...

    African Journals Online (AJOL)

    Relation Between Demographic Factors And Hospitalization In Patients With Gastrointestinal Disorders, Using Quantail Regression Analysis. ... East African Journal of Public Health ... Objective: The aim of this study is to investigate relation between demographic factors and hospitalization in gastrointestinal disorders.

  19. Antibiotic-Related Adverse Drug Reactions at a Tertiary Care Hospital in South Korea

    Directory of Open Access Journals (Sweden)

    In Young Jung

    2017-01-01

    Full Text Available Background. Adverse drug reactions (ADRs are any unwanted/uncomfortable effects from medication resulting in physical, mental, and functional injuries. Antibiotics account for up to 40.9% of ADRs and are associated with several serious outcomes. However, few reports on ADRs have evaluated only antimicrobial agents. In this study, we investigated antibiotic-related ADRs at a tertiary care hospital in South Korea. Methods. This is a retrospective cohort study that evaluated ADRs to antibiotics that were reported at a 2400-bed tertiary care hospital in 2015. ADRs reported by physicians, pharmacists, and nurses were reviewed. Clinical information reported ADRs, type of antibiotic, causality assessment, and complications were evaluated. Results. 1,277 (62.8% patients were considered antibiotic-related ADRs based on the World Health Organization-Uppsala Monitoring Center criteria (certain, 2.2%; probable, 35.7%; and possible, 62.1%. Totally, 44 (3.4% patients experienced serious ADRs. Penicillin and quinolones were the most common drugs reported to induce ADRs (both 16.0%, followed by third-generation cephalosporins (14.9%. The most frequently experienced side effects were skin manifestations (45.1% followed by gastrointestinal disorders (32.6%. Conclusion. Penicillin and quinolones are the most common causative antibiotics for ADRs and skin manifestations were the most frequently experienced symptom.

  20. Survey alerts hospital to needs of consumers.

    Science.gov (United States)

    Schoenfeldt, R C; Seale, W B; Hale, A W

    1987-09-01

    Because of rapidly changing developments in the healthcare field, more emphasis is being placed on marketing of hospital services. A hospital's success will depend more and more on strategic planning based on timely and accurate information. In light of this, Lourdes Hospital, Paducah, KY, undertook a survey to evaluate its current performance and to determine a path for the future. The survey found, among other discoveries, that patients want more voice in determining their own treatment; they prefer outpatient treatment when possible, even if it is not covered by insurance; and stress management and health assessment clinics are the most popular extra services a hospital could offer. Physicians surveyed said they wanted more input into the evaluation of new services and equipment at the hospital. The survey also found that most patients either select a hospital in conjunction with their physician or have their physician choose the hospital. The findings led to some major changes at the hospital, including a restructuring of the planning process to get physicians more involved, a new marketing strategy to enhance communication with consumers, and increased outpatient services. The results have given direction to the hospital administration, helped shape advertising, and provided support for certificate-of-need requests.

  1. Euthanasia and physician-assisted suicide in cases of terminal cancer: the opinions of physicians and nurses in Greece.

    Science.gov (United States)

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Vlahos, Lambros

    2008-10-01

    The aim of this study was to investigate the opinions of physicians and nurses on euthanasia and physician-assisted suicide in advanced cancer patients in Greece. Two hundred and fifteen physicians and 250 nurses from various hospitals in Greece completed a questionnaire concerning issues on euthanasia and physician-assisted suicide. More physicians (43.3%) than nurses (3.2%, p < 0.0005) reported that in the case of a cardiac or respiratory arrest, they would not attempt to revive a terminally ill cancer patient. Only 1.9% of physicians and 3.6% of nurses agreed on physician-assisted suicide. Forty-seven per cent of physicians and 45.2% of nurses would prefer the legalization of a terminally ill patient's hastened death; in the case of such a request, 64.2% of physicians and 55.2% of nurses (p = 0.06) would consider it if it was legal. The majority of the participants tended to disagree with euthanasia or physician-assisted suicide in terminally ill cancer patients, probably due to the fact that these acts in Greece are illegal.

  2. Minor emergency clinic: key to the future of successful hospitals.

    Science.gov (United States)

    Chawla, S; Kathawala, Y; Elmuti, D

    1992-01-01

    This project set out to determine whether there is a relationship between the minor emergency facility an individual uses and their choice of a hospital for in-patient care. In studying this relationship, the factors that are important to persons choosing a clinic or hospital facility, as well as the influence of a physician, were also identified. A structured, undisguised telephone survey was used for interviewing a randomly selected sample population of 189 San Angelo residents. Analysis of the survey data indicated that dependency does exist between minor emergency clinic use and the hospital chosen for in-patient care. The results of this study also suggested that hospitals' marketing strategy should shift the emphasis of their advertising from the hospital itself to their physician association and clinics. In addition, a number of other interesting observations concerning the relative importance of various medical factors to the participants was also explored.

  3. Breaking bad news among cancer physicians

    Directory of Open Access Journals (Sweden)

    Sami Ayed Alshammary

    2017-01-01

    Full Text Available Background: Breaking bad news to patients with cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and prognosis must be well-discussed in the most gentle and comfortable manner. It is important that the disclosure is performed in a way that patients will not lose all hope and get very depressed, leading them to undergo an abrupt change of their outlook in life. Objective: The aim of this study was to explore the physicians' perceptions and perspectives of breaking bad news to cancer patients. Methods: A cross-sectional survey of all comprehensive cancer centre physicians currently working in a university teaching hospital in the Middle East was conducted from August to September 2016. Results: Sixty-eight percent responded to the survey. Eighty-four percent were comfortable with breaking bad news, and 70% had training in breaking bad news. Eighty-six percent of responders stated that patients should be told about their cancer. Almost 30% of the respondents stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that they would only tell the details to the patients if asked while 67% of them disagreed that patients should be told about the diagnoses only if the relatives consent. About 51% of physicians wanted to discuss the bad news with the family members and patient together, whereas 24% stated that the patient alone should be involved in the discussion. Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into considerations, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

  4. 42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

    Science.gov (United States)

    2010-10-01

    ... other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... other than psychiatric hospitals. (a) Content of certification and recertification. Medicare Part A pays for inpatient hospital services of hospitals other than psychiatric hospitals only if a physician...

  5. Explaining turnover intention in Korean public community hospitals: occupational differences.

    Science.gov (United States)

    Hwang, Jee-In; Chang, Hyejung

    2008-01-01

    Personnel in public hospitals had relatively low job satisfaction despite of tenure employment. High turnover rates degrade hospital image and incur additional costs related to recruitment and training. The purposes of this study were to describe the occupational differences and to identify factors affecting turnover intention among public hospital personnel. A questionnaire survey was conducted as part of Administrative Services Quality Evaluation Program by Seoul metropolitan municipality from 1 November to 1 December in 2003. The subjects were 1251 entire hospital personnel in four hospitals. The questionnaire was designed to measure job satisfaction, organizational commitment, turnover intention, and demographic characteristics. Logistic regression analysis was performed to determine factors influencing turnover intention. There were significant differences in job satisfaction, organizational commitment, and turnover intention according to the occupations. The turnover intention rates were highest among physicians, followed by paramedicals and nursing staffs and then administrators. The significant factors affecting turnover intention were involvement and loyalty among physicians, hospital type, satisfaction with systems and loyalty among nursing staffs, satisfaction with relationship and loyalty among administrators, and loyalty among paramedicals. There were different moderators that influence turnover intentions of hospital personnel. Loyalty had the most important effect upon turnover intention in all occupations. 2007 John Wiley & Sons, Ltd

  6. Hospital reforms in France under a Socialist government.

    Science.gov (United States)

    De Pouvourville, G

    1986-01-01

    French health care faced the dual crises of rising costs and excess physicians. No government, whether left or right, could avoid focusing reform on the extensive public hospital system. Many differences introduced by the Socialists after 1981 were rhetorical and relational--matters of "democratization" of governance and "control" of physicians. Paradoxically, the two major structural reforms, "departmentalization" and "global budgeting," were extensions of actions begun under preceding governments. Neither has come to fruition yet.

  7. The impact of economic and noneconomic exchange on physicians' organizational attitudes: The moderating effects of the Chief Medical Officer.

    Science.gov (United States)

    Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

    2016-01-01

    Hospital-physician relationships are critical to hospitals' organizational success. A distinction can be drawn between economic and noneconomic physician-hospital exchange. Physician senior leadership could be an important component of managerial strategies aimed at optimizing hospital-physician relationships. The purpose of this study was to investigate the moderating role of the quality of exchange with the Chief Medical Officer (CMO) in the relationship between economic and noneconomic exchange and physicians' key organizational attitudes. Self-employed physicians practicing at six Belgian hospitals were surveyed. Economic exchange was conceptualized by the concepts of distributive and procedural justice, whereas noneconomic exchange was conceptualized by the concepts of administrative and professional psychological contract. Our outcomes comprise three key organizational attitudes identified in the literature (job satisfaction, affective organizational commitment, and intention to leave). The moderating role of leader-member exchange with the CMO in these relationships was assessed. Our results showed a relationship between both psychological contract breach and organizational justice and physicians' organizational attitudes. The quality of exchange with the CMO buffered the negative effect of psychological contract breach and reinforced the positive effects of organizational justice with respect to physicians' organizational attitudes. Our results demonstrate that both economic and noneconomic aspects are important when considering physicians' key organizational attitudes. The reciprocity dynamic between physician and hospital can be enhanced by high-quality exchange with the CMO.

  8. Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

    Science.gov (United States)

    Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

    2016-01-01

    State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

  9. [Problems in integrative postgraduate medical training of physicians at anthroposophic hospitals in Germany and Switzerland].

    Science.gov (United States)

    Heusser, Peter; Eberhard, Sabine; Weinzirl, Johannes; Orlow, Pascale; Berger, Bettina

    2014-01-01

    Anthroposophic hospitals provide integrative medical care by complementing conventional (CON) with anthroposophic medicine (AM). They teach integrative medicine in postgraduate medical training (PGMT). In a first evaluation of PGMT quality in AM, we analyzed the problems of this training from the perspectives of trainers and trainees. We conducted an anonymous cross-sectional full survey of all trainee and trainer physicians at the 15 AM hospitals in Germany (DE) and Switzerland (CH) with questionnaires of the Swiss Institute of Technology (ETH) Zürich, complemented by a module for AM. We also conducted descriptive statistics for questions with answering scales as well as calculations of group differences (two-tailed Mann-Whitney U test) and a qualitative content analysis (Mayring) of free text answers related to the problem analysis. The response rate in DE embraced 89 out of 215 (41.39%) surveyed trainees and 78 out of 184 (42.39%) trainers; in CH, the response rate comprised 19 out of 25 (76%) trainees and 22 out of 30 (73.33%) trainers. Free text answers related to problem analysis in DE and CH were given by 16 out of 108 (14.8%) trainees and by 20 out of 100 (20%) trainers, overall. Perceived main problems include work overload; shortcomings in work organization; delimitation of competences; interprofessional cooperation; financial resources (trainers); wages (trainees DE); practical relevance of AM (trainees and trainers in DE); professional or didactic competence of trainers; lack of interest in AM (trainees); problems with learning and practicing AM; no curriculum for postgraduate medical training in AM; tensions between AM and CON. Explanations for the differences between DE and CH include larger departments and the DRG system in DE, but also better structural conditions for AM PGMT in CH. Main problems of PGMT in AM include not only non-specific and systemic aspects, but also AM-specific issues. In order to develop a basis for concrete problem solving

  10. Impact of a State Law on Physician Practice in Sports-Related Concussions.

    Science.gov (United States)

    Flaherty, Michael R; Raybould, Toby; Jamal-Allial, Aziza; Kaafarani, Haytham M A; Lee, Jarone; Gervasini, Alice; Ginsburg, Richard; Mandell, Mark; Donelan, Karen; Masiakos, Peter T

    2016-11-01

    To determine physician-reported adherence to and support of the 2010 Massachusetts youth concussion law, as well as barriers to care and clinical practice in the context of legislation. Primary care physicians (n = 272) in a large pediatric network were eligible for a cross-sectional survey in 2014. Survey questions addressed key policy and practice provisions: concussion knowledge, state regulations and training, practice patterns, referrals, patient characteristics, and barriers to care. Analyses explored relationships between practice and policy, adjusting for physician demographic and practice characteristics. The survey response rate was 64% among all responders (173 of 272). A total of 146 respondents who had evaluated, treated, or referred patients with a suspected sports-related concussion in the previous year were eligible for analysis. The vast majority (90%) of providers agreed that the current Massachusetts laws regarding sports concussions are necessary and support the major provisions. Three-quarters (74%) had taken a required clinician training course on concussions. Those who took training courses were significantly more likely to develop individualized treatment plans (OR, 3.6; 95% CI, 1.1-11.0). Physician training did not improve screening of youth with concussion for depression or substance use. Most physicians (77%) advised patients to refrain from computer, telephone, or television for various time periods. Physicians reported limited communication with schools. Primary care physicians report being comfortable with the diagnosis and management of concussions, and support statewide regulations; however, adherence to mandated training and specific legal requirements varied. Broader and more frequent training may be necessary to align current best evidence with clinical care and state-mandated practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. A quantitative day in the life of a Saskatchewan rural physician.

    Science.gov (United States)

    Harrison, Emmett; Dhillon, Paul B A

    2018-01-01

    Rural family physicians are often required to meet a wide variety of medical service demands that are otherwise the responsibility of specialty physicians in urban centres. However, many rural physicians enjoy the practice variety and ability to meet patients' medical needs through this wider spectrum of care. We aimed to quantify and summarize the workload and clinical disorders seen by rural family physicians in Saskatchewan relative to urban family physicians. We used Saskatchewan Ministry of Health billing data for 2015/16 to compare rural and urban care provision. The data were summarized in a graphic 1-month format to portray a typical month in the life of a rural physician in the province. In the office setting, rural family physicians saw 16.8% more cardiac presentations in adults over 65 years of age than did urban family physicians; otherwise, there were no significant differences in the top office diagnosis categories seen by the 2 groups. Differences were apparent, however, in the hospital setting: urban family physicians saw more patients presenting with pain and, reflective of centralization of obstetric delivery services, performed more deliveries than did rural physicians. There are differences in the clinical presentations seen by rural and urban family physicians, and these need to be considered by new physicians considering rural practice. Our simple visual depiction of average workload, vacation and activity levels of rural physicians can further inform medical residents on the realities of working in rural Saskatchewan as a family physician. A more complete understanding of clinical workload expectations may promote recruitment of resident physicians.

  12. Computer Literacy Improvement Needs: Physicians' Self Assessment in the Makkah Region

    Directory of Open Access Journals (Sweden)

    Hani Abdulsattar Shaker

    2013-11-01

    Full Text Available Objective: A confidential inquiry by the Directorate General of health affairs, Makkah region, Saudi Arabia, found physicians were resistant to enter patient-related information in the electronic medical records system at different hospitals. This study aims to highlight their computer literacy needs.Methods: This cross-sectional survey was conducted on physicians using a structured questionnaire bearing nine questions/stems with dichotomous answers, (i.e., yes/no that was distributed among physicians at six different Ministry of Health hospitals in the Makkah Region, Saudi Arabia, between May and August 2009. The results for future needs in computer skills were categorized as "none" if the rate of answer "yes" to any stem was 0-25%, "little" if 26-50%, "some" if 51-75% and "substantial" if >75% rated "yes".Results: The response rate of 82% of determined sample size (n = 451 was attained. Computer literacy improvement elements (CLIE, i.e., "word processing software skills (MS Word", "presentation software skills (Power Point", "internet search skills", "medical database search skills", "spreadsheet software skills (Excel" and "advanced e-mail management skills" were in "substantial" need of improvement among the majority of settings and categories. All other computer literacy improvement elements were in "some" need of improvement.Conclusion: The overall outcome of this study indicates that physicians need further computer literacy improvements.

  13. Physician’ entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

    NARCIS (Netherlands)

    Koelewijn, Wout Theodoor; de Rover, Matthijs; Ehrenhard, Michel Léon; van Harten, Willem H.

    2014-01-01

    Background Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers

  14. Reported beverage consumed and alcohol-related diseases among male hospital inpatients with problem drinking.

    Science.gov (United States)

    Coder, Beate; Freyer-Adam, Jennis; Lau, Katharina; Riedel, Jeannette; Rumpf, Hans-Jürgen; Meyer, Christian; John, Ulrich; Hapke, Ulfert

    2009-01-01

    The aim of this study was to examine if problem drinkers have varying risks of having alcohol-related diseases according to their reported beverage consumed. In a cross-sectional study all consecutive inpatients aged 18- 64 years from four general hospitals of one catchment area were systematically screened for alcohol use. A total of 1011 men with problem drinking were used for this study. Routine treatment diagnoses for all participants were provided by hospital physicians and were classified into three categories according to their alcohol-attributable fractions (AAF; AAF = 0; AAF spirits drinkers, 26.0% mixed beer and spirits drinkers and 6.9% individuals drinking wine exclusively or in combination with one or two other beverages (mixed wine drinkers). Compared to spirits drinkers and controlling for possible confounders (i.e. alcohol-associated characteristics, demographic variables), multinomial regressions revealed that beer drinkers, mixed beer and spirits drinkers, and mixed wine drinkers had lower odds of having diseases with AAF = 1 than spirits drinkers (e.g. for AAF = 1: beer versus spirits drinkers: OR = 0.42, CI: 0.25-0.72). Beer drinkers and mixed wine drinkers also had lower odds of having diseases with AAF spirits drinkers (e.g. mixed wine versus spirits drinkers: OR = 0.36, CI: 0.18-0.72). These data suggest an association between the reported beverage consumed and alcohol-related diseases. Among hospitalized problem drinkers, spirits drinkers had the greatest risk of having diseases with AAF < 1 and with AAF = 1.

  15. [Organ donation following physician-hastened death at home].

    Science.gov (United States)

    Mulder, J G H; Sonneveld, J P C

    2017-01-01

    Patients considering physician-hastened death (PHD) increasingly express a wish to donate organs after death. This fairly unique proposition stems from patients' desire to do something good with (parts of) the same diseased body that has prompted them to request physician-hastened death. In this article we describe a patient with amyotrophic lateral sclerosis (ALS) who expressed this wish. In March 2017 a national guideline on 'Organ donation following physician-hastened death' (ODP) was presented to the Minister of Health, Welfare and Sport of the Netherlands. From the development of this guideline it emerged that, for PHD patients, being forced to experience their final conscious moments in hospital - in order to facilitate organ donation - was a key reason for not choosing ODP. Together with an anaesthesiologist-intensivist, the GP of the ALS patient developed a domestic ODP, thereby overcoming the hurdle of experiencing death in hospital and maintaining the possible option of organ donation. The applied solution is an 'anaesthesia bridge' which separates the experience of farewells, and losing consciousness under pre-medication at home, from biological death and organ donation in hospital.

  16. Physician practice management companies: should physicians be scared?

    Science.gov (United States)

    Scott-Rotter, A E; Brown, J A

    1999-01-01

    Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions.

  17. Violence exposure among health care professionals in Saudi public hospitals. A preliminary investigation.

    Science.gov (United States)

    Algwaiz, Waleed M; Alghanim, Saad A

    2012-01-01

    To identify the prevalence, causes, types, and sources of workplace violence among health professionals in public hospitals in the Kingdom of Saudi Arabia. This exploratory cross-sectional survey employed self-administered questionnaires to collect data on aspects of workplace violence against physicians and nurses in Saudi hospitals. The questionnaires were distributed randomly to 600 physicians and nurses, of which 383 (63.8%) completed the questionnaires at 2 public hospitals in Riyadh city between May and July 2011. More than two-thirds (67.4%) of respondents reported they were victims of violence in the previous 12 months. Nurses were more likely to be exposed to violent incidents than physicians (pviolence. Verbal abuse was the most common type encountered. The assailants were mostly the patients' relatives or friends, followed by the patients themselves. Reasons for not reporting violent events included: feel it is a part of the job, previous experience of no action, and fear of consequences. Physicians and nurses are at high risk of violent incidents. Health decision makers need to be aware of the potential consequences of such events. Appropriate preventive measures are needed to make hospitals safer environments.

  18. Physician Wellness Is an Ethical and Public Health Issue.

    Science.gov (United States)

    Walker, Rosandra; Pine, Harold

    2018-06-01

    Attention to physician well-being has traditionally focused on substance abuse, usually with disciplinary implications. But, in recent years, greater notice has been granted toward physician burnout and overall wellness. Burnout and its sequelae not only affect physicians and physicians-in-training as individuals, but the impact then multiplies as it affects these physicians' patients, colleagues, and hospital systems. In addition, the American Medical Association Code of Medical Ethics charges physicians with a responsibility to maintain their own health and wellness as well as promote that of their colleagues. Therefore, the question of physician wellness has both public health and ethical implications. The causes of burnout are multifactorial, and the solutions to sustainable change are multitiered.

  19. Physician job satisfaction related to actual and preferred job size.

    Science.gov (United States)

    Schmit Jongbloed, Lodewijk J; Cohen-Schotanus, Janke; Borleffs, Jan C C; Stewart, Roy E; Schönrock-Adema, Johanna

    2017-05-11

    Job satisfaction is essential for physicians' well-being and patient care. The work ethic of long days and hard work that has been advocated for decades is acknowledged as a threat for physicians' job satisfaction, well-being, and patient safety. Our aim was to determine the actual and preferred job size of physicians and to investigate how these and the differences between them influence physicians' job satisfaction. Data were retrieved from a larger, longitudinal study among physicians starting medical training at Groningen University in 1982/83/92/93 (N = 597). Data from 506 participants (85%) were available for this study. We used regression analysis to investigate the influence of job size on physicians' job satisfaction (13 aspects) and ANOVA to examine differences in job satisfaction between physicians wishing to retain, reduce or increase job size. The majority of the respondents (57%) had an actual job size less than 1.0 FTE. More than 80% of all respondents preferred not to work full-time in the future. Respondents' average actual and preferred job sizes were .85 FTE and .81 FTE, respectively. On average, respondents who wished to work less (35% of respondents) preferred a job size reduction of 0.18 FTE and those who wished to work more (12%) preferred an increase in job size of 0.16 FTE. Job size influenced satisfaction with balance work-private hours most (β = -.351). Physicians who preferred larger job sizes were - compared to the other groups of physicians - least satisfied with professional accomplishments. A considerable group of physicians reported a gap between actual and preferred job size. Realizing physicians' preferences as to job size will hardly affect total workforce, but may greatly benefit individual physicians as well as their patients and society. Therefore, it seems time for a shift in work ethic.

  20. The challenges of emerging HISs in bridging the communication gaps among physicians and nurses in China: an interview study.

    Science.gov (United States)

    Wen, Dong; Zhang, Xingting; Wan, Jie; Fu, Jing; Lei, Jianbo

    2017-06-12

    To explore the current situation, existing problems and possible causes of said problems with regards to physician-nurse communication under an environment of increasingly widespread usage of Hospital Information Systems and to seek out new potential strategies in information technology to improve physician-nurse communication. Semi-structured interviews were conducted with 20 physicians and nurses in five leading tertiary grade A hospitals in Beijing, China (two physicians and two nurses in each hospital). The interviews primarily included three aspects comprising the current situation and problems of clinical physician-nurse communication, the application and problems of Hospital Information Systems, and assessments on the improvement of physician-nurse communication through the usage of information technology. The inductive conventional content analysis approach was employed. (1) Physicians and nurses are generally quite satisfied with the current situation of communication. However, the information needs of nurses are prone to being overlooked, and the communication methods are primarily synchronous communication such as face-to-face and phone communication. (2) Hospital Information Systems are gradually being used for physician-nurse communication; in the meantime, physicians and nurses face challenges with regards to the improvement of physician-nurse communication through the usage of information technology. Challenges differ based on the different stages of using the system and the different levels of understanding of physicians and nurses towards information technology. Their dissatisfaction mainly deals with system errors and the level of convenience in using the system. (3) In-depth interviews found that in general, physicians and nurses have a strong interest and trust in improving physician-nurse communication through appropriate information technology, e.g., communication methods such as information reminders for physicians and nurses through mobile

  1. Predictors of physicians' stress related to information systems: a nine-year follow-up survey study.

    Science.gov (United States)

    Heponiemi, Tarja; Hyppönen, Hannele; Kujala, Sari; Aalto, Anna-Mari; Vehko, Tuulikki; Vänskä, Jukka; Elovainio, Marko

    2018-04-13

    Among the important stress factors for physicians nowadays are poorly functioning, time consuming and inadequate information systems. The present study examined the predictors of physicians' stress related to information systems (SRIS) among Finnish physicians. The examined predictors were cognitive workload, staffing problems, time pressure, problems in teamwork and job satisfaction, adjusted for baseline levels of SRIS, age, gender and employment sector. The study has a follow-up design with two survey data collection waves, one in 2006 and one in 2015, based on a random sample of Finnish physicians was used. The present study used a sample that included 1109 physicians (61.9% women; mean age in 2015 was 54.5; range 34-72) who provided data on the SRIS in both waves. The effects of a) predictor variable levels in 2006 on SRIS in 2015 and b) the change in the predictor variables from 2006 to 2015 on SRIS in 2015 were analysed with linear regression analyses. Regression analyses showed that the higher level of cognitive workload in 2006 significantly predicted higher level of SRIS in 2015 (β = 0.08). The reciprocity of this association was tested with cross-lagged structural equation model analyses which showed that the direction of the association was from cognitive workload to SRIS, not from SRIS to cognitive workload. Moreover, increases in time pressure (β = 0.16) and problems in teamwork (β = 0.10) were associated with higher levels of SRIS in 2015, whereas job satisfaction increase was associated with lower SRIS (β = - 0.06). According to our results, physicians' cognitive workload may have long-lasting negative ramifications in regard to how stressful physicians experience their health information systems to be. Thus, organisations should pay attention to physicians workload if they wish physicians to master all the systems they need to use. It is also important to provide physicians with enough time and collegial support in their

  2. The Comparison of Psychological Contract Perception of Physicians and Nurses

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    Necmettin Cihangiroglu

    2012-02-01

    Full Text Available OBJECTIVE: In this study, it was aimed to find out if psychological contract perception of physicians and nurses is different or not. METHODS: The study has been cross sectionaly contucted from May to June 2010, in a 1200 bed education and research hospital in Ankara. We aimed at reaching all of the physicians and nurses without any sampling. A questionnaire method was used for data collection. Out of 646 surveys given out, we collected 413. To measure psychological contract perception of workers, Psychological Contract Scale with the 17 items developed by Millward and Hopkins. RESULTS: The reliability analysis of the Scale showed that Cronbach Alpha coefficient for the transactional contract dimension is 0,66, and for the relational contract dimension is 0,71. Whereas the univarite analysis showed that differences between transactional contract perception of physicians and nurses were significant multivarite variance analysis showed that differences between transactional (F=1.38, p=0.241 and relational (F=3.01, p=0.084 contract perception of physicians and nurses were not significant, and their perception related to both dimensions were affected only by their educational level (p<0.05. CONSLUSION: We hope that the results of this study provides significant information for healthcare organisation managers. But a more detailed study is needed to claim that these results are marginal. [TAF Prev Med Bull 2012; 11(1.000: 63-70

  3. Pricing of prescription drugs and its impact on physicians' choice behavior.

    Science.gov (United States)

    Miao-Sheng, Chen; Yu-Ti, Shih

    2008-09-01

    This research presents an analysis of Taiwan's health care market with the focus on the pricing of prescription drugs and its impact on physicians' choice behavior. Since the advent of Taiwan's national health insurance, with the competent authority being Bureau of National Health Insurance (BNHI), hospitals are allowed to sell prescription drugs to patients at prices above the purchasing prices, so each prescription drug has two prices: one at which drugs are sold to hospitals; the other which BNHI reimbursement to hospitals. The margin between the different prices is the sales discount that pharmaceutical companies offer to the hospitals. We find that sales discount has a great impact on physicians' choice behavior: i.e., physicians are price-sensitive to prescription drugs. In addition, it is found that too high a sales discount of a prescription drug would result in a too low weighted average price of that drug sold; thus BNHI would be more likely to adjust downward the rate it reimbursement to the hospital. This presents a sales strategy problem to pharmaceutical companies. To solve this, we use the distribution of physicians' evaluations of prescription drugs to establish a profit maximization model in hopes of helping companies to price drugs and find the optimal promotion expending. Ten popular prescription drugs are used in this research as examples.

  4. When Reducing Low-Value Care in Hospital Medicine Saves Money, Who Benefits ?

    Science.gov (United States)

    Liao, Joshua M; Navathe, Amol S; Schapira, Marilyn M; Weissman, Arlene; Mitra, Nandita; Asch, David A

    2018-01-01

    One emerging policy solution for deterring low-value care is to financially penalize physicians who prescribe it. However, physicians' willingness to support such policies may depend on whether they perceive that benefits accrue to patients or to insurers and hospitals. We surveyed physicians practicing hospital medicine to evaluate the association between policy support and physician beliefs about who benefits from the money saved through reducing low-value services in hospital medicine. Overall, physicians believed that more of any money saved would go to profits and leadership salaries for insurance companies and hospitals and/or health systems rather than to patients. These beliefs were associated with policy support: 66% of those supporting physician penalties were more likely to believe that benefits accrue to patients or physicians, compared to 39% of those not supporting policies (P benefits accrue to corporate or organizational interests. Effective physician penalties will likely need to address the belief that insurers and provider organizations stand to gain more than patients when low-value care services are reduced. © 2017 Society of Hospital Medicine.

  5. Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency.

    Science.gov (United States)

    Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay

    2014-10-01

    In 2003, work hours for physicians-in-training (residents) were capped by regulation at eighty hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work-hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000-09 that were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and patients' length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, assessment of the impact of the duty-hour reforms on other clinical outcomes is needed. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Bellanger, Martine M; Quentin, Wilm; Tan, Siok Swan

    2013-05-01

    The study compares how Diagnosis-Related Group (DRG) based hospital payment systems in eleven European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) deal with women giving birth in hospitals. It aims to assist gynaecologists and national authorities in optimizing their DRG systems. National or regional databases were used to identify childbirth cases. DRG grouping algorithms and indicators of resource consumption were compared for those DRGs which account for at least 1% of all childbirth cases in the respective database. Five standardized case vignettes were defined and quasi prices (i.e. administrative prices or tariffs) of hospital deliveries according to national DRG-based hospital payment systems were ascertained. European DRG systems classify childbirth cases according to different sets of variables (between one and eight variables) into diverging numbers of DRGs (between three and eight DRGs). The most complex DRG is valued 3.5 times more resource intensive than an index case in Ireland but only 1.1 times more resource intensive than an index case in The Netherlands. Comparisons of quasi prices for the vignettes show that hypothetical payments for the most complex case amount to only € 479 in Poland but to € 5532 in Ireland. Differences in the classification of hospital childbirth cases into DRGs raise concerns whether European systems rely on the most appropriate classification variables. Physicians, hospitals and national DRG authorities should consider how other countries' DRG systems classify cases to optimize their system and to ensure fair and appropriate reimbursement. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. Are long physician working hours harmful to patient safety?

    Science.gov (United States)

    Ehara, Akira

    2008-04-01

    Pediatricians of Japanese hospitals including not only residents but also attending physicians work long hours, and 8% work for >79 h per week. Most of them work consecutively for >or=32 h when they are on call. The aim of the present study was to evaluate the effect of long work hours on patient safety. The electronic databases MEDLINE and EMBASE to searched identify the English- and Japanese-language literature for studies on work hours, medical errors, patient safety, and malpractice for years 1966-2005. Studies that analyzed the relationship between physician work hours and outcomes directly related to patient safety were selected. Seven studies met the criteria. Four studies suggest that reduction of work hours has a favorable effect on patient safety indicators. In the other three studies no significant changes of the indicators were observed, but no report found that shorter work hours were harmful to patient safety. Decrease of physician work hours is not harmful but favorable to patient safety.

  8. Perceptions of trust in physician-managers.

    Science.gov (United States)

    Cregård, Anna; Eriksson, Nomie

    2015-01-01

    The purpose of this paper is to explore the dual role of physician-managers through an examination of perceptions of trust and distrust in physician-managers. The healthcare sector needs physicians to lead. Physicians in part-time managerial positions who continue their medical practice are called part-time physician-managers. This paper explores this dual role through an examination of perceptions of trust and distrust in physician-managers. The study takes a qualitative research approach in which interviews and focus group discussions with physician-managers and nurse-managers provide the empirical data. An analytical model, with the three elements of ability, benevolence and integrity, was used in the analysis of trust and distrust in physician-managers. The respondents (physician-managers and nurse-managers) perceived both an increase and a decrease in physicians' trust in the physician-managers. Because elements of distrust were more numerous and more severe than elements of trust, the physician-managers received negative perceptions of their role. This paper's findings are based on perceptions of perceptions. The physicians were not interviewed on their trust and distrust of physician-managers. The healthcare sector must pay attention to the diverse expectations of the physician-manager role that is based on both managerial and medical logics. Hospital management should provide proper support to physician-managers in their dual role to ensure their willingness to continue to assume managerial responsibilities. The paper takes an original approach in its research into the dual role of physician-managers who work under two conflicting logics: the medical logic and the managerial logic. The focus on perceived trust and distrust in physician-managers is a new perspective on this complicated role.

  9. Leadership in Ophthalmology: The Role of Physician-MBAs.

    Science.gov (United States)

    Pathipati, Akhilesh S; Tsai, James C

    2018-04-01

    As American health care evolves, an increasing number of doctors are pursuing MBAs. However, relatively little is known about how business training translates into their future careers. This study characterizes ophthalmologists who have completed MBAs and identifies opportunities for physician leadership in the field. Cross-sectional study. We identified 120 ophthalmologists who hold MBAs. We searched each individual's online profiles to collect information on demographics, training, and professional activities. Physician-MBAs in ophthalmology are 80% male; 80% are fellowship trained; and 28% are in primarily nonclinical roles and 55% participate in significant nonclinical activity. Hospital administration is most common (31%), followed by pharmaceutical administration (7%) and consulting (5%). Older ophthalmologist-MBAs were more likely to work in nonclinical roles, with 79% of those who completed residency before 2000 engaged in significant nonclinical activity compared to 30% of those who completed residency after 2000. The most common employers of physician-MBAs in ophthalmology are academic medical centers (43%), large group practices (30%), and private practices (13%). The majority of ophthalmologist-MBAs work in primarily clinical roles, although a sizable proportion hold nonclinical positions. Moving forward, we anticipate an increased role for physician leaders in health care administration, policy, and entrepreneurship. While formal management training is not necessary for these roles, a growing number of physicians have sought out MBAs to support their nonclinical interests. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. The Palliative Treatment Plan as a Bone of Contention between Attending Physicians and Nurses

    Directory of Open Access Journals (Sweden)

    Wolfgang Lederer

    2015-10-01

    Full Text Available Acute vital crisis in end-of-life situations may result in hospitalization and intensive care without recognizable benefit in many cases. Advance directives regarding indications for resuscitation, hospitalization, and symptomatic treatment help ensure that acute complications can be managed quickly and satisfactorily in the patient’s customary surroundings. A plan was designed and implemented in Austrian nursing homes to provide emergency physicians with rapidly obtainable information on the patient’s current situation, and whether resuscitation attempts and hospitalization are advised or not. This palliative treatment plan is arranged by a physician together with caregivers, close relatives, and the patient or his court-appointed health care guardian or holder of power of attorney. Four years after implementation of the plan, a user satisfaction survey was carried out. The majority of participating nurses, emergency physicians and family doctors judged application and design of the palliative treatment plan positively. However, the low response rate of family doctors indicates nonconformity. In particular, the delegation of symptomatic treatment to nurses proved to be controversial. There is still a need to provide up-to-date information and training for health professionals in order for them to understand advance directives as extended autonomy for patients who have lost their ability to make their own decisions.

  11. Exploring physicians' extended use of electronic health records (EHRs): A social influence perspective.

    Science.gov (United States)

    Wang, Wen; Zhao, Xiping; Sun, Jinglei; Zhou, Guangquan

    2016-12-01

    Once electronic health records (EHRs) have been fully implemented and integrated into the daily work of a healthcare organisation/hospital, there is considerable pressure on management to demonstrate the benefits that these systems can deliver to the organisation. One practical way to maximise the value and highlight the benefits of EHRs is to encourage physicians to increase and extend their use of EHR functions. This study used a social influence theory context to examine the impact of mechanisms of social influence on the intentions of physicians to extend their use of EHRs. A survey of physicians (n = 205) in a first-class comprehensive hospital in southern China was conducted approximately 2 years after the hospital's introduction of EHRs. A 16-item questionnaire was developed to measure the impact of four social influence factors (reward, punishment, social image and group norm) on physicians' intentions to extend their use of EHRs. The research model included two additional control variables (perceived usefulness and perceived ease of use) to account for potential covariance among social influence measures. The study's research model showed significant relationships between physicians' responses on two of the social influence measures (rewards and group norm) and their intentions to extend their use of EHRs. Punishment and social image measures did not influence physicians' intentions to increase their use of EHRs. These findings have suggested that for healthcare organisations to maximise the benefits of EHRs, the efforts of hospital management should be directed towards rewarding those physicians who increase their use of EHRs; and to promoting and reinforcing the increased usage of EHRs among physicians as a group norm. © The Author(s) 2016.

  12. Association between quality domains and health care spending across physician networks

    Science.gov (United States)

    Rahman, Farah; Guan, Jun; Glazier, Richard H.; Brown, Adalsteinn; Bierman, Arlene S.; Croxford, Ruth; Stukel, Therese A.

    2018-01-01

    One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care. Each domain rate was computed as a weighted average of QI rates, weighting by network population at risk. We also measured overall and sector-specific per capita healthcare network spending. We evaluated the associations between domain rates, and between domain rates and spending using weighted correlations, weighting by network population at risk, using an ecological design. All indicators were measured using Ontario health administrative databases. Large variations were seen in timely hospital-community transitions and potentially avoidable hospitalizations. Networks with timely hospital-community transitions had lower rates of avoidable admissions and readmissions (r = -0.89, -0.58, respectively). Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations (r = -0.83) and higher rates of timely hospital-community transitions (r = 0.81) and moderately associated with lower readmission rates (r = -0.46). Investment in effective primary care services may help reduce burden on the acute care sector and associated expenditures. PMID:29614131

  13. Mapping and modeling of physician collaboration network.

    Science.gov (United States)

    Uddin, Shahadat; Hamra, Jafar; Hossain, Liaquat

    2013-09-10

    Effective provisioning of healthcare services during patient hospitalization requires collaboration involving a set of interdependent complex tasks, which needs to be carried out in a synergistic manner. Improved patients' outcome during and after hospitalization has been attributed to how effective different health services provisioning groups carry out their tasks in a coordinated manner. Previous studies have documented the underlying relationships between collaboration among physicians on the effective outcome in delivering health services for improved patient outcomes. However, there are very few systematic empirical studies with a focus on the effect of collaboration networks among healthcare professionals and patients' medical condition. On the basis of the fact that collaboration evolves among physicians when they visit a common hospitalized patient, in this study, we first propose an approach to map collaboration network among physicians from their visiting information to patients. We termed this network as physician collaboration network (PCN). Then, we use exponential random graph (ERG) models to explore the microlevel network structures of PCNs and their impact on hospitalization cost and hospital readmission rate. ERG models are probabilistic models that are presented by locally determined explanatory variables and can effectively identify structural properties of networks such as PCN. It simplifies a complex structure down to a combination of basic parameters such as 2-star, 3-star, and triangle. By applying our proposed mapping approach and ERG modeling technique to the electronic health insurance claims dataset of a very large Australian health insurance organization, we construct and model PCNs. We notice that the 2-star (subset of 3 nodes in which 1 node is connected to each of the other 2 nodes) parameter of ERG has significant impact on hospitalization cost. Further, we identify that triangle (subset of 3 nodes in which each node is connected to

  14. Second medical opinions: the views of oncology patients and their physicians.

    Science.gov (United States)

    Philip, Jennifer; Gold, Michelle; Schwarz, Max; Komesaroff, Paul

    2010-09-01

    Second medical opinions (SMOs) are common in oncology practice, but the nature of these consultations has received relatively little attention. This study examines the views of patients with advanced cancer and their physicians of SMOs. Parallel, concurrent surveys were developed for patients and physicians. The first was distributed to outpatients with advanced cancer-attending specialist clinics in an Australian quaternary hospital. The second survey, developed on the basis of results of exploratory interviews with medical oncologists, was distributed to medical oncologists in Australia. Seventeen of fifty two (33%) patients had sought a SMO, most commonly prompted by concerns around communication with their first doctor, the extreme and desperate nature of their medical condition and the need for reassurance. Most (94%) patients found the SMO helpful, with satisfaction related to improved communication and reassurance. Patients were concerned that seeking a second medical opinion may affect their relationship with their primary doctor. Most physicians (82%) reported seeing between one and five SMO per month, with patients being motivated by the need for additional information and reassurance. Physicians regarded SMO patients as having greater information needs (84%), greater psychosocial needs (58%) and requiring more of the physician's time and energy (77%) than other patients. SMOs are common in cancer care with most patients motivated by the need for improved communication, additional information and reassurance. Physicians identify patients who seek SMOs as having additional psychosocial needs compared with other oncology patients.

  15. The knowledge level of chest physicians about the pulmonary rehabilitation topic

    Directory of Open Access Journals (Sweden)

    Hadice Selimoğlu Şen

    2014-09-01

    Full Text Available Objective: The pulmonary rehabilitation (PR is multidisciplinary, evidence-based and personalized treatment approach for patients with a symptomatic chronic respiratory disease and reduced daily living activities. In this study, we aimed to determine the knowledge level of chest physicians about PR in our city. Methods: A standardized questionnaire consisting of 10 questions was conducted to a total of 40 chest diseases specialist and assistant doctors who are working at the university hospital, training and research hospital and a private hospital in Diyarbakir city and its purlieus. The questions about the definition of PR, goals, evaluation criteria, patient who candidate for rehabilitation and rehabilitation team, were asked in questionnaire. Ten points was given for each correct answer to closed-ended questions. The knowledge level were identified as low, moderate and high when points were <50, 50-79 and 80-100 respectively. Results: The mean age of participants was 36.1 ± 7.79 and working duration time in chest disease department was 5.57 ± 7.71 years. Seventy-eight point nine percent of university hospital doctors, 57.1% of training and research hospital doctors, 50% of private hospital doctors were answered correctly more than half of the questions. Conclusion: The knowledge of chest physicians about PR is substantially in low and moderate levels in our city. The creation of a curriculum about PR in medical schools, and postgraduate training of physicians in the field will raise awareness about this issue, and might increase the interest of physicians and patients to PR. J Clin Exp Invest 2014; 5 (3: 386-390

  16. The perception and experience of gender-based discrimination related to professional advancement among Japanese physicians.

    Science.gov (United States)

    Yasukawa, Kosuke; Nomura, Kyoko

    2014-01-01

    Previous studies from the US have found that female physicians often experience gender-based discrimination related to professional advancement. In Japan, female physicians are underrepresented in leadership positions but little is known about the prevalence of gender discrimination. We investigated the perception and prevalence of gender-based career obstacles and discrimination among Japanese physicians. The study was based on surveys of alumnae from 13 medical schools and alumni from 3 medical schools. In total, 1,684 female and 808 male physicians completed a self-administered questionnaire (response rate 83% and 58%). More women than men had the perception of gender-based career obstacles for women (77% vs. 55%; p gender discrimination related to professional advancement (21% vs. 3%; p gender discrimination included age (p gender discrimination compared with younger women (OR 5.77, 95% CI: 1.83-18.24 for women above 50, and OR 3.2, 95% CI: 1.48-7.28 for women between 40 and 49) and women with PhD were more likely to experience gender discrimination (OR 4.23, 95% CI: 1.81-9.89). Our study demonstrated that a significant proportion of Japanese women experienced gender-based discrimination and perceived gender-based career obstacles compared with male physicians.

  17. Alzheimer's Disease Increases the Incidence of Hospitalization Due to Fall-related Bone Fracture in Elderly Chinese

    Directory of Open Access Journals (Sweden)

    Fang Li

    2016-12-01

    Conclusion: On the basis of our findings, we conclude that AD may increase the incidence of hospitalization due to falls and bone fracture. We also found that AD has no effect on fracture location, but larger studies are needed to confirm this finding. Physicians and family members should emphasize the possibility of falls and bone fracture in patients with AD. Our findings suggest that preventing falls in AD patients may reduce the number of hospitalized AD patients.

  18. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety

    Science.gov (United States)

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

    2011-01-01

    formalize a moonlighting policy and establish systems for actively monitoring resident physician moonlighting Safety of resident physicians The “Sleep, supervision and safety” report also addresses fatigue-related harm done to resident physicians themselves. The report focuses on two main sources of physical injury to resident physicians impaired by fatigue, ie, needle-stick exposure to blood-borne pathogens and motor vehicle crashes. Providing safe transportation home for resident physicians is a logistical and financial challenge for hospitals. Educating physicians at all levels on the dangers of fatigue is clearly required to change driving behavior so that safe hospital-funded transport home is used effectively. Fatigue-related injury prevention (including not driving while drowsy) should be taught in medical school and during residency, and reinforced with attending physicians; hospitals and residency programs must be informed that resident physicians’ ability to judge their own level of impairment is impaired when they are sleep deprived; hence, leaving decisions about the capacity to drive to impaired resident physicians is not recommendedHospitals should provide transportation to all resident physicians who report feeling too tired to drive safely; in addition, although consecutive work should not exceed 16 hours, hospitals should provide transportation for all resident physicians who, because of unforeseen reasons or emergencies, work for longer than consecutive 24 hours; transportation under these circumstances should be automatically provided to house staff, and should not rely on self-identification or request Training in effective handovers and quality improvement Handover practice for resident physicians, attendings, and other health care providers has long been identified as a weak link in patient safety throughout health care settings. Policies to improve handovers of care must be tailored to fit the appropriate clinical scenario, recognizing that

  19. Psychosocial challenges facing physicians of today.

    Science.gov (United States)

    Arnetz, B B

    2001-01-01

    Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico-chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the

  20. [Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals].

    Science.gov (United States)

    Martínez, Cristina; Martínez-Sánchez, Jose M; Antón, Laura; Riccobene, Anna; Fu, Marcela; Quirós, Nuria; Saltó, Esteve; Fernández, Esteve

    2016-01-01

    To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital. A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  1. Physician job satisfaction related to actual and preferred job size

    OpenAIRE

    Schmit Jongbloed, Lodewijk J.; Cohen-Schotanus, Janke; Borleffs, Jan C. C.; Stewart, Roy E.; Schonrock-Adema, Johanna

    2017-01-01

    Background: Job satisfaction is essential for physicians' well-being and patient care. The work ethic of long days and hard work that has been advocated for decades is acknowledged as a threat for physicians' job satisfaction, well-being, and patient safety. Our aim was to determine the actual and preferred job size of physicians and to investigate how these and the differences between them influence physicians' job satisfaction. Method: Data were retrieved from a larger, longitudinal study a...

  2. Nurse/physician conflict management mode choices: implications for improved collaborative practice.

    Science.gov (United States)

    Hendel, Tova; Fish, Miri; Berger, Ornit

    2007-01-01

    In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction.

  3. A Physician's Perspective On Vertical Integration.

    Science.gov (United States)

    Berenson, Robert A

    2017-09-01

    Vertical integration has been a central feature of health care delivery system change for more than two decades. Recent studies have demonstrated that vertically integrated health care systems raise prices and costs without observable improvements in quality, despite many theoretical reasons why cost control and improved quality might occur. Less well studied is how physicians view their newfound partnerships with hospitals. In this article I review literature findings and other observations on five aspects of vertical integration that affect physicians in their professional and personal lives: patients' access to physicians, physician compensation, autonomy versus system support, medical professionalism and culture, and lifestyle. I conclude that the movement toward physicians' alignment with and employment in vertically integrated systems seems inexorable but that policy should not promote such integration either intentionally or inadvertently. Instead, policy should address the flaws in current payment approaches that reward high prices and excessive service use-outcomes that vertical integration currently produces. Project HOPE—The People-to-People Health Foundation, Inc.

  4. Physician’ entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

    Science.gov (United States)

    2014-01-01

    Background Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. Methods For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics. Results We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians’ groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic. Conclusions These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are ‘glued’ to the central medical logic. PMID:24885912

  5. Physician characteristics and prescribing for elderly people in New Brunswick: relation to patient outcomes.

    OpenAIRE

    Davidson, W; Molloy, D W; Bédard, M

    1995-01-01

    OBJECTIVE: To examine the relation between physician characteristics, prescribing behaviour and patient outcomes. DESIGN: Descriptive study linking four provincial databases. SETTING: New Brunswick. PARTICIPANTS: All 366 general practitioners (GPs) (accounting for 40% of all physicians with a general licence in New Brunswick) who ordered at least 200 prescriptions for elderly beneficiaries of the New Brunswick Prescription Drug Program and saw at least 20 elderly patients in an office setting...

  6. Hospital administrator's perspectives regarding the health care industry.

    Science.gov (United States)

    McDermott, D R; Little, M W

    1988-01-01

    Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies

  7. Understanding a Nonlinear Causal Relationship Between Rewards and Physicians' Contributions in Online Health Care Communities: Longitudinal Study.

    Science.gov (United States)

    Wang, Jying-Nan; Chiu, Ya-Ling; Yu, Haiyan; Hsu, Yuan-Teng

    2017-12-21

    The online health care community is not just a place for the public to share physician reviews or medical knowledge, but also a physician-patient communication platform. The medical resources of developing countries are relatively inadequate, and the online health care community is a potential solution to alleviate the phenomenon of long hospital queues and the lack of medical resources in rural areas. However, the success of the online health care community depends on online contributions by physicians. The aim of this study is to examine the effect of incentive mechanisms on physician's online contribution behavior in the online health community. We addressed the following questions: (1) from which specialty area are physicians more likely to participate in online health care community activities, (2) what are the factors affecting physician online contributions, and (3) do incentive mechanisms, including psychological and material rewards, result in differences of physician online contributions? We designed a longitudinal study involving a data sample in three waves. All data were collected from the Good Doctor website, which is the largest online health care community in China. We first used descriptive statistics to investigate the physician online contribution behavior in its entirety. Then multiple linear and quadratic regression models were applied to verify the causal relationship between rewards and physician online contribution. Our sample included 40,300 physicians from 3607 different hospitals, 10 different major specialty areas, and 31 different provinces or municipalities. Based on the multiple quadratic regression model, we found that the coefficients of the control variables, past physician online contributions, doctor review rating, clinic title, hospital level, and city level, were .415, .189, -.099, -.106, and -.143, respectively. For the psychological (or material) rewards, the standardized coefficient of the main effect was 0.261 (or 0

  8. Dinosaurs, Hospital Ecosystems, and the Future of Family Medicine

    Science.gov (United States)

    Glazner, Cherie

    2008-01-01

    The continued presence of the family physician within hospital systems is key to family medicine remaining an attractive, viable specialty in the ever-evolving world of medicine. One physician muses about her place in this complex ecosystem and believes that family physicians lose their voice and thus risk their own extinction when they opt out of hospital practice. PMID:18626038

  9. Hospital law: the changing scene.

    Science.gov (United States)

    Hirsh, H L

    1978-01-01

    The liability of hospitals in tort law has been a fairly recent development. Formerly, hospitals were protected from liability under the doctrine of charitable immunity. Legal "immunity" avoids liability in tort essentially under all circumstances. It is conferred not because of the particular facts of the situation but because of the status or position of the favored defendant. It does not deny the tort, merely the resulting liability. Such immunity does not mean that conduct that would amount to a tort on the part of other defendants is not still equally tortious in character, but merely that for the protection of the particular defendant, or of the interests which he represents, he is given absolution from liability. Similarly, the "captain-of-the-ship" and the attendant "borrowed or lent servant" doctrine is being abandoned. As medical technology continues to advance, the modern hospital will undoubtedly assume a greater responsibility toward its patients--with amplified medical-legal implications. The hospital is no longer a hotel where patients stay, awaiting treatment by their private physicians. The theory that the hospital does not act through its employees--physicians, nurses, and others--no longer reflects the trend in judicial philosophy. The decisions cited reflect the current trend in judicial analysis and thinking. Medical science has provided numerous benefits to humankind, but along with those benefits, numerous risks have accrued. Whether hospitals should have to bear the responsibilities inherent in such risks is a much-argued matter. However, hospital liability, in fact, is the trend of our judicial determination. The ramifications of this trend have been many. Hospitals and physicians will closely scrutinize surgical operations and other hospitals procedures and practices. The fact remains clear that responsibility for every patient is now shared by both the physicians and the hospital--share and share alike. The present thinking is that the

  10. Financial Ties Between Emergency Physicians and Industry: Insights From Open Payments Data.

    Science.gov (United States)

    Fleischman, William; Ross, Joseph S; Melnick, Edward R; Newman, David H; Venkatesh, Arjun K

    2016-08-01

    The Open Payments program requires reporting of payments by medical product companies to teaching hospitals and licensed physicians. We seek to describe nonresearch, nonroyalty payments made to emergency physicians in the United States. We performed a descriptive analysis of the most recent Open Payments data released to the public by the Centers for Medicare & Medicaid Services covering the 2014 calendar year. We calculated the median payment, the total pay per physician, the types of payments, and the drugs and devices associated with payments to emergency physicians. For context, we also calculated total pay per physician and the percentage of active physicians receiving payments for all specialties. There were 46,405 payments totaling $10,693,310 to 12,883 emergency physicians, representing 30% of active emergency physicians in 2013. The percentage of active physicians within a specialty who received a payment ranged from 14.6% in preventive medicine to 91% in orthopedic surgery. The median payment and median total pay to emergency physicians were $16 (interquartile range $12 to $68) and $44 (interquartile range $16 to $123), respectively. The majority of payments (83%) were less than $100. Food and beverage (86%) was the most frequent type of payment. The most common products associated with payments to emergency physicians were rivaroxaban, apixaban, ticagrelor, ceftaroline, canagliflozin, dabigatran, and alteplase. Nearly a third of emergency physicians received nonresearch, nonroyalty payments from industry in 2014. Most payments were of small monetary value and for activities related to the marketing of antithrombotic drugs. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  11. Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

    Science.gov (United States)

    Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

    2017-05-01

    To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

  12. Hospital responses to pay-for-performance incentives.

    Science.gov (United States)

    Reiter, Kristin L; Nahra, Tammie A; Alexander, Jeffrey A; Wheeler, John R C

    2006-05-01

    Not-for-profit hospitals are complex organizations and, therefore, may face unique challenges in responding to financial incentives for quality. In this research, we explore the types of behavioural changes made by not-for-profit Michigan hospitals in response to a pay-for-performance system for quality. We also identify factors that motivate or facilitate changes in effort. We apply a conceptual framework based on agency theory to motivate our research questions. Using data derived from structured interviews and surveys administered to 86 hospitals participating in a pay-for-performance system, we compare hospitals reporting and not reporting behavioural changes. Separate analyses are performed for hospitals reporting structure-related changes and hospitals reporting process-related changes. Our findings confirm that hospitals respond to incentive payments; however, our findings also reveal that hospital responses are not universal. Rather, involvement by boards of trustees, willingness to exert leverage with physicians, and financial and competitive motivations are all associated with hospitals' behavioural responses to incentives. Results of this research will help inform payers and hospital managers considering the use of incentives about the nature of hospitals' responses.

  13. Education and training circumstances of radiology for residents in qualified hospitals

    International Nuclear Information System (INIS)

    Imamura, Keiko; Nakajima, Yasuo; Kiba, Ritsuko; Mizunuma, Kimiyoshi; Ida, Masahiro; Kawabuchi, Koichi

    2005-01-01

    This report is a summary of investigations on the title from the aspect of human resources. Data were collected from databases of websites of Residency Electronic Information System, www.reisjp.org, and Foundation for Promotion of Medical training, www.pmet.org.jp, and from Hospital List (February, 2003) where Japanese radiology physicians were actually working. Investigations were performed on: qualification criteria of hospitals for training, their bed number, number of residents to be admitted, number of physicians and supervising doctors, presence/absence of independent radiology department, number of physicians, supervising doctors and expert physicians in the department. The number rate of physicians in the department is identified to be 64.7% and 84.3% of general and university hospitals, respectively; number of residents to be admitted per one supervisor in the university hospitals is 1.5-2.6 times as high as that in general hospitals; and about 1/4 of residents to be admitted may be in circumstances poor for radiology training. (author)

  14. Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo

    2012-05-01

    Full Text Available Abstract Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR and nurse-to-bed ratio (NBR were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds and high NBR (≥77.0 nurses per 100 beds was significantly lower than that in the group with low PBR ( Conclusions Well-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.

  15. Staffing for infectious diseases, clinical microbiology and infection control in hospitals in 2015: results of an ESCMID member survey.

    Science.gov (United States)

    Dickstein, Y; Nir-Paz, R; Pulcini, C; Cookson, B; Beović, B; Tacconelli, E; Nathwani, D; Vatcheva-Dobrevska, R; Rodríguez-Baño, J; Hell, M; Saenz, H; Leibovici, L; Paul, M

    2016-09-01

    We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internet-based survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physician-bed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56-2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring device-related or surgical site infections), the ratio was 1.21 (interquartile range 0.57-2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  16. Physician Leadership: A Central Strategy to Transforming Healthcare.

    Science.gov (United States)

    Oostra, Randall D

    2016-01-01

    As the role of the physician leader becomes increasingly important in the transformation of healthcare, how hospitals, health systems, and other healthcare organizations define that role is undergoing radical change. Traditional physician leadership roles no longer are effective, and the independent medical staff approach is changing to a collaborative, team-oriented model. The dyad relationship between physician leaders and operational leaders is shifting from a rigid, siloed set of responsibilities to a model characterized by a distributed, situational framework of accountabilities, and the scope of influence of the physician leader and operational leader fluctuates depending on the situation and individuals involved. In addition, the focus of the physician leader is moving to one founded in servant leadership, with an increased emphasis on creating supportive models to enhance physicians' success and place them in the roles of leader and integrator of health.

  17. The strategic management of organizational knowledge exchange related to hospital quality measurement and reporting.

    Science.gov (United States)

    Rangachari, Pavani

    2008-01-01

    CONTEXT/PURPOSE: With the growing momentum toward hospital quality measurement and reporting by public and private health care payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding accuracy. This study explores the relationship between the organizational knowledge-sharing structure related to quality and hospital coding accuracy for quality measurement. Simultaneously, this study seeks to identify other leadership/management characteristics associated with coding for quality measurement. Drawing upon complexity theory, the literature on "professional complex systems" has put forth various strategies for managing change and turnaround in professional organizations. In so doing, it has emphasized the importance of knowledge creation and organizational learning through interdisciplinary networks. This study integrates complexity, network structure, and "subgoals" theories to develop a framework for knowledge-sharing network effectiveness in professional complex systems. This framework is used to design an exploratory and comparative research study. The sample consists of 4 hospitals, 2 showing "good coding" accuracy for quality measurement and 2 showing "poor coding" accuracy. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. Findings of this study indicate that good coding performance is systematically associated with a knowledge-sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment), rather than in density (where everyone is directly connected to everyone else). It also implies that for the hospital organization to adapt to the changing environment of quality transparency, senior leaders must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and

  18. Factors that trigger emergency physicians to contact a poison centre: findings from a Swiss study.

    Science.gov (United States)

    Schurter, David; Rauber-Lüthy, Christine; Jahns, Maximilian; Haberkern, Monika; Kupferschmidt, Hugo; Exadaktylos, Aristomenis; Eriksson, Urs; Ceschi, Alessandro

    2014-03-01

    Poison centres offer rapid and comprehensive support for emergency physicians managing poisoned patients. This study investigates institutional, case-specific and poisoning-specific factors which influence the decision of emergency physicians to contact a poison centre. Retrospective, consecutive review of all poisoning-related admissions to the emergency departments (EDs) of a primary care hospital and a university hospital-based tertiary referral centre during 2007. Corresponding poison centre consultations were extracted from the poison centre database. Data were matched and analysed by logistic regression and generalised linear mixed models. 545 poisonings were treated in the participating EDs (350 (64.2%) in the tertiary care centre, 195 (35.8%) in the primary care hospital). The poison centre was consulted in 62 (11.4%) cases (38 (61.3%) by the tertiary care centre and 24 (38.7%) by the primary care hospital). Factors significantly associated with poison centre consultation included gender (female vs male) (OR 2.99; 95% CI 1.69 to 5.29; p1 vs 1) (OR 2.84; 95% CI 1.65 to 4.9; ppoison centre consultation. Poison centre consultation was significantly higher during the week, and significantly less during night shifts. The poison centre was consulted significantly more when patients were admitted to intensive care units (OR 5.81; 95% CI 3.25 to 10.37; ppoison centre consultation by emergency physicians. It appears that intensive care unit admission and other factors reflecting either complexity or uncertainty of the clinical situation are the strongest predictors for poison centre consultation. Hospital size did not influence referral behaviour.

  19. Motorcycle-related hospitalizations of the elderly.

    Science.gov (United States)

    Hsieh, Ching-Hua; Liu, Hang-Tsung; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun; Chen, Yi-Chun

    2017-04-01

    To investigate the injury pattern, mechanisms, severity, and mortality of the elderly hospitalized for treatment of trauma following motorcycle accidents. Motorcycle-related hospitalization of 994 elderly and 5078 adult patients from the 16,548 hospitalized patients registered in the Trauma Registry System between January 1, 2009 and December 31, 2013. The motorcycle-related elderly trauma patients had higher injury severity, less favorable outcomes, higher proportion of patients admitted to the intensive care unit (ICU), prolonged hospital and ICU stays and higher mortality than those adult motorcycle riders. It also revealed that a significant percentage of elderly motorcycle riders do not wear a helmet. Compared to patients who had worn a helmet, patients who had not worn a helmet had a lower first Glasgow Coma Scale (GCS) score, and a greater percentage presented with unconscious status (GCS score ≤8), had sustained subdural hematoma, subarachnoid hemorrhage, cerebral contusion, severe injury (injury severity score 16-24 and ≥25), had longer hospital stay and higher mortality, and had required admission to the ICU. Elderly motorcycle riders tend to present with a higher injury severity, worse outcome, and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury. Copyright © 2017 Chang Gung University. Published by Elsevier B.V. All rights reserved.

  20. The role of public relations activities in hospital choice.

    Science.gov (United States)

    Tengilimoglu, Dilaver; Yesiltas, Mehmet; Kisa, Adnan; Dziegielewski, Sophia F

    2007-01-01

    Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities.

  1. Physician-patient communication in HIV disease: the importance of patient, physician, and visit characteristics.

    Science.gov (United States)

    Wilson, I B; Kaplan, S

    2000-12-15

    Although previous work that considered a variety of chronic conditions has shown that higher quality physician-patient communication care is related to better health outcomes, the quality of physician-patient communication itself for patients with HIV disease has not been well studied. To determine the relationship of patient, visit, physician, and physician practice characteristics to two measures of physician-patient communication for patients with HIV disease. Cross-sectional survey of physicians and patients. Cohort study enrolling patients from throughout eastern Massachusetts. 264 patients with HIV disease and their their primary HIV physicians (n = 69). Two measures of physician-patient communication were used, a five-item general communication measure (Cronbach's alpha = 0.93), and a four-item HIV-specific communication measure that included items about alcohol, drug use, and sexual behaviors (Cronbach's alpha = 0.92). The mean age of patients was 39. 5 years, 24% patients were women, 31.1% were nonwhite, and 52% indicated same-sex contact as their principal HIV risk factor. The mean age of physicians was 39.1 years, 33.3% were female, 39.7% were specialists, and 25.0% self-identified as gay, lesbian, or bisexual. In multivariable models relating patient and visit characteristics to general communication, longer reported visit length (pbetter communication. The interaction of patient gender and visit length was also significant (p =.02); longer visit length was more strongly associated with better general communication for male than female patients. In similar models relating patient and visit characteristics to HIV-specific communication, longer visit length (p better communication. In multivariable models relating physician and practice characteristics to general communication no variables were significant. However, both female physician gender (p =.002) and gay/lesbian/bisexual sexual preference (p =.003) were significantly associated with better HIV

  2. Physician training rotations in a large urban health department.

    Science.gov (United States)

    Alkon, Ellen; Kim-Farley, Robert; Gunzenhauser, Jeffrey

    2014-01-01

    Hospitals are the normal setting for physician residency training within the United States. When a hospital cannot provide the specific training needed, a special rotation for that experience is arranged. Linkages between clinical and public health systems are vital to achieving improvements in overall health status in the United States. Nevertheless, most physicians in postgraduate residency programs receive neither training nor practical experience in the practice of public health. For many years, public health rotations have been available within the Los Angeles County Department of Public Health (and its antecedent organizations). Arrangements that existed with local medical schools for residents to rotate with Los Angeles County Department of Health hospitals were extended to include a public health rotation. A general model for the rotation ensured that each resident received education and training relevant to the clinician in practice. Some parts of the model for experience have changed over time while others have not. Also, the challenges and opportunities for both trainees and preceptors have evolved and varied over time. A logic model demonstrates the components and changes with the public health rotation. Changes included alterations in recruitment, expectations, evaluation, formal education, and concepts related to the experience. Changes in the rotation model occurred in the context of other major environmental changes such as new electronic technology, changing expectations for residents, and evolving health services and public health systems. Each impacted the public health rotation. The evaluation method developed included content tests, assessment of competencies by residents and preceptors, and satisfaction measures. Results from the evaluation showed increases in competency and a high level of satisfaction after a public health rotation. The article includes examples of challenges and benefits to a local health department in providing a public

  3. Should physicians have facial piercings?

    Science.gov (United States)

    Newman, Alison W; Wright, Seth W; Wrenn, Keith D; Bernard, Aline

    2005-03-01

    The objective of this study was to assess attitudes of patrons and medical school faculty about physicians with nontraditional facial piercings. We also examined whether a piercing affected the perceived competency and trustworthiness of physicians. Survey. Teaching hospital in the southeastern United States. Emergency department patrons and medical school faculty physicians. First, patrons were shown photographs of models with a nontraditional piercing and asked about the appropriateness for a physician or medical student. In the second phase, patrons blinded to the purpose of the study were shown identical photographs of physician models with or without piercings and asked about competency and trustworthiness. The third phase was an assessment of attitudes of faculty regarding piercings. Nose and lip piercings were felt to be appropriate for a physician by 24% and 22% of patrons, respectively. Perceived competency and trustworthiness of models with these types of piercings were also negatively affected. An earring in a male was felt to be appropriate by 35% of patrons, but an earring on male models did not negatively affect perceived competency or trustworthiness. Nose and eyebrow piercings were felt to be appropriate by only 7% and 5% of faculty physicians and working with a physician or student with a nose or eyebrow piercing would bother 58% and 59% of faculty, respectively. An ear piercing in a male was felt to be appropriate by 20% of faculty, and 25% stated it would bother them to work with a male physician or student with an ear piercing. Many patrons and physicians feel that some types of nontraditional piercings are inappropriate attire for physicians, and some piercings negatively affect perceived competency and trustworthiness. Health care providers should understand that attire may affect a patient's opinion about their abilities and possibly erode confidence in them as a clinician.

  4. Physician Acceptance of Gateway to Care at Irwin Army Community Hospital

    Science.gov (United States)

    1992-07-27

    frontier cavalry post once commanded by General George Armstrong Custer. Today it is the home of almost 20,000 soldiers of the Big Red One, First Infantry...especially important for the future. Physicians, as key "players" in healthcare organizations, are also key to the success of Gateway to Care. Kotler and...research (3rd ed.). New York: Holt. Physician Acceptance 32 Kotler , P., & Clarke, R. (1987). Marketing for health care organizations. Englewood Cliffs

  5. Treating a physician patient with psychosis.

    Science.gov (United States)

    Freedman, Jacob L; Crow, Fredrick F; Gutheil, Thomas G; Sanchez, Luis T; Suzuki, Joji

    2012-06-01

    The authors present a case of a psychotic female patient who is a former graduate of a locally prestigious medical school and has subsequently been diagnosed with schizophrenia. The patient entered treatment in an outpatient clinic following discharge from her 11th hospitalization. This hospitalization was initiated after the patient's physician friend had called the police and notified them that the patient was significantly disorganized to warrant further evaluation. Treatment was characterized by significant transference and counter-transference reactions amongst her clinicians - both treatment-promoting and treatment-interfering - based on her status as a physician. The problem of insight was a significant hurdle in the treatment of the patient as her medical knowledge of mental illness was substantially greater than her insight into her own mental illness. Throughout treatment, a number of medical-legal and ethical issues arose. Initially, the question was raised as to the legality of the actions by the patient's friend-having made a clinical assessment without having a clinical role in the patient's care. As the patient's clinical status improved and she sought to re-enter the medical field as a resident, new medical legal issues surfaced. What were the roles of the patient's treaters in maintaining confidentiality and simultaneously ensuring the safety of patients that the psychotic physician might care for? This case highlights the universality of psychiatric vulnerability. Insight in psychosis as well as the transference and counter-transference issues involved in caring for a psychotic physician are discussed. Additionally, a thorough medical-legal discussion addresses the various complexities of caring for a psychotic physician. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. [Scientific publications: a resource for the physician's intellectual development].

    Science.gov (United States)

    Zárate, Arturo

    2013-01-01

    The physician's professional life involves reading and analysis of scientific journals, regardless of the specialization field. The hospital and academic areas lead to the scientific-literary activity development. The aim of this editorial is to make some reflections about the way a physician reaches intellectual development, through the creation of a culture of writing and reading scientific publications.

  7. A Model for Physician Leadership Development and Succession Planning.

    Science.gov (United States)

    Dubinsky, Isser; Feerasta, Nadia; Lash, Rick

    2015-01-01

    Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.

  8. What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians.

    Science.gov (United States)

    Pasman, H Roeline W; Willems, Dick L; Onwuteaka-Philipsen, Bregje D

    2013-09-01

    Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused. In-depth interviews with nine patients whose EAS request was refused and seven physicians of these patients, and with three relatives of patients who had died after a request was refused and four physicians of these patients. Interviews were conducted at least 6 months after the refusal. A wish to die remained in all patients after refusal, although it sometimes diminished. In most cases patient and physician stopped discussing this wish, and none of the physicians had discussed plans for the future with the patient or evaluated the patient's situation after their refusal. Physicians were aware of patients' continued wish to die. Patients who are refused EAS may subsequently be silent about a wish to die without abandoning it. Open communication about wishes to die is important, even outside the context of EAS, because if people feel unable to talk about them, their quality of life may be further diminished. Follow up appointments after refusal could give patients the opportunity to discuss their feelings and physicians to support them. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. Medical work Assessment in German hospitals: a Real-time Observation study (MAGRO – the study protocol

    Directory of Open Access Journals (Sweden)

    Mache Stefanie

    2009-06-01

    Full Text Available Abstract Background The increasing economic pressure characterizes the current situation in health care and the need to justify medical decisions and organizational processes due to limited financial resources is omnipresent. Physicians tend to interpret this development as a decimation of their own medical influence. This becomes even more obvious after a change in hospital ownership i.e. from a public to a private profit oriented organization. In this case each work procedure is revised. To date, most research studies have focused mainly on differences between hospitals of different ownership regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Little attention has been devoted to the effects of hospital ownership on physicians' working routines. The aim of this observational real time study is to deliver exact data about physicians' work at hospitals of different ownership. Methods The consequences of different management types on the organizational structures of the physicians' work situation and on job satisfaction in the ward situation are monitored by objective real time studies and multi-level psycho diagnostic measurements. Discussion This study is unique in its focus. To date no results have been found for computer-based real time studies on work activity in the clinical field in order to objectively evaluate a physician's work-related stress. After a complete documentation of the physicians' work processes the daily work flow can be estimated and systematically optimized. This can stimulate an overall improvement of health care services in Germany.

  10. Workplace violence against physicians in Turkey’s emergency departments: a cross-sectional survey

    Science.gov (United States)

    Bayram, Başak; Çetin, Murat; Çolak Oray, Neşe; Can, İsmail Özgür

    2017-01-01

    Objective We aimed to determine the prevalence of violence directed at emergency department (ED) physicians in Turkey and confirm the factors influencing such violence. Design Cross-sectional survey study. Setting Country of Turkey. Participants Physicians currently practising in EDs in Turkey. Main outcome measures The prevalence of violence directed at physicians and factors that may influence it, such as physicians’ personal characteristics, ED characteristics and physicians’ opinions regarding the causes of and suggested methods of preventing violence. Results A total of 713 physicians participated. Of these, 78.1% reported being subjected to violence in the past year and 65.9% reported more than one such incident. Being subjected to violence was related to age (p=0.008), working in an ED with a high patient admission rate (p=0.018), current position (pviolence. The present safety precautions against violence do not appear to influence the prevalence of violence. Conclusions Our results indicated that ED physicians’ experience of violence is related to personal characteristics such as age and level of expertise, and hospital and ED characteristics such as high patient admission rates. Presently, no measures taken to reduce this violence have been proven effective. PMID:28663323

  11. [Compatibility of Work and Family Life: Survey of Physicians in the Munich Metropolitan Area].

    Science.gov (United States)

    Lauchart, Meike; Ascher, Philipp; Kesel, Karin; Weber, Sabine; Grabein, Beatrice; Schneeweiss, Bertram; Fischer-Truestedt, Cordula; Schoenberg, Michael; Rogler, Gudrun; Borelli, Claudia

    2017-05-15

    Aim Investigation of the compatibility of work and family life for physicians in the Munich metropolitan area. Methods Survey of a representative sample of 1,800 physicians using a questionnaire. Results Men were less satisfied (7% very satisfied vs. 21%) with compatibility between work and family life than women. The group least satisfied overall was hospital-based physicians (p=0.000, chi-square=122.75). Women rather than men cut back their career due to children, perceived their professional advancement as impaired, desisted from establishing private practice or quit hospital employment altogether. Respondents strove for flexible childcare and makeshift solution if the established service failed. Most did not have that at their disposal. Hospital-based physicians wished for predictable working hours, and would like to have a say in the structure of their schedule. For the majority this was not the case. While for 80% it would be important to participate in the definition of their working hours, this was only possible in 17%. 86% found the opportunity to work part-time important, but many doctors (more than 30%) did not have that option. The biggest help for office-based physicians would be an expedited procedure by the Bavarian Association of Statutory Health Insurance Physicians (KVB) when applying for a proxy. The second most important would be the ability to hand over on-call duties. 36% of respondents felt that compatibility of work and family life was best achieved outside of patient care, during residency 42% believed this to be the case. Only 6% of physicians felt the best compatibility to be achieved in a hospital. Among the physician owners of practices, 34% considered their model to be the best way to reconcile both aspects of life. Conclusion More flexible options for childcare and more influence on the definition of working hours are necessary in order to better reconcile work and family life. For office-based physicians it must be made easier to

  12. Orthopedic specialty hospitals: centers of excellence or greed machines?

    Science.gov (United States)

    Badlani, Neil; Boden, Scott; Phillips, Frank

    2012-03-07

    Orthopedic specialty hospitals have recently been the subject of debate. They are patient-centered, physician-friendly health care alternatives that take advantage of the economic efficiencies of specialization. Medically, they provide a higher quality of care and increase patient and physician satisfaction. Economically, they are more efficient and profitable than general hospitals. They also positively affect society through the taxes they pay and the beneficial aspects of the competition they provide to general hospitals. Their ability to provide a disruptive innovation to the existing hospital industry will lead to lower costs and greater access to health care. However, critics say that physician ownership presents potential conflicts of interest and leads to overuse of medical care. Some general hospitals are suffering as a result of unfair specialty hospital practices, and a few drastic medical complications have occurred at specialty hospitals. Specialty hospitals have been scrutinized for increasing the inequality of health care and continue to be a target of government regulations. In this article, the pros and cons are examined, and the Emory Orthopaedics and Spine Hospital is analyzed as an example. Orthopedic specialty hospitals provide excellent care and are great assets to society. Competition between specialty and general hospitals has provided added value to patients and taxpayers. However, physicians must take more responsibility in their appropriate and ethical leadership. It is critical to recognize financial conflicts of interest, disclose ownership, and act ethically. Patient care cannot be compromised. With thoughtful and efficient leadership, specialty hospitals can be an integral part of improving health care in the long term. Copyright 2012, SLACK Incorporated.

  13. Consolidation of medical groups into physician practice management organizations.

    Science.gov (United States)

    Robinson, J C

    1998-01-14

    Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality

  14. [Job satisfaction of hospital doctors. Results of a study of a national sample of hospital doctors in Germany].

    Science.gov (United States)

    Rosta, J; Gerber, A

    2008-01-01

    This paper presents the findings on the level of job satisfaction among hospital physicians in Germany and puts the results into relation to demographic variables and employment status. Data were collected as part of the survey "Work Life, Lifestyle and Health among Hospital Doctors in Germany 2006" using anonymous self-reporting questionnaires. Job satisfaction was scored using the scale according to Warr et al. It consists of 10 items with a seven-point Likert scale (1=dissatisfaction; 7=satisfaction), so the sum score ranks between 10 and 70. The following variables were correlated to job satisfaction: demographic variables (gender, age), and employment status (specialty, geographical localisation of hospital, hospital type, level of seniority, working time pattern). The response rate was 58% (n=1917). Doctors reported an average job satisfaction of 44.3. Comparing different specialties, physicians in radiology had the highest (47.6) and in surgery (43.0) the lowest level of job satisfaction. Below-average job satisfaction could also be found in urology (43.5) and internal medicine (43.7). The regression analysis showed that the younger age group (B=-1.45; p=0.031) and those with a status as junior physician (B=-4.97; p=0.0001) were significantly dissatisfied. Out of the ten items assessed "working hours" (3.25), "payment" (3.59), "physical working conditions" (3.96) and "recognition for good work" (4.08) attained the lowest ratings. Hospital doctors in Germany are moderately satisfied with their jobs - less satisfied than their colleagues in England, New Zealand and Norway. Improvement of job satisfaction and working conditions should be achieved via effective regulation of working hours and improvement of recognition for medical work regarding monetary and non-monetary factors such as payment and positive feedback for good work.

  15. Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals.

    Science.gov (United States)

    Kanai-Pak, Masako; Aiken, Linda H; Sloane, Douglas M; Poghosyan, Lusine

    2008-12-01

    To describe nurse burnout, job dissatisfaction and quality of care in Japanese hospitals and to determine how these outcomes are associated with work environment factors. Nurse burnout and job dissatisfaction are associated with poor nurse retention and uneven quality of care in other countries but comprehensive data have been lacking on Japan. Cross-sectional survey of 5956 staff nurses on 302 units in 19 acute hospitals in Japan. Nurses were provided information about years of experience, completed the Maslach Burnout Inventory and reported on resource adequacy and working relations with doctors using the Nursing Work Index-Revised. Fifty-six per cent of nurses scored high on burnout, 60% were dissatisfied with their jobs and 59% ranked quality of care as only fair or poor. About one-third had fewer than four years of experience and more than two-thirds had less than 10. Only one in five nurses reported there were enough registered nurses to provide quality care and more than half reported that teamwork between nurses and physicians was lacking. The odds on high burnout, job dissatisfaction and poor-fair quality of care were twice as high in hospitals with 50% inexperienced nurses than with 20% inexperienced nurses and 40% higher in hospitals where nurses had less satisfactory relations with physicians. Nurses in poorly staffed hospitals were 50% more likely to exhibit burnout, twice as likely to be dissatisfied and 75% more likely to report poor or fair quality care than nurses in better staffed hospitals. Improved nurse staffing and working relationships with physicians may reduce nurse burnout, job dissatisfaction and low nurse-assessed quality of care. Staff nurses should engage supervisors and medical staff in discussions about retaining more experienced nurses at the bedside, implementing strategies to enhance clinical staffing and identifying ways to improve nurse-physician working relations.

  16. Patient-Physician Communicative Patterns, Physicians’ Job Satisfaction, and Patients’ Satisfaction: The Case of a Hospital in Isfahan

    Directory of Open Access Journals (Sweden)

    Maryam Yaghoubi

    2014-04-01

    Full Text Available Abstract Background and purpose:Now-a-days, patient satisfaction is increasingly receiving the attention of health-service providers, which is a necessary step to enhance the quality of health services. The present study aimed at exploring patient-physician communicative patterns, physicians’ job satisfaction, and patients’ satisfaction at Isfahan, Iran. Materials and Methods:This study was a descriptive analytical and cross-sectional survey in the summer of 2010. Simple random sampling was used to select participants. Data were collected through using three self-designed questionnaires on physicians’ job satisfaction, patient-physician relationship patterns (based on Hollander and Szase’ ideas, and patients’ satisfaction. Validity of the questionnaire was checked by a panel of experts. Furthermore, internal consistency reliability of the questionnaires was confirmed by Cronbach’s alpha (α = 0.80. Different dimensions of the job satisfaction questionnaire were salary, supervision, setting, promotion, fringe benefits, and working conditions. Data were analyzed by using SPSS for Windows 13.0 software. Results:The mean score of patient-physician relationship was 63. Therefore, the most frequent patient-physician communication pattern was guidance-cooperation. The mean score of physician’ job satisfaction was 50.2. The mean score of patients’ satisfaction was 86.5. Physicians’ job satisfaction was found to be related to patient-physician communication pattern (P < 0.05. Conclusion:Although patient-physician communication patterns are important, different variable such as patients’ and physicians’ satisfaction influence the patterns. Furthermore, improvement communication process between health care providers can be useful in the increasing patient satisfaction and patient quality of care.

  17. National Survey of Emergency Physicians Concerning Home-Based Care Options as Alternatives to Emergency Department-Based Hospital Admissions.

    Science.gov (United States)

    Stuck, Amy R; Crowley, Christopher; Killeen, James; Castillo, Edward M

    2017-11-01

    Emergency departments (EDs) in the United States play a prominent role in hospital admissions, especially for the growing population of older adults. Home-based care, rather than hospital admission from the ED, provides an important alternative, especially for older adults who have a greater risk of adverse events, such as hospital-acquired infections, falls, and delirium. The objective of the survey was to understand emergency physicians' (EPs) perspectives on home-based care alternatives to hospitalization from the ED. Specific goals included determining how often EPs ordered home-based care, what they perceive as the barriers and motivators for more extensive ordering of home-based care, and the specific conditions and response times most appropriate for such care. A group of 1200 EPs nationwide were e-mailed a six-question survey. Participant response was 57%. Of these, 55% reported ordering home-based care from the ED within the past year as an alternative to hospital admission or observation, with most doing so less than once per month. The most common barrier was an "unsafe or unstable home environment" (73%). Home-based care as a "better setting to care for low-acuity chronic or acute disease exacerbation" was the top motivator (79%). Medical conditions EPs most commonly considered for home-based care were cellulitis, urinary tract infection, diabetes, and community-acquired pneumonia. Results suggest that EPs recognize there is a benefit to providing home-based care as an alternative to hospitalization, provided they felt the home was safe and a process was in place for dispositioning the patient to this setting. Better understanding of when and why EPs use home-based care pathways from the ED may provide suggestions for ways to promote wider adoption. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  18. Scale and structure of capitated physician organizations in California.

    Science.gov (United States)

    Rosenthal, M B; Frank, R G; Buchanan, J L; Epstein, A M

    2001-01-01

    Physician organizations in California broke new ground in the 1980s by accepting capitated contracts and taking on utilization management functions. In this paper we present new data that document the scale, structure, and vertical affiliations of physician organizations that accept capitation in California. We provide information on capitated enrollment, the share of revenue derived by physician organizations from capitation contracts, and the scope of risk sharing with health maintenance organizations (HMOs). Capitation contracts and risk sharing dominate payment arrangements with HMOs. Physician organizations appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures, and consolidating into larger entities.

  19. Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians

    Directory of Open Access Journals (Sweden)

    Vanessa Schultz

    2013-07-01

    Full Text Available Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018. Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006. Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019. Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024. Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013. When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015, whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054. Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.

  20. Managers' perceptions of the manager role in relation to physicians: a qualitative interview study of the top managers in Swedish healthcare.

    Science.gov (United States)

    von Knorring, Mia; de Rijk, Angelique; Alexanderson, Kristina

    2010-09-17

    This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs) in Sweden were subjected to qualitative analysis. The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1) they have high status and expertise; 2) they lack knowledge of the system; 3) they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others) in relation to the physician role. Further research is needed to elucidate how managers in healthcare organisations assume the manager role in relation to the medical

  1. HSIP Hospitals in New Mexico

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — Hospitals in New Mexico The term "hospital" ... means an institution which- (1) is primarily engaged in providing, by or under the supervision of physicians, to...

  2. National Ambulatory Medical Care Survey: terrorism preparedness among office-based physicians, United States, 2003-2004.

    Science.gov (United States)

    Niska, Richard W; Burt, Catharine W

    2007-07-24

    This investigation describes terrorism preparedness among U.S. office-based physicians and their staffs in identification and diagnosis of terrorism-related conditions, training methods and sources, and assistance with diagnosis and reporting. The National Ambulatory Medical Care Survey (NAMCS) is an annual national probability survey of approximately 3,000 U.S. nonfederal, office-based physicians. Terrorism preparedness items were added in 2003 and 2004. About 40 percent of physicians or their staffs received training for anthrax or smallpox, but less than one-third received training for any of the other exposures. About 42.2 percent of physicians, 13.5 percent of nurses, and 9.4 percent of physician assistants and nurse practitioners received training in at least one exposure. Approximately 56.2 percent of physicians indicated that they would contact state or local public health officials for diagnostic assistance more frequently than federal agencies and other sources. About 67.1 percent of physicians indicated that they would report a suspected terrorism-related condition to the state or local health department, 50.9 percent to the Centers for Disease Control and Prevention (CDC), 27.5 percent to the local hospital, and 1.8 percent to a local elected official's office. Approximately 78.8 percent of physicians had contact information for the local health department readily available. About 53.7 percent had reviewed the diseases reportable to health departments since September 2001, 11.3 percent had reviewed them before that month, and 35 percent had never reviewed them.

  3. Pre-hospital advanced airway management by anaesthesiologists: is there still room for improvement?

    Science.gov (United States)

    Sollid, Stephen J M; Heltne, Jon Kenneth; Søreide, Eldar; Lossius, Hans Morten

    2008-07-21

    Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  4. Consensus on the leadership of hospital CEOs and its impact on the participation of clinicians in improvement projects.

    NARCIS (Netherlands)

    Dückers, M.L.A.; Stegeman, I.; Spreeuwenberg, P.; Wagner, C.; Sanders, K.; Groenewegen, P.P.

    2009-01-01

    Objectives: The success of a Dutch program to disseminate quality improvement projects depends on the participation of physicians working in program hospitals. The leadership of hospital executives (CEOs) is considered an important explanation. This study aims to determine whether the relation,

  5. Work-related well-being of South African hospital pharmacists

    Directory of Open Access Journals (Sweden)

    Sebastiaan Rothmann

    2011-06-01

    Research purpose: The objective of this study was to investigate whether job stress and coping strategies could predict the work-related well-being (burnout and work engagement of hospital pharmacists in South Africa. Motivation for the study: Information about the work-related well-being and coping strategies of hospital pharmacists could be used to plan individual and organisational interventions which can be used to retain them and to manage their well-being and performance. Research design, approach and method: A survey design was used. A stratified random sample (N = 187 of pharmacists in South African hospitals was studied. The Maslach Burnout Inventory – Human Services Survey, Utrecht Work Engagement Scale, Pharmacist Stress Inventory and the COPE questionnaire were administered. Main findings: The results showed that job related stress and three coping strategies (approach coping, avoidant coping, and turning to religion predicted burnout and work engagement of South African hospital pharmacists. Practical implications: Job stressors that are in the main responsible for the unfavourable work environment and that lead to the development of burnout amongst hospital pharmacists should be addressed. It is also important to enhance the coping capabilities of the hospital pharmacists. Contribution/value-add: The findings of this study provide insight into the factors impacting on the work-related well-being of hospital pharmacists in South Africa.

  6. Nurses perceptions of the nurse-physician collaboration in relation to medication safety

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

    to medication safety and medication management. Methods: A qualitative design using a semi-structured interview guide. The interviews took place in two focus groups consisting of psychiatric nurses (Group 1 (n= 9) and group 2 (n=8)) from two bedwards in a Danish University Hospital. The interviews were carried......Background: Medication errors continue to challenge patient safety across health sectors, including psychiatry. Nurses are integral safeguards in the medication process and a growing body of research demonstrates that nurse’s ability to ensure medication safety also depend on organizational factors....... Nurses with somatic experience felt reduced in their professional competencies and perceived the hierarchy in the NPR as profoundly explicit compared to somatic care. Access to discussing specific medication problems with a physician could be difficult due to the type of rounds (an example was group care...

  7. Pesticide-Related Hospitalizations Among Children and Teenagers in Texas, 2004-2013.

    Science.gov (United States)

    Trueblood, Amber B; Shipp, Eva; Han, Daikwon; Ross, Jennifer; Cizmas, Leslie H

    2016-01-01

    Acute exposure to pesticides is associated with nausea, headaches, rashes, eye irritation, seizures, and, in severe cases, death. We characterized pesticide-related hospitalizations in Texas among children and teenagers for 2004-2013 to characterize exposures in this population, which is less well understood than pesticide exposure among adults. We abstracted information on pesticide-related hospitalizations from hospitalization data using pesticide-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and E-codes. We calculated the prevalence of pesticide-related hospitalizations among children and teenagers aged #19 years for all hospitalizations, unintentional exposures, intentional exposures, pesticide classifications, and illness severity. We also calculated age- and sex-specific prevalence of pesticide-related hospitalizations among children. The prevalence of pesticide-related hospitalizations among children and teenagers was 2.1 per 100,000 population. The prevalence of pesticide-related hospitalizations per 100,000 population was 2.7 for boys and 1.5 for girls. The age-specific prevalence per 100,000 population was 5.3 for children aged 0-4 years, 0.3 for children and teenagers aged 5-14 years, and 2.3 for teenagers aged 15-19 years. Children aged 0-4 years had the highest prevalence of unintentional exposures, whereas teenagers aged 15-19 years had the highest prevalence of intentional exposures. Commonly reported pesticide categories were organophosphates/carbamates, disinfectants, rodenticides, and other pesticides (e.g., pyrethrins, pyrethroids). Of the 158 pesticide-related hospitalizations, most were coded as having minor (n=86) or moderate (n=40) illness severity. Characterizing the prevalence of pesticide-related hospitalizations among children and teenagers leads to a better understanding of the burden of pesticide exposures, including the type of pesticides used and the severity of potential

  8. Physicians and architects - not an odd couple.

    Science.gov (United States)

    Ohry, Avi

    2013-01-01

    One may think that there is no apparent interface between so different occupations as medicine and architecture. The historical and present-day connections between these academic fields resulted in the creation of healthy environment, housing and hospital. This article also speaks about another meeting point of these professions: physicians who became architects (or amateur-architects) and personal friendships between physicians, scientists, and architects which resulted in fruitful and progressive architectural creations. Both professions may be regard as art and science as well.

  9. Physician use of updated anti-virus software in a tertiary Nigerian ...

    African Journals Online (AJOL)

    While physicians are becoming increasingly dependent on computers and the internet, highly lethal malware continue to be loaded into cyberspace. We sought to assess the proportion of physicians with updated anti-virus software in Jos University Teaching Hospital Nigeria and to determine perceived barriers to getting ...

  10. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    Science.gov (United States)

    2014-08-22

    are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

  11. Supporting cancer patients with work-related problems through an oncological occupational physician: a feasibility study.

    Science.gov (United States)

    Zaman, A C G N M; Bruinvels, D J; de Boer, A G E M; Frings-Dresen, M H W

    2017-09-01

    To evaluate the feasibility of an oncological occupational physician (OOP) who is trained in oncological work-related problems, and in providing work-related support to cancer patients within the curative setting. We assessed facilitators and barriers that affect the activities of an OOP, and the satisfaction of the OOPs and patients with this new form of health care. Interviews were held with (1) OOPs (N = 13) to assess facilitators, barriers and their satisfaction with their ability to give supportive care and (2) cancer patients (N = 8) to assess their satisfaction concerning consulting an OOP. The main facilitators were positive feedback from health care providers and patients about the received care and support that the OOP had given, and the additional knowledge of the OOPs about cancer and work-related problems. Major barriers for being active as an OOP were lack of financial support for the OOP and the unfamiliarity of patients and health care providers with the specialised occupational physician. Both OOPs and the specialised knowledge and additional training of the OOPs facilitated providing support to cancer patients and survivors with work-related problems. Familiarity with the specialised occupational physician and financial support should be improved. © 2015 John Wiley & Sons Ltd.

  12. Does the professional attitude of physicians always affect their professional behaviour? A survey in tertiary hospitals in Nanchang City, China.

    Science.gov (United States)

    Wang, Xuan; Wang, Xuan; Du, Xin; Du, Xin; Liu, Chenxi; Liu, Chenxi; Zhang, Xinping; Zhang, Xinping

    2018-03-23

    Objective Understanding the effect of professional attitude on professional behaviour is conducive to the development of targeted measures to promote professionalism. The aim of the present study was to explore the effect of professional attitude on professional behaviour. Methods Using a self-reported questionnaire, 212 physicians were surveyed using quota sampling in six tertiary hospitals in Nanchang City. The effect of professional attitude on professional behaviour was analysed through logistic regression analysis. Results Providing necessary care regardless of a patient's ability to pay, working on quality improvement initiatives, informing patients of medical errors and reporting incompetent colleagues had significant positive effects on corresponding professional behaviour (odds ratios (95% confidence intervals) 11.06 (3.78, 32.40), 9.42 (1.93, 46.01), 4.04 (1.29, 12.63) and 5.51 (1.26, 24.08) respectively). However, attitudes towards minimising disparities in care, undergoing periodic recertification examinations and reporting medical errors did not significantly affect corresponding professional behaviour. Conclusions Professional attitude affects professional behaviour, but such an effect varies with different professional norms. These findings imply that improving the professional attitude is useful but insufficient to promote medical professionalism. A management system conducive to the conversion of professional attitude to professional behaviour should be established. What is known about the topic? Several studies have affirmed that Chinese physicians accept most areas of medical professionalism embodied in the Charter on Medical Professionalism. However, only a few published studies have examined the effect of professional attitude on professional behaviour. Understanding the effect of professional attitude on professional behaviour is conducive to the development of targeted measures to promote professionalism. The present study attempted to fill

  13. Physician and nursing perceptions concerning interprofessional communication and collaboration.

    Science.gov (United States)

    Matziou, Vasiliki; Vlahioti, Efrosyni; Perdikaris, Pantelis; Matziou, Theodora; Megapanou, Efstathia; Petsios, Konstantinos

    2014-11-01

    The aim of the study was to investigate the physician and nursing perceptions regarding communication and collaboration as well as the factors that may influence these activities. A self-administered questionnaire survey was sent to a random sample of 93 physicians and 197 nurses based in two large public hospitals in Athens, Greece. Descriptive statistics, t-test and chi square test were performed with the SPSS 19.0 statistical package. Years of experience, the size of the clinic, the university degree and the postgraduate studies were found to be significant factors according to nurses' view (p clinic affected the communication and collaboration with the nursing staff significantly (p nurses and physicians do not share the same views concerning the effectiveness of their communication and nurses' role in the decision-making process of the patients' care. The most important barrier for the establishment of good relations between these professions, according to the physicians, was that they did not recognize the nurses' professional role. The study also indicated that the absence of interprofessional collaboration may result in a higher possibility of errors and omissions in patients' care. Therefore, in everyday practice, both nurses and physicians should acknowledge the importance of their effective communication and they should develop and implement interprofessional teamwork interventions to improve collaboration. Moreover, nurses have to constantly consolidate their role in the decision process and patients' care, especially in countries with limited interprofessional collaboration culture. In addition, factors that improve physicians' attitudes toward collaboration and effective communication should be further explored.

  14. Patients' perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals.

    Science.gov (United States)

    Yang, Lianping; Liu, Chaojie; Huang, Cunrui; Mukamel, Dana B

    2018-01-29

    Reducing 30-day hospital readmissions has become a focus of the current national payment policies. Medicare requires that hospitals collect and report patients' experience with their care as a condition of payment. However, the extent to which patients' experience with hospital care is related to hospital readmission is unknown. We established multivariate regression models in which 30-day risk-adjusted readmission rates were the dependent variables and patients' perceptions of the responsiveness of the hospital staff and communication (as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores) were the independent variables of interest. We selected six different clinical conditions for analyses, including acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure, hip/knee surgery, pneumonia, and stroke. Data included all acute care hospitals reporting in Hospital Compare in 2014. The number of hospitals with reported readmissions ranged from 2234 hospitals for AMI to 3758 hospitals for pneumonia. The average 30-day readmission rates ranged from 5.19% for knee/hip surgery to 22.7% for COPD. Patient experience of hospital-staff responsiveness as "top-box" ranged from 64% to 67% across the six clinical conditions, communication with nurses ranged from 77% to 79% and communication with doctors ranged from 80% to 81% (higher numbers are better). Our finding suggests that hospitals with better staff responsiveness were significantly more likely to have lower 30-day readmissions for all conditions. The effect size depended on the baseline readmission rates, with the largest effect on hospitals in the upper 75th quartile. A ten-percentage-point increase in staff responsiveness led to a 0.03-0.18 percentage point decrease in readmission rates. We found that neither communication with physicians nor communication with nurses was significantly associated with hospital readmissions. Our findings

  15. COLLABORATION PRACTICE BETWEEN NURSES AND PHYSICIAN AND THE AFFECTING FACTORS

    Directory of Open Access Journals (Sweden)

    Wiwin Martiningsih

    2017-04-01

    Full Text Available Introduction: Collaboration is basically discuss about togetherness, cooperation, sharing tasks, equality, responsibility, and accountability. Purpose of this research was to learn the collaboration practice beetwen nurses and physician and the factors affecting. Method: Design of this research was correlational and comparational study, and population were the physician who work in Ngudi Waluyo Blitar hospitals, intensive cooperation with the nurse in the room, not holding structural positions and not studying, there are 19 peoples taken by total population and nurses who work in Ngudi Waluyo hospitals, not holding structural positions (Head of Division or Head of Section, having relationship with the physician and the samples were 31 peoples taken by probability proportional to size (PPS. Methods of data collection by giving questionnaire about the characteristics of respondents (nurses and physician and practice of collaboration scale. Data characteristics and attitudes of nurses and physicians about the practice of collaboration is analyzed with descriptive statistics, to know the differences between nurses and physicians attitude using mann whitney u test. To know affecting characteristic with nurses and physician attitude by multivariate analysis. Result: Results of mann whitney test p value is 0.611, which means that there is no difference between nurses and physician attitude in practice collaboration, and result of multivariate analysis the influence of nurse characteristics (age, education, functional potition, length of working with attitude are 0.460 or 46%, while 54% influenced by other factors, and the influence of physician characteristics (age, education, length of working with attitude are 0.435 or 43.5%, while 56.5% influenced by other factors. Discussion: Further need to study other factors that influence and research by observation the impact of collaboration between the nurse with physician on the service quality.

  16. Perceived communication between physicians and breast cancer patients as a predicting factor of patients' health-related quality of life: a longitudinal analysis.

    Science.gov (United States)

    Trudel, Julie G; Leduc, Nicole; Dumont, Serge

    2014-05-01

    Communication between cancer patients and healthcare providers is recognized as an important aspect of these patients' health-related quality of life (HRQOL). Nevertheless, no study has examined whether perceived communication between physicians and breast cancer patients is a determining factor in their HRQOL along the disease's trajectory. This longitudinal study aimed to ascertain whether such communication influenced the HRQOL of such women at three points in time. The sample consisted of 120 French-speaking women with stage I or II breast cancer aged 18 years or over (mean = 55 years) who underwent a lumpectomy with adjuvant treatment. The women filled out questionnaires at three different times: around the time of diagnosis, halfway through radiotherapy and at follow-up. Either at the hospital or at home, they completed demographic and medical data questionnaires, the Medical Outcomes Study-Social Support Survey, an HRQOL questionnaire (EORTC QLQ-C30/BR23) and the Medical Communication Competence Scale. Generalized estimated equations analyses indicated that the women's perceptions of their own communication skills towards physicians had a greater impact on their HRQOL than the women's perception of physicians' communication skills. The women had better global health and better role, emotional, cognitive and sexual functioning as well as fewer side effects and symptoms during radiotherapy and at follow-up when they perceived themselves as competent communicators at diagnosis and during radiotherapy. The results underscore the importance for breast cancer patients of being proactive in information seeking and in the socio-emotional aspect of their relationship with physicians to enhance their HRQOL. Copyright © 2013 John Wiley & Sons, Ltd.

  17. Relationship between physicians' perceived stigma toward depression and physician referral to psycho-oncology services on an oncology/hematology ward.

    Science.gov (United States)

    Kim, Won-Hyoung; Bae, Jae-Nam; Lim, Joohan; Lee, Moon-Hee; Hahm, Bong-Jin; Yi, Hyeon Gyu

    2018-03-01

    This study was performed to identify relationships between physicians' perceived stigma toward depression and psycho-oncology service utilization on an oncology/hematology ward. The study participants were 235 patients in an oncology/hematology ward and 14 physicians undergoing an internal medicine residency training program in Inha University Hospital (Incheon, South Korea). Patients completed the Patient Health Questionnaire-9 (PHQ-9), and residents completed the Perceived Devaluation-Discrimination scale that evaluates perceived stigma toward depression. A total PHQ-9 score of ≥5 was defined as clinically significant depression. Physicians decided on referral on the basis of their opinions and those of their patients. The correlates of physicians' recommendation for referral to psycho-oncology services and real referrals psycho-oncology services were examined. Of the 235 patients, 143 had PHQ-9 determined depression, and of these 143 patients, 61 received psycho-oncology services. Physicians recommended that 87 patients consult psycho-oncology services. Multivariate analyses showed that lower physicians' perceived stigma regarding depression was significantly associated with physicians' recommendation for referral, and that real referral to psycho-oncology services was significantly associated with presence of a hematologic malignancy and lower physicians' perceived stigma toward depression. Physicians' perceived stigma toward depression was found to be associated with real referral to psycho-oncology services and with physician recommendation for referral to psycho-oncology services. Further investigations will be needed to examine how to reduce physicians' perceived stigma toward depression. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Physician-Pharmacist collaboration in a pay for performance healthcare environment.

    Science.gov (United States)

    Farley, T M; Izakovic, M

    2015-01-01

    Healthcare is becoming more complex and costly in both European (Slovak) and American models. Healthcare in the United States (U.S.) is undergoing a particularly dramatic change. Physician and hospital reimbursement are becoming less procedure focused and increasingly outcome focused. Efforts at Mercy Hospital have shown promise in terms of collaborative team based care improving performance on glucose control outcome metrics, linked to reimbursement. Our performance on the Centers for Medicare and Medicaid Services (CMS) post-operative glucose control metric for cardiac surgery patients increased from a 63.6% pass rate to a 95.1% pass rate after implementing interventions involving physician-pharmacist team based care.Having a multidisciplinary team that is able to adapt quickly to changing expectations in the healthcare environment has aided our institution. As healthcare becomes increasingly saturated with technology, data and quality metrics, collaborative efforts resulting in increased quality and physician efficiency are desirable. Multidisciplinary collaboration (including physician-pharmacist collaboration) appears to be a viable route to improved performance in an outcome based healthcare system (Fig. 2, Ref. 12).

  19. How do physicians discuss e-health with patients? the relationship of physicians' e-health beliefs to physician mediation styles.

    Science.gov (United States)

    Fujioka, Yuki; Stewart, Erin

    2013-01-01

    A survey of 104 physicians examined the role of physicians' evaluation of the quality of e-health and beliefs about the influence of patients' use of e-health in how physicians discuss e-health materials with patients. Physicians' lower (poor) evaluation of the quality of e-health content predicted more negative mediation (counter-reinforcement of e-health content). Perceived benefits of patients' e-health use predicted more positive (endorsement of e-health content). Physician's perceived concerns (negative influence) regarding patients' e-health use were not a significant predictor for their mediation styles. Results, challenging the utility of restrictive mediation, suggested reconceptualizing it as redirective mediation in a medical interaction. The study suggested that patient-generated e-health-related inquiries invite physician mediation in medical consultations. Findings and implications are discussed in light of the literature of physician-patient interaction, incorporating the theory of parental mediation of media into a medical context.

  20. Hospital network performance: a survey of hospital stakeholders' perspectives.

    Science.gov (United States)

    Bravi, F; Gibertoni, D; Marcon, A; Sicotte, C; Minvielle, E; Rucci, P; Angelastro, A; Carradori, T; Fantini, M P

    2013-02-01

    Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders' perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders' perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers' rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score>8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review.

    Science.gov (United States)

    Visser, Mieke; Deliens, Luc; Houttekier, Dirk

    2014-11-18

    Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup. Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians' knowledge, physicians' attitudes or physicians' practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported. Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians' attitudes, 24 to physicians' knowledge and 20 to physicians' practice. Stronger evidence was found for physicians' lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient's true condition. We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance

  2. Burnout and satisfaction with work-life balance among US physicians relative to the general US population.

    Science.gov (United States)

    Shanafelt, Tait D; Boone, Sonja; Tan, Litjen; Dyrbye, Lotte N; Sotile, Wayne; Satele, Daniel; West, Colin P; Sloan, Jeff; Oreskovich, Michael R

    2012-10-08

    Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields. We conducted a national study of burnout in a large sample of US physicians from all specialty disciplines using the American Medical Association Physician Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored. Of 27 276 physicians who received an invitation to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burnout. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%) (P < .001 for both). Highest level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Compared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; P < .001), whereas individuals with a bachelor's degree (OR, 0.80; P = .048), master's degree (OR, 0.71; P = .01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P = .04) were at lower risk for burnout. Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk.

  3. The communication atmosphere between physician colleagues: competitive perfectionism or supportive dialogue? A Norwegian study.

    Science.gov (United States)

    Akre, V; Falkum, E; Hoftvedt, B O; Aasland, O G

    1997-02-01

    Open and supportive communication is probably one of the most important promotors of learning, coping and satisfaction at the workplace. The aim of this paper is to describe and predict the communication atmosphere between Norwegian physicians. Twenty statements describing communication, as perceived by the physicians themselves, were presented to a random sample of the members of the Norwegian Medical Association of which more than 90% of the physicians in the country are members (N = 2628). In general, this investigation indicates that the communication atmosphere among Norwegian physicians is characterised by support and mutual respect. More than half of the respondents fully agreed that communication between colleagues in the workplace is marked by solidarity, and that experienced colleagues show respect for the less experienced in both personal and professional matters. Physicians working in hospitals described the communication atmosphere as substantially more selfish and competitive than non-hospital physicians, whilst general practitioners considered the atmosphere between colleagues to be more supportive than non-specialists. In addition, high perceived stress was associated with the perception of a less supportive atmosphere. However, the strongest predictor of the communication atmosphere was clearly the physician's perceived autonomy. The comprehensive retrenchment programmes implemented in Norwegian hospitals during recent years have increased stress and restricted professional autonomy among both physicians and other occupational groups. Our findings indicate that the communication atmosphere necessary to secure continuity of knowledge within the medical profession may have been jeopardised by this process. In the long term, this may prove hazardous to the quality of medical care.

  4. Evaluation of Documentation Patterns of Trainees and Supervising Physicians Using Data Mining.

    Science.gov (United States)

    Madhavan, Ramesh; Tang, Chi; Bhattacharya, Pratik; Delly, Fadi; Basha, Maysaa M

    2014-09-01

    The electronic health record (EHR) includes a rich data set that may offer opportunities for data mining and natural language processing to answer questions about quality of care, key aspects of resident education, or attributes of the residents' learning environment. We used data obtained from the EHR to report on inpatient documentation practices of residents and attending physicians at a large academic medical center. We conducted a retrospective observational study of deidentified patient notes entered over 7 consecutive months by a multispecialty university physician group at an urban hospital. A novel automated data mining technology was used to extract patient note-related variables. A sample of 26 802 consecutive patient notes was analyzed using the data mining and modeling tool Healthcare Smartgrid. Residents entered most of the notes (33%, 8178 of 24 787) between noon and 4 pm and 31% (7718 of 24 787) of notes between 8 am and noon. Attending physicians placed notes about teaching attestations within 24 hours in only 73% (17 843 of 24 443) of the records. Surgical residents were more likely to place notes before noon (P Data related to patient note entry was successfully used to objectively measure current work flow of resident physicians and their supervising faculty, and the findings have implications for physician oversight of residents' clinical work. We were able to demonstrate the utility of a data mining model as an assessment tool in graduate medical education.

  5. Managers' perceptions of the manager role in relation to physicians: a qualitative interview study of the top managers in Swedish healthcare

    Directory of Open Access Journals (Sweden)

    de Rijk Angelique

    2010-09-01

    Full Text Available Abstract Background This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Methods Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs in Sweden were subjected to qualitative analysis. Results The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1 they have high status and expertise; 2 they lack knowledge of the system; 3 they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Conclusions Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others in relation to the physician role. Further research is needed to elucidate how managers in healthcare

  6. Turnaround distressed physician practices. 20 tips for success.

    Science.gov (United States)

    Wolper, L F

    1999-01-01

    Physician practices are restructuring through merger and acquisition, and sale to practice management companies and to hospital systems. Many also are expanding internally by recruiting new physicians and opening additional offices. For many these strategies are working, but many others are experiencing operational and financial distress and failure that arise from rapid organizational growth without concomitant infrastructural change. Further, in the last several months, many national and regional practice management companies have decided to withdraw from the business, and others have declared bankruptcy. The number of physician practices that are in financial and operational distress is unprecedented. These groups require a solution, as proposed in this article.

  7. Evaluation of an inpatient psychiatric hospital physician education program and adherence to American Diabetes Association practice recommendations.

    Science.gov (United States)

    Koffarnus, Robin L; Mican, Lisa M; Lopez, Debra A; Barner, Jamie C

    2016-03-01

    This study evaluated adherence to American Diabetes Association (ADA) recommendations for diabetes monitoring following an educational intervention for physicians in an inpatient psychiatric hospital. This retrospective chart review was conducted in an inpatient psychiatric institution from July 1, 2010-January 15, 2011. A total of 120 subjects (60 subjects each in the pre- and post-intervention groups) meeting the inclusion criteria served as the study sample. Included subjects were admitted and discharged from an inpatient psychiatric institution within 90 days prior to (pre-intervention) and following (post-intervention) the physician education program. The medical staff was presented an educational program intervention, consisting of a 30 minute overview of the ADA 2010 Standards of Care recommendations and distribution of laminated treatment reminders. Electronic grouped order sets for patients with diabetes were also created and implemented. The primary outcome was change (pre-intervention to post-intervention) in frequency of hemoglobin A1c documentation on admission following the intervention. Secondary outcomes included the change in frequency of documentation of fasting plasma glucose, serum creatinine, urine creatinine/microalbumin ratio (UMA), fasting lipid profile (FLP), and change in days on sliding scale insulin. Regarding change in frequency of documentation of A1c values on admission, chi-square analysis revealed a significant increase from pre-intervention to post-intervention period of 30% (n = 18) to 61.7% (n = 37), respectively (p = 0.0005). Documentation of FLP also significantly increased [73.3% vs. 91.7% (p = 0.0082)]. There were no significant differences in the documentation of fasting plasma glucose, serum creatinine, and UMA or days treated with sliding scale insulin. The physician education program was successful in increasing the assessment of A1c values and lipid profiles for patients with diabetes mellitus in a psychiatric

  8. Interdisciplinary teamwork in hospitals: a review and practical recommendations for improvement.

    Science.gov (United States)

    O'Leary, Kevin J; Sehgal, Niraj L; Terrell, Grace; Williams, Mark V

    2012-01-01

    Recognizing the importance of teamwork in hospitals, senior leadership from the American College of Physician Executives (ACPE), the American Hospital Association (AHA), the American Organization of Nurse Executives (AONE), and the Society of Hospital Medicine (SHM) established the High Performance Teams and the Hospital of the Future project. This collaborative learning effort aims to redesign care delivery to provide optimal value to hospitalized patients. With input from members of this initiative, we prepared this report which reviews the literature related to teamwork in hospitals. Teamwork is critically important to provide safe and effective hospital care. Hospitals with high teamwork ratings experience higher patient satisfaction, higher nurse retention, and lower hospital costs. Elements of effective teamwork have been defined and provide a framework for assessment and improvement efforts in hospitals. Measurement of teamwork is essential to understand baseline performance, and to demonstrate the utility of resources invested to enhance it and the subsequent impact on patient care. Interventions designed to improve teamwork in hospitals include localization of physicians, daily goals of care forms and checklists, teamwork training, and interdisciplinary rounds. Though additional research is needed to evaluate the impact on patient outcomes, these interventions consistently result in improved teamwork knowledge, ratings of teamwork climate, and better understanding of patients' plans of care. The optimal approach is implementation of a combination of interventions, with adaptations to fit unique clinical settings and local culture. Copyright © 2011 Society of Hospital Medicine.

  9. Violence toward physicians in emergency departments of Morocco: prevalence, predictive factors, and psychological impact

    Directory of Open Access Journals (Sweden)

    Zekraoui Aicha

    2010-09-01

    Full Text Available Abstract Introduction Anyone working in the hospital may become a victim of violence. The effects of violence can range in intensity and include the following: minor physical injuries, serious physical injuries, temporary or permanent physical disability, psychological trauma, and death. The aim of this study was to determine the frequency of exposure, characteristics, and psychological impact of violence toward hospital-based emergency physicians in Morocco. Methods This was a survey including emergency physicians who ensured emergency service during the last fortnight. The variables studied were those related to the victim (age and gender, and those related to aggression: assaulter gender, number, time, reason (delay of consultation and/or care, acute drunkenness, neuropsychiatric disease, and type (verbal abuse, verbal threat and/or physical assault. After the questionnaire was completed, State-Trait Anxiety Inventory (STAI of Spielberg was applied to all participants. Results A total of 60 physicians have achieved permanence in emergency department during the 15 days preceding the questionnaire response. The mean age was 24 ± 1 year and 57% were male. A total of 42 (70% had been exposed to violence. The violence occurred at night n = 16 (27%, afternoon n = 13 (22%, evening n = 7 (12% and morning n = 6 (10%. Reasons for violence were: the delay of consultation or care in n = 31 (52% cases, acute drunkenness in n = 10 (17% cases and neuropsychiatric disease in n = 3 (5% cases. Twenty eight (47% participants stated that they experienced verbal abuse, n = 18 (30% verbal threat and n = 5 (8.3% physical assault. Exposure to some form of violence was related to a higher median [interquartile range, IQR] state anxiety point (SAP; (51 [46-59] vs 39 [34-46]; P P = 0,01. Conclusions This study revealed a high prevalence (70% of violence toward doctors in Morocco emergency departments. The exposure of physicians to some form of violence is greater

  10. [Good clinical practices in clinical trials: the responsibility of the researcher. A survey of 827 hospital physicians (I). Availability. Monitoring. Safety. Contract].

    Science.gov (United States)

    Dal-Ré, R

    1993-03-06

    The Law of Medicaments establishes that clinical trials (CT) with drugs must be carried out following the of Good Clinical Practice guidelines (GCP). The attitude of hospital physicians to the GCP prior to its implementation as mandatory in accordance with Spanish legislation was considered to be of interest. An anonymous survey was used with closed response questions. Questions referring to the responsibilities of the investigator included in the GCP were included. From December 1988 to February 1990 the survey was distributed among 1,706 hospital medical staff members, of any specialty, who had or had not participated in CT. In this article the results of the questions regarding the availability of the investigative team, CT monitorization, management of adverse reactions, the safety of the participants in the CT and the contract between the sponsor and the researcher are presented. A total of 827 hospital doctors replied to the survey. Fifty-nine percent had intervened in CT with drugs. At least 94% of those surveyed considered that the researcher must have the time and number of eligible patients which the CT requires. There was high acceptance (> or = 78%) of the clinical audits to be performed by the health authorities and the sponsor company of the CT. The need of urgent communication of the severe adverse reactions is admitted by a great majority (> or = 95%) of those surveyed. Eighty-five percent believe that patients should be insured against damage derived from CT with 76% considering that the investigator should sign a contract with the sponsor; 68% and 59% would hand in a copy of the same to the CT committee and the remainder of the research team, respectively. According to the Good Clinical Practice dealt with in this article, the responsibilities of the investigator have been widely accepted by the hospital physicians surveyed, therefore no problems should be expected upon the implementation of the same in this country. However, the economic

  11. Relationships of work-related psychosocial risks, stress, individual factors and burnout - Questionnaire survey among emergency physicians and nurses.

    Science.gov (United States)

    Ilić, Ivana M; Arandjelović, Mirjana Ž; Jovanović, Jovica M; Nešić, Milkica M

    2017-03-24

    Psychosocial risks represent a great challenge for safety and health protection at work in Europe. The purpose of this study has been to determine the relationships of psychosocial risks arising from work, stress, personal characteristics and burnout among physicians and nurses in the Emergency Medical Service (EMS). We performed a cross-sectional study based on a questionnaire survey which contained the Copenhagen Psychosocial Questionnaire (COPSOQ) and Copenhagen Burnout Inventory (CBI). A total of 88 physicians and 80 nurses completed the survey. Physicians demonstrated higher emotional (mean (M) ± standard deviation (SD) = 74.57±16.85) and cognitive (M±SD = 75.95±13.74) demands as compared to nurses. Both groups had high sensory demands and responsibilities at work, in spite of the low degree of their autonomy. The meaning of work, commitment to the workplace, and insecurity at work were high for both groups. Among all participants, stressful behavior and reactions were within the limits of low values ( 60). Personal and patient-related burnout was high for both groups, where physicians were significantly affected by work-related burnout. The influence at work, degree of freedom at work, social support, sense of coherence, mental health, and problem-focused coping are negatively related to work-related burnout. Based on personal factors and coping styles, emergency physicians and nurses are representing a self-selective professional group that meets high work demands, great responsibility, strong commitment and insecurity at work. Burnout of physicians and nurses in the EMS tends to be ignored, although it has severe consequences on their mental and general health. Med Pr 2017;68(2):178-178. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  12. Associations of psychosocial working conditions and working time characteristics with somatic complaints in German resident physicians.

    Science.gov (United States)

    Fischer, Nina; Degen, Christiane; Li, Jian; Loerbroks, Adrian; Müller, Andreas; Angerer, Peter

    2016-05-01

    Somatic complaints (SC) are highly prevalent in working populations and cause suffering and extensive health-care utilization. Adverse psychosocial working conditions as conceptualized in the Job Demand-Control-Support Model (JDC-S) and adverse working time characteristics (WTC) are potential risk factors. This combination is particularly common in hospital physicians. This study examines associations of JDC-S and WTC with SC in resident physicians from Germany. A cross-sectional study was conducted among 405 physicians at the end of residency training. SC were measured using the Giessen Subjective Complaints List (GBB-24) containing the sub-categories exhaustion, gastrointestinal, musculoskeletal, and cardiovascular complaints. Data on working conditions were collected by a self-report method for work analysis in hospitals (TAA-KH-S) and by questions on WTC (i.e., working hours). Multivariable stepwise regression analyses were applied. Workload showed the most pronounced relationship with all sub-categories of SC except gastrointestinal complaints. Job autonomy was not significantly related to any SC sub-category. Social support at work was inversely associated with all SC sub-categories except for cardiovascular complaints. Free weekends were associated with reduced SC except for exhaustion. Shift work was related to an increased SC total score and musculoskeletal complaints. Working hours showed no association with SC. In resident physicians, high workload and shift work are associated with increased SC, while social support at work and free weekends are associated with decreased SC. These insights may inform the development of preventive measures to improve the health of this professional group. Prospective studies are needed though to corroborate our findings.

  13. Questions abound as start-up nears for physician data bank.

    Science.gov (United States)

    Gardner, E; Wagner, L; Burda, D

    1990-07-02

    The start-up of the National Practitioner Data Bank is only weeks away, but hospitals and physicians still are raising questions about the system's pros and cons. While most laud the data bank's original mission--to prevent practitioners from concealing a history of incompetence--many physicians claim the scope of the system has grown too big and fear abuse of the information.

  14. Can advanced paramedics in the field diagnose patients and predict hospital admission?

    LENUS (Irish Health Repository)

    Cummins, Niamh Maria

    2013-02-13

    BACKGROUND: Accurate patient diagnosis in the prehospital environment is essential to initiate suitable care pathways. The advanced paramedic (AP) is a relatively recent role in Ireland, and refers to a prehospital practitioner with advanced life-support skills and training. OBJECTIVES: The objectives of this study were to compare the diagnostic decisions of APs with emergency medicine (EM) physicians, and to investigate if APs, as currently trained, can predict the requirement for hospital admission. METHODS: A prospective study was initiated, whereby each emergency ambulance call received via the statutory 999 system was recorded by the attending AP. The AP was asked to provide a clinical diagnosis for each patient, and to predict if hospital admission was required. The data was then cross-referenced with the working diagnosis of the receiving emergency physician and the hospital admission records. RESULTS: A total of 17 APs participated in the study, and 1369 emergency calls were recorded over a 6-month period. Cases where a general practitioner attended the scene were excluded from the concordance analysis. Concordance with the receiving emergency physician represents 70% (525\\/748) for all cases of AP diagnosis, and is mirrored with 70% (604\\/859) correct hospital admission predictions. CONCLUSIONS: AP diagnosis and admission prediction for emergency calls is similar to other emergency medical services systems despite the relative recency of the AP programme in Ireland. Recognition of non-concordance case types may identify priorities for AP education, and drive future AP practice in areas such as \\'treat and refer\\'.

  15. The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: lessons from one Taiwan university hospital.

    Science.gov (United States)

    Wang, Hsiu-Ling; Huang, Jun-Ying; Howng, Shen-Long

    2011-02-01

    The reimbursement system changed from fee-for-service to fixed prospective payments in Taiwan, the effect on the physician-patient's relationship is worth being studied. We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of switching visit costs, yielded additional insights into the importance of service quality for patient retention. The CSQ of physicians becomes a more important determinant of loyalty than ISQ as patients' VE increases. The importance of CSQ and ISQ increases in relation to PL as the perceived procedural and relational costs of changing care providers increases. Neither CSQ nor ISQ has a reduced relationship with PL as the perceived financial costs of switching hospitals increase. Our study indicates that the impact of CSQ and ISQ on loyalty varies according to the perceived visit costs of changing hospitals and the patients' VE.

  16. Financial capital and intellectual capital in physician practice management.

    Science.gov (United States)

    Robinson, J C

    1998-01-01

    Medical groups need financial resources yet most retain no earnings and have no reserves. Physician practice management (PPM) companies have recognized the need for investment and the scarcity of indigenous capital in the physician sector and are rushing to fill the void. Resources are being contributed by venture capitalists, bond underwriters, private investors, pharmaceutical manufacturers, health plans, hospital systems, and public equity markets. The potential contribution of PPM firms is to nurture the intellectual capital of leading physician organizations and diffuse it throughout the health care system. The risk is that short-term financial imperatives will impede necessary long-term investments.

  17. Referring physicians' experiences of outsourcing radiological examinations – A variety of views on the consequences

    International Nuclear Information System (INIS)

    Olofsson, P.T.; Blomqvist, L.; Fridell, K.; Aspelin, P.

    2016-01-01

    Introduction: There are strengths, weaknesses, opportunities and challenges when outsourcing advanced radiological examinations such as magnetic resonance examinations from university hospitals to external private institutions. Aim: The aim of this study was to explore the experiences of referring physicians when their referrals for radiological examinations are outsourced from a university hospital in Stockholm, Sweden. Method: This qualitative study is a part of a larger study investigating the consequences of outsourcing referrals for radiological examinations from a university hospital to private external units. Ten referring physicians from orthopedic and oncology departments, representing clinics with large volumes of radiological referrals at a university hospital, were interviewed. Results: The results showed that the requirements for radiological services differ between these specialties. The overall opinion was that examinations performed by external radiology departments needed additional re-assessment work which causes higher costs for their clinics. This indicates that there is insufficient communication between referring physicians and the radiological department at the University Hospital. Conclusions: For better planning of radiological services, radiology departments must consider the referring physicians' needs and develop suitable contract when organizing the practice of outsourcing. The management structure in radiology departments and communication between referring physicians and radiologists in the radiology departments should be studied further, to promote better understanding and improve the efficiency of the outsourcing process. - Highlights: • The requirements for radiological services differ between specialties. • Outsourced examinations need more frequent re-assessment. • Outsourced examinations cause higher costs for referring departments. • Outsourcing radiological examinations entail more administrative work.

  18. Specialty and full-service hospitals: a comparative cost analysis.

    Science.gov (United States)

    Carey, Kathleen; Burgess, James F; Young, Gary J

    2008-10-01

    To compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors. The primary data sources are the Medicare Cost Reports for 1998-2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database. We identified all physician-owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full-service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t-tests of significance compared the inefficiency measures of specialty hospitals with those of full-service hospitals to make general comparisons between these classes of hospitals. Results do not provide evidence that specialty hospitals are more efficient than the full-service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect. Policymakers should not embrace the assumption that physician-owned specialty hospitals produce patient care more efficiently than their full-service hospital competitors.

  19. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2008-07-01

    Full Text Available Abstract Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88% felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  20. In search of practice performance data? Call the hospital.

    Science.gov (United States)

    Bellile, S K

    1997-01-01

    Comparative performance data is increasingly being used by hospitals and managed care plans to evaluate physician practices. Outcomes data can also be a valuable tool for continuous improvement within a practice. Administrators need to understand the different categories and sources of physician practice data. Hospitals are a particularly good, yet often underutilized, data resource. Descriptive, financial and clinical information available from hospital systems can be used to compare one physician's performance to norms for specific case types (e.g. DRG's), focus internal review efforts and support managed care marketing and negotiation. Administrators need to identify key hospital contacts, make specific data requests and knowledgeably (and cautiously) interpret the data received. Finally, the administrator plays a crucial role turning data into information: identifying and presenting key findings and insuring that the information is used to the group's competitive advantage.