Working atmosphere,job satisfaction and individual characteristics of community mental health professionals in integrated care

Working requirements of community mental healthcare professionals in integrated care are complex. There is a lack of research concerning the relation of job satisfaction, working atmosphere and individual characteristics. For the current study, a survey evaluating job satisfaction and working atmosphere of mental healthcare professionals in integrated care was performed. About 321 community mental healthcare professionals were included in the survey; the response rate was 59.5%. The professional background of community mental healthcare professionals included nursing, social work and psychology. Community mental healthcare professionals reported the highest satisfaction with colleagues and the lowest satisfaction with income. Moreover, it could be shown that more responsibility, more recognition and more variety in job tasks lead to an increase of overall job satisfaction. Healthcare for mentally ill patients in the community setting is complex and requires well‐structured care with appropriate responsibilities within the team. A co‐operative relationship among colleagues as well as clearly defined responsibilities seem to be the key for the job satisfaction of community mental healthcare professionals in integrated care.     

The continuum of patient satisfaction--from satisfied to very satisfied

In a move towards a more informed understanding of the concept of satisfaction, this paper aims to explore how 30 dermatology patients describe what it meant to them to be either satisfied or very satisfied with their healthcare. This was undertaken using in-depth interviews and the findings suggest that participants clearly differentiated between being satisfied or very satisfied with healthcare. While for some participants, being satisfied with healthcare was described in terms of care being adequate or average, for others it meant that there were aspects of healthcare that could be improved, or that something was missing and that optimal care was not achieved. Care and management had been 'acceptable' or 'sufficient' but not 'outstanding.' In contrast, being very satisfied with particular aspects of healthcare was described in ways that suggested that the service was not only more than adequate, but ranged from 'better than average' to 'outstanding', i.e. optimal care had been provided. This observation of a 'continuum of satisfaction' has specific and important implications for the future analysis and presentation of patient satisfaction surveys. It is suggested that attention to the differences between the two constructs provides a useful means to highlighting areas of patient concern and that researchers reporting the results of patient satisfaction surveys should cease to collapse them.     

Pastoral care's role in a reformed system. Pastoral care professionals need to promote the spiritual dimension of healing throughout the continuum of care

The emerging structure of healthcare delivery is challenging many elements of traditional pastoral care. With these changes, how can pastoral care professionals be on the cutting edge of tomorrow's pastoral care ministry? Pastoral care givers must understand that the individual with holistic needs will be at the center of the reformed healthcare system. All providers will share the responsibility and financial risk of providing high-quality care to each client. Pastoral care departments will need to develop systems to objectively measure the quality of their spiritual and religious care services, as well as patient or client satisfaction. Pastoral care professionals must take the lead in developing a vision of spiritual care that reflects the new paradigm of integrated delivery. They must also share the vision of integrated spiritual care with opinion leaders who can be advocates for an expanded vision of pastoral and spiritual care within the network. Ideally, faith communities should be centers for care, healing, and wellness, with hospitals as extensions of those communities. Within such a network, pastoral care givers can organize programs, workshops, and retreats around spirituality and wellness as part of the faith community's mission. In addition, pastoral care professionals can help clients learn about themselves and their life-styles and make healthier choices. Pastoral care givers need to recognize that within brokenness there is also wholeness, wisdom, and new opportunities. When we are free of our own agenda, we can empower others. Together, with God's grace, pastoral care givers can shape a new future and make it happen.     

Is caring a viable component of health care?

The attitudes and behaviours that constitute caring affect both the quality of the patient's experience and the outcomes of medical care. They can be identified and can be nurtured or discouraged by the structures of organisation and financing within which health care is provided. They have costs, so their viability is threatened as pressures increase to make health care more economically efficient. Yet the value of caring behaviour may justify what is necessary to sustain it. This issue deserves prompt and extensive debate as health care systems undergo revision throughout the world.     

Understanding nursing: the usefulness of a philosophical perspective *

Abstract The work of nursing involves both treatment orientated action and care orientated action, but there exists a ‘treatment–care’ dichotomy that is structured by social factors and views of knowledge that privilege scientific, instrumental rationality. It is a claim of this paper that there is a need to establish connections between ‘treatment’ and ‘care’. The study of work processes in the healthcare field make it possible for nursing to recognize the technical and social separation of work, the separation between manual and intellectual work, the dominance of medicine among healthcare professionals, and other relations of power within institutions. The authors believe that Habermas' theory of communicative action offers an alternative view, one suitable for transforming healthcare practices and helping nurses build new responses to healthcare needs.     

Collaborative models of patient care:new opportunities for hospital social workers

Hospitals are increasingly recognizing the importance of moving away from the traditional medical model of care to more collaborative models that integrate patients and families into the planning and delivery of healthcare. A few existing studies suggest that collaborative models of care result in higher levels of consumer satisfaction, treatment compliance, effective team performance, and increased care coordination (Gance-Cleveland, 2005; DiMatteo et al., 2002; Reid Ponte et al., 2004; Institute for Family-Centered Care, 2004). Key values underpinning social work practice make medical social workers well-positioned to play leadership roles as hospitals make the shift to more patient-centered care. Specific strategies are presented for medical social workers to use in advocating for change in the way health services are planned and delivered within hospital settings.     

A qualitative analysis of women's satisfaction with primary care from a panel of focus groups in the National Centers of Excellence in Women's Health

Health issues unique to women and differences in healthcare experiences have recently gained attention as health plans and systems seek to extend and improve health promotion and disease prevention in the population. Successful efforts focused on enhancing quality of care will require information from the patient's perspective on how to improve such services to best support women's attempts to lead healthy and productive lives. The National Centers of Excellence in Women's Health program (CoE), sponsored by the Office on Women's Health within the Department of Health and Human Services, is based on an integrated model uniting research, training, healthcare, and community education and outreach. To examine women's concept and definitions of healthcare quality, 18 focus groups comprising 137 women were conducted nationwide on experiences and attributes of healthcare that women value in primary care. Following the focus groups, a woman-focused healthcare satisfaction instrument was developed for the purpose of assessing and improving healthcare delivery. We describe the qualitative results of the focus group study.     

Identifying factors that impact patient length of stay metrics for healthcare providers with advanced analytics

Managing patients' length of stay is a critical task for healthcare organizations. In order to better manage the processes impacting this performance metric, providers can leverage data resources describing the network of activities that impact a patient's stay with analytic methods. Interdependencies between departmental activities exist within the patient treatment process, where inefficiency in one element of the patient care network of activities can adversely affect process outcomes.This work utilizes the method of neural networks to analyze data describing inpatient cases that incorporate radiology process variables to determine their effect on patient length of stay excesses for a major NJ based healthcare provider. The results indicate that inefficiencies at the radiology level can adversely extend a patient's length of stay beyond initial estimations. Proactive analysis of networks of activities in the patient treatment process can enhance organizational efficiencies of healthcare providers by enabling decision makers to better optimize resource allocations to increase throughput of activities.     

Factors associated with constructive staff-family relationships in the care of older adults in the institutional setting

Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff-family relationships. Search strategy A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. Selection criteria The review was limited to studies involving residents and patients within acute, subacute, rehabilitation and residential settings, aged over 65?years, their family and healthcare staff. Papers addressing family members and healthcare staff perceptions of their relationships with each other were considered for this review. Studies in this review also included those relating to interventions to promote constructive staff-family relationships including organisational strategies, staff-family meetings, case conferencing, environmental approaches, etc. The review considered both quantitative and qualitative research and opinion papers for inclusion. Data collection and analysis All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Appraisal forms and data extraction forms designed by the Joanna Briggs Institute as part of the QARI and NOTARI systematic review software packages were used for this review. Findings Family members' perceptions of their relationships with staff showed that a strong focus was placed on opportunities for the family to be involved in the patient's care. Staff members also expressed a theoretical support for the collaborative process, however, this belief often did not translate to the staff members' clinical practice. In the studies included in the review staff were frequently found to rely on traditional medical models of care in their clinical practice and maintaining control over the environment, rather than fully collaborating with families. Four factors were found to be essential to interventions designed to support a collaborative partnership between family members and healthcare staff: communication, information, education and administrative support. Based on the evidence analysed in this systematic review, staff and family education on relationship development, power and control issues, communication skills and negotiating techniques is essential to promoting constructive staff-family relationships. Managerial support, such as addressing workloads and staffing issues; introducing care models focused on collaboration with families; and providing practical support for staff education, is essential to gaining sustained benefits from interventions designed to promote constructive family-staff relationships.     

Patients' experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care

Objective: To determine what aspects of healthcare provision are most likely to influence satisfaction with care and willingness to recommend hospital services to others and, secondly, to explore the extent to which satisfaction is a meaningful indicator of patient experience of healthcare services.

Design: Postal survey of a sample of patients who underwent a period of inpatient care. Patients were asked to evaluate their overall experience of this episode of care and to complete the Picker Inpatient Survey questionnaire on specific aspects of their care.

Sample: Patients aged 18 and over presenting at five hospitals within one NHS trust in Scotland.

Method: 3592 questionnaires were mailed to patients' homes within 1 month of discharge from hospital during a 12 month period. Two reminders were sent to non-responders; 2249 (65%) questionnaires were returned.

Results: Almost 90% of respondents indicated that they were satisfied with their period of inpatient care. Age and overall self-assessed health were only weakly associated with satisfaction. A multiple linear regression indicated that the major determinants of patient satisfaction were physical comfort, emotional support, and respect for patient preferences. However, many patients who reported their satisfaction with the care they received also indicated problems with their inpatient care as measured on the Picker Inpatient Survey; 55% of respondents who rated their inpatient episode as "excellent" indicated problems on 10% of the issues measured on the Picker questionnaire.

Discussion: The evidence suggests that patient satisfaction scores present a limited and optimistic picture. Detailed questions about specific aspects of patients' experiences are likely to be more useful for monitoring the performance of various hospital departments and wards and could point to ways in which delivery of health care could be improved.

     

Family caregiver satisfaction with care at end of life: report from the cultural variations study (CVAS)

The objective of this study was to examine differences in family caregiver satisfaction with care at end of life based on site of death, in an observational study involving advanced cancer patients and their family caregivers. The study was based on follow-up interviews with 28 family caregivers of 28 patients who died during a two-year prospective study involving 68 patients and 68 family caregivers. Telephone interviews addressed the circumstances of the patients 'death, their satisfaction with the care provided to the patient, and their satisfaction with how well they were attended to by health providers. There were no associations between site of death (died at home vs. did not die at home) and family caregiver satisfaction with the overall care provided to the patient. However family caregivers of patients who died at home responded that they thought the patient was more at peace (with respect to spiritual and religious matters) than did family caregivers of patients who did not die at home (p = 0.003). Family caregivers of patients who died at home appeared to feel less satisfied with the attention paid to their own wishes regarding the patient's care (p = 0. 13), less satisfied with the emotional support provided to them by healthcare personnel taking care of the patient (p = 0. 08), and less satisfied with communication from health providers (p = 0. 11). Findings indicate that although dying at home appears to provide a more peaceful death for the patient, it may also distance family caregivers from health professionals and leave them feeling less supported during the patient's last days of life.     

Consumer satisfaction with occupational health services: should it be measured?

OBJECTIVES—To find answers in the literature to the questions if, why, and how consumer satisfaction with occupational health services (OHSs) should be measured.
METHODS—Publications about the concept of consumer satisfaction with health care and surveys of consumer satisfaction with occupational health care were reviewed.
RESULTS—For care providers, surveys of consumer satisfaction can be useful to improve quality or as indicators of non-compliant behaviour among patients. For clients, satisfaction surveys can be helpful for choosing between healthcare providers. Satisfaction is made up of an affective component of evaluation and a cognitive component of expectations. Also, in occupational health care, patient satisfaction is measured by dimensions such as the humanness and competence of the care provider similar to health care in general. However, there are dimensions that are specific to occupational health—such as the perceived independence of the physician, unclear reasons for visiting an OHS, and the perceived extent of knowledge of OHS professionals about the patient's working conditions. Dimensions of client satisfaction are mostly similar to patient satisfaction but include more businesslike aspects. They are different for the two groups of client, employers and employees. To measure consumer satisfaction in occupational healthcare specific questionnaires must be constructed. To achieve the highest possible reader satisfaction guidelines are provided for construction of a questionnaire.
CONCLUSIONS—Consumer satisfaction is a complex theoretical concept, but it is relatively easy to measure in practice and can be a valuable tool for quality improvement. Consumers' evaluations of occupational health services will become increasingly important due to changes in the organisation of occupational health care. Occupational healthcare providers are encouraged to measure the consumer satisfaction of their services.


Keywords: consumer satisfaction; occupational health services     

Benzodiazepine use and the biopsychosocial model

Longstanding concern about possible misuse of the physician's unique prerogative to prescribe sedative drugs that control behavior has been accentuated by the increasing use of benzodiazepines since 1960. The appropriateness of their use in solving psychosocial predicaments is increasingly questioned because their availability has coincided with social movements toward personal autonomy and scientific doubts about the adequacy of a biomedical model in health care. Recent information about patients, physicians' prescribing habits, and drugs leads to an exploration of the existing alternatives. Adoption of a biopsychosocial model could result in lowered drug use with increased levels of public and professional satisfaction.     

What health care services does the public want and who should decide? Ask them!

Most of the parties involved in healthcare decisions – governments, politicians, healthcare professionals, pharmaceutical companies, special interest groups – actively work to make their desires known. In Israel the public is part of the decision committee; in Germany health care decision are made more or less without the public being involved. In a recently published IJHPR article, Giora Kaplan and Orna Baron-Epel raise the question of how well acquainted senior decision makers in the Israeli health system are with the public’s priorities regarding the services being considered for inclusion in the public funding list. This commentary speculates about the reasons for the discrepancies found in that article between the decision makers’ and the public’s view. Furthermore, it reports on survey results from Germany about who should be part of the decision making committee and briefly touches upon the situation in other OECD countries. While public opinion may not be the determining factor, all authors advocate a strengthening of the public’s contribution to the health care decision making process, including steps to make decision makers aware of public priorities on an ongoing basis.     

Patient satisfaction in 21st century medicine: revolution or evolution?

The Moment-of-Truth (MOT) patient satisfaction system was created to address each patient's medical care and service needs at the "point-of-care," before the patient leaves the medical facility. The MOT system is patient-centered by actively involving each patient in his or her own healthcare evaluation, planning, and continuous quality improvement. Patient needs are aligned with the required healthcare resources, which simultaneously produce information that can be acted upon "immediately," at the point-of-care, with "a sense of urgency"-addressing patient expectations each and every time the patient encounters the healthcare system. Major changes that occurred in medical service delivery at Hudson Hospital after implementation of the MOT system included a change in the focus of healthcare delivery toward the patient each and every time medical care or service occurred by placing the patient at the center of the care continuum; the ability to capture and react to what the patient needed at the place and time the patient needed it; and the incorporation of patient satisfaction as a way of doing business, throughout the healthcare organization. Results in 2007 to date have averaged 98% among responding patients indicating that they would recommend the Hudson Hospital to family and friends.     

Four strategies for recruitment and retention.

The combined pressures of a shrinking work force, an aging population, changing social attitudes toward work, financial constraints, and public perception of healthcare have contributed to a growing personnel problem for healthcare organizations across the country. In fact, decreasing job satisfaction among healthcare employees has them headed for the doors in search of nonhospital jobs that can offer flexible hours, more opportunities, equal or better pay, and less stress. Without sufficient numbers of personnel, healthcare organizations will not be able to meet the needs of their communities. And the need for healthcare services will continue to grow as the Baby Boomers age.     

Prevailing issues in long-term care. CEOs see urgent need for adequate funding and better communications among Catholic organizations

The ongoing crisis in long-term care has forced administrators and chief executive officers (CEOs) to reassess their position within the U.S. healthcare system and define their response to the challenges they face. This article identifies the issues that Catholic long-term care CEOs find most pressing based on two recent opinion surveys conducted by the Catholic Health Association (CHA). In the area of management and governance, the subject of a 1990 CHA survey, respondents rated as their top concern the inadequacy of funds to treat chronically ill elderly persons. Other important issues included threats to the tax-exempt status of healthcare providers, availability of healthcare for the poor, and scarcity of nursing staff. Respondents to a 1991 survey that focused on collaboration within the Catholic healthcare ministry cited the lack of a forum for communications as the greatest hindrance to collaborative enterprises. A lack of available time to pursue and develop collaborative projects and the absence of compelling reasons to collaborate with other Catholic organizations were also identified as important issues. Overall, the consensus among long-term care CEOs was strong on the importance of certain management and governance issues and on the need for Catholic organizations to work together more closely.     

'Like a friend going round': reducing the stigma attached to mental healthcare in rural communities

Traditionally, stigma is seen as something that is the fault of the mental health system, and that involves an individual suffering social disapprobation and reduced life chances as a result of having been given a diagnostic label and an identity as a patient as a result of their contact with psychiatric institutions. The present study, based on focus group discussions conducted with users and mental healthcare workers in a rural setting, suggests that this classic conception of stigma does not readily apply to care in the community. First, workers described themselves as actively trying to challenge stigma at an institutional level, as well as being apt to change their own practice to reduce the stigmatizing effect of mental healthcare on their clients and make their presence less conspicuous. The ideal was to be 'like a friend going round'. However, this view included a somewhat passive notion of clients. By contrast, the present investigation showed that clients described themselves in much more active terms as being aware of possible sources of stigma and being inclined to challenge negative attitudes themselves. Future mental healthcare practice could draw upon professionals' stock of knowledge as to how their practice could lead to less stigma and could build upon clients' own strengths to achieve stigma reduction.     

Mentors matter: relationships that increase the number of oral health professionals serving the underserved

Access to oral healthcare is a persistent problem in the United States. One barrier to this multifaceted issue is the shortage of oral healthcare providers who are willing to provide care for underserved populations. Mentoring relationships with oral health professionals is one solution that will increase the number of public oral health professionals. Using narrative inquiry, this interpretive study explored the relationships that public health dental hygienists had with mentors who leveraged their capital to empower those they mentored. The stories of six dental hygienists practicing in public health and four of their mentors were gathered through one or two 60- to 90-minute interviews. Qualitative data analysis was used to untangle and make meaning of their narrations. The findings are reported in the words of dental hygienists and their mentors, wherever possible, to embrace the voice of the participants. The Iroquois legend of The Three Sisters is used as a metaphor to illustrate the mentoring relationship. These mentor relationships, in which there was mutual growth, were built on a symbiotic, natural bond. The dental hygienists recalled relationships with multiple mentors who leveraged their social and political capital to empower and thereby encouraged a career path in public health.     

General physicians' viewpoint on the evaluation of health care quality in the hospital

The principal objective of this work was to determine whether the evaluation of general practitioners' satisfaction vis-à-vis a health care establishment impacted that establishment to improve the quality of the services it provides. Ten doctors were randomly selected and 100% agreed to respond to a semi-directive interview. Two independent doctors analysed each corpus and identified 15 themes, of which 5 systematically came up: the organisation of the care of patients, the availability of hospital doctors, the transmission of information, the speed of emergency admissions, and the patient-hospital doctor relationship. The opinion of private practice doctors usefully complements the evaluation of patient satisfaction used to identify the weaknesses of an establishment. It is proposed to include this evaluation in the procedure of continued improvement of the quality of care within establishments.