The Effects of Patient-Centered Communication: Exploring the Mediating Role of Trust in Healthcare Providers

ABSTRACT

This study examined the effects of patient-centered communication (PCC) on two major outcomes: patients’ trust in healthcare providers and their evaluation of the quality of healthcare received. Based on conceptual model regarding the impacts of PCC, the former is considered a proximal communication outcome and the latter an intermediate outcome. Both are known to be associated with ultimate health outcomes. Analyses conducted on a dataset of 3273 respondents from the 2012 Health Information National Trends Survey in the U.S. showed that PCC was positively associated with both patients’ trust in healthcare providers and evaluation of healthcare quality. Moreover, trust was a significant mediator between PCC and patients’ perceptions of the quality of healthcare, and stronger mediation of trust was observed as the frequency of hospital visits increased. Some theoretical and practical implications are discussed.     

Innovative teaching for health law: a case study of a hospital medical malpractice lawsuit simulation

In this article we describe a case study of a learning exercise for healthcare management students to more effectively understand how the legal process impacts healthcare organizations and healthcare professionals. Through a semester-long mock trial, we illustrate how healthcare executives can better understand and prepare their employees, their organization, and fellow administrators for the financial, emotional, and time investment that a lawsuit requires. Students participate as a member of the plaintiff team, defendant team, or juror in a simulated lawsuit brought by a patient against a hospital. We explain how students who participate in the simulated lawsuit gain a better understanding of difficult legal principles discussed throughout the course. We further indicate how the mock trial simulation may support achievement of current Commission on Accreditation of Healthcare Management Education (CAMHE) criteria. Next, we highlight how the mock trial allowed students to put into practice many of the health law principles discussed in class through role playing the different stages of medical malpractice trial. The article concludes with examples of how a simulated mock trial may also provide similar interdisciplinary educational, performance improvement, and cost saving benefits to healthcare professionals and their organizations.     

Walking towards health in a university community: a feasibility study

OBJECTIVE: Using a randomised control trial design, this study assessed the impact of two walking interventions, on the work day step counts and health of UK academic and administrative, university employees. METHOD: A convenience sample of 58 women (age 42+/-10 years) and 6 men (age 40+/-11 years) completed baseline and intervention measures for step counts, % body fat, waist circumference and systolic/diastolic blood pressure, during a ten-week period (October to December, 2005). Before intervention, baseline step counts (five working days) were used to randomly allocate participants to a control (maintain normal behaviour, n=22) and two treatment groups ("walking routes", n=21; "walking in tasks", n=21). Intervention effects were evaluated by calculating differences between pre-intervention and intervention data. A one-way ANOVA analysed significant differences between groups. RESULTS: A significant intervention effect (p<0.002) was found for step counts, with mean differences indicating a decrease in steps for the control group (-767 steps/day) and increases in the "walking routes" (+926 steps/day) and "walking in tasks" (+997 steps/day) groups. Small, non-significant changes were found in % body fat, waist circumference and blood pressure. CONCLUSIONS: Findings have implications for work-based physical activity promotion and the development of walking interventions within the completion of work-based tasks.     

Preparing for increased union organizing. A commitment to deal justly with employees is the best response to the new bargaining unit rules

The U.S. Supreme Court recently upheld a National Labor Relations Board regulation giving unions of healthcare workers the right to organize as many as eight different kinds of hospital bargaining units. With the Court's decision, hospital administrators must prepare for increased union organizing by maintaining policies that evidence the institution's commitment to social justice in the workplace. Hospital administrators can reduce the potential for labor-management conflict by stressing the institution's commitment to social justice and establishing programs to educate managers and other employees about Catholic teaching on social justice. Facility administrators should also establish a written philosophy statement outlining the institution's position on unionization, institute labor relations training, survey employees' opinions of management and their work environment, conduct audits of managers' perceptions of the organization's effectiveness, and periodically review the state of labor relations in the organization.     

"Walk in to Work Out": a randomised controlled trial of a self help intervention to promote active commuting

Study objective: To determine if a self help intervention, delivered via written interactive materials (the "Walk in to Work Out" pack), could increase active commuting behaviour (walking and cycling). Design: Randomised controlled trial. The intervention group received the "Walk in to Work Out" pack, which contained written interactive materials based on the transtheoretical model of behaviour change, local information about distances and routes, and safety information. The control group received the pack six months later. Focus groups were also conducted after six months. Setting: Three workplaces in the city of Glasgow, Scotland, UK. Participants: 295 employees who had been identified as thinking about, or doing some irregular, walking or cycling to work. Main results: The intervention group was almost twice as likely to increase walking to work as the control group at six months (odds ratio of 1.93, 95% confidence intervals 1.06 to 3.52). The intervention was not successful at increasing cycling. There were no distance travelled to work, gender, or age influences on the results. Twenty five per cent (95% confidence intervals 17% to 32%) of the intervention group, who received the pack at baseline, were regularly actively commuting at the 12 month follow up. Conclusion: The "Walk in to Work Out" pack was successful in increasing walking but not cycling. The environment for cycling must be improved before cycling will become a popular option.     

Private obstetric practice in a public hospital: mythical trust in obstetric care

There is evidence to suggest the decline of trusting relationships in modern healthcare systems. The primary aim of this study was to investigate the role of trust in medical transactions in Thailand, using obstetric care as a tracer service. The paper proposes an explanatory framework of trust for further investigation in other healthcare settings. The study site was a 1300-bed tertiary public hospital in Bangkok which it provides two forms of obstetric care: regular obstetric practice (RP) and private obstetric practice (PP). Forty pregnant women were selected and interviewed using a set of guiding questions. A thematic analysis of the interviews was undertaken to generate understanding and develop an explanatory framework. It was found that patients' trust in obstetric services was influenced by their perceptions of risk and uncertainty in pregnancy and childbirth, and that these perceptions were linked to their social class. Social class also influenced the accessibility and affordability of care to patients. Middle class pregnant women with relatively high-level concerns about risk and uncertainty preferred using PP service as a means to achieve interpersonal trust. These women thought that an informal payment would provide the basis for interpersonal trust between themselves and the chosen obstetricians. In practice, however, obstetricians involved in PP rarely acknowledged this reciprocal relationship and hardly expressed the additional courtesy expected by patients. As a result, PP service only created an expensive impersonal trust that was mistaken as interpersonal trust by patients. Negative outcomes from PP often caused disappointment that could eventually lead to medical litigation. The study suggests that there are some negative impacts of PP within the health system. Negative experiences among PP users may undermine trust not only in the specific doctor but also trust in health professionals and hospitals more generally. Steps need to be undertaken to protect and strengthen existing impersonal trust, which combine institutional trust based on good governance and service quality with trust in the professional standard of practice. The explanatory framework developed through this study provides a foundation for further studies of trust in different specialties and care settings.     

医院公信力对患者抱怨行为层次的影响

本研究旨在探讨医院公信力对医疗服务抱怨行为层次的影响,以期为医疗公信力的践行提供理论依据。331名有过不满意就诊或住院医疗服务抱怨经历的患者参与了线上问卷调查。结果显示:(1)医院公信力对一般抱怨水平和是否向第三方抱怨有正向影响;(2)医院公信力对一般抱怨水平和是否向第三方机构抱怨的影响机制不同,对一般抱怨水平高低的影响主要通过患者就诊的不满意度,而对是否向第三方抱怨则通过抱怨的预期收益影响;(3)医院公信力对是否向第三方抱怨的影响效果(0.301)要大于其对患者一般抱怨水平的影响效果(0.060);(4)医院公信力也会通过对医疗服务质量的期望落差、患者对医生的信任对一般抱怨水平与是否向第三方抱怨同时产生影响,但相比其直接通过患者就诊不满意度、抱怨的预期收益的影响要小,尤其是通过患者对医生的信任产生的间接影响很小。这表明医院公信力践行离不开微观层次的抱怨管理,一方面可能通过基于关系的医患沟通培训提升医生沟通技能及抱怨管理人事来改善患者对医疗服务的信任,另一方面更应该通过改善医疗服务报怨管理制度与机构设立来提升。     

Psychosocial care as a marketing tool: gaining hospital-wide commitment through guest relations training.

Spurred primarily by the new climate of competition in health care, a number of hospitals have instituted training programs in "guest relations" to ensure that all hospital employees, from administrators to maintenance workers, interact in helpful, caring ways with patients and visitors. These programs provide an excellent means of acquainting all employees with the special needs of children and their parents and offer concrete suggestions for how a wide variety of employees can contribute to total psychosocial care.     

Health and economic consequences of an outbreak of pertussis among healthcare workers in a hospital in France.

BACKGROUND: Bordetella pertussis is highly contagious, and because immunity wanes after vaccination, it continues to be a cause of cough among adults. OBJECTIVE: To describe the healthcare services used and productivity losses accrued by healthcare workers (HCWs) missing work due to pertussis. METHODS: After 3 pertussis cases were confirmed among HCWs, all hospital employees and patients with a cough were screened between November 2000 and March 2001. Each potential case underwent diagnostic tests and received antibiotics (spiramycin or azithromycin) when appropriate. Symptomatic employees were not allowed to return to work until they received an antibiotic for at least 5 days. Services used (physician visits and calls, antibiotics, diagnostic tests, hospitalization, and treatment provided to their contacts) were combined with cost estimates (in 2002 euros) for these services in France. RESULTS: Ninety-one potential cases were identified (77 HCWs, 12 patients, and 2 family members). Of them, 89% received antibiotics and 22% had at least one contact who was also treated. Approximately half (55%) of the HCWs who were cases missed 5 days of work. Four patients were admitted to the hospital as a result of the infection. The average medical cost was 297 euros per potential case: diagnostic tests accounted for 32% and hospitalization for 31%. Total cost (medical and productivity) was 46,661 euros for 91 cases, 42% from productivity losses. An investigation to identify these potential cases also accrued additional costs. CONCLUSION: Serious adverse health and economic consequences arose from transmission of pertussis among HCWs, their families, and patients.     

Fostering a culture of service excellence

Patients' level of satisfaction with healthcare providers can have profound implications for operational and clinical outcomes. Are your organizational leaders fostering a practice culture of "service excellence"? Has your organization defined what "service excellence" means? Do your employees have a clear understanding of your expectations for service delivery? Medical practice leaders can improve patients' level of satisfaction by adopting and fostering a culture of service excellence in their practice. Strengthening the practice-patient relationship through patient-service initiatives can lead to improved patient perception of care quality and overall satisfaction with their healthcare providers. When patients feel wanted and well cared for by their healthcare providers, they are less likely to be noncompliant and more likely to achieve positive clinical outcomes. Operationally, service-excellence initiatives will have a profound impact on patient retention and new referrals, and possibly a reduction of litigious risks.     

基于员工调查的深圳市罗湖医院集团化改革的成效初探

目的:研究员工对深圳市罗湖医院集团化改革后的初步评价。方法:采用问卷调查法,对罗湖区医疗集团内的3家区属医院和23家社康管理中心的员工进行调查。结果:共发放问卷480份,回收有效问卷412份,有效回收率为85.83%。37.21%的医生表示下社康管理中心出诊很有动力或非常有动力;75.38%的员工感受到集团化改革近两年来医院发生"较明显"或"非常明显"的变化;员工对于工作本身、人际关系和医院发展的满意度评分均值均在4.20分以上,且一致性较高。结论:被调查员工对改革初期的评价总体较积极。集团建设运营近两年来,附设医疗机构的总体发展呈上行态势,集团内纵向联合局面有所显现,二级及以上医院医生下社区意愿增强,尤其体现在内科、中医科等。集团不断引导各附设医院错位布局,协同发展,带动集团整体提升。各医院员工对集团的未来发展有所期待,希望集团能协调好各方利益,兑现承诺。     

Occupational Pressure–Targeting Organisational Factors to Ameliorate Occupational Dysfunction

Introduction Chronic pressure at work has debilitating impact on healthcare employers (e.g. reduced productivity, high costs, poor patient care) and on female healthcare employees (e.g. sickness, dysfunction). This paper highlights relationship at work as the key occupational source of work-stress which is organisational in nature. Methods A cross-sectional study (n = 230) was conducted using the Pressure Management Inventory on several female dominated health professions within a large public hospital. Analysis of variance was used to show relationship between sources and outcome of pressure. Linear regressions were used to predict which sources of pressure (IV) was linked to the outcomes of occupational pressure (DV). Results The number one source of occupational pressure is Relationships at work (i.e. with supervisors), and not workload. ‘Relationship’ is also the key predictor of several negative outcomes of pressure at work. Analysis of variance showed significant differences in two sources of pressures, i.e. Workload (P = 0.04) and Home-work balance (P = 0.03). Conclusion This paper provides insights into the occupational pressure of women health professionals by highlighting the organisational sources of pressure and the implications for preventing occupational dysfunction secondary to stress at work.     

Tuberculosis in healthcare workers at a general hospital in Mexico.

OBJECTIVE: To determine the incidence rate of tuberculosis (TB) disease among healthcare workers (HCWs) at a general hospital. DESIGN: Retrospective analysis of TB cases among HCWs over the course of 5 years. SETTING: A 140-bed general hospital in Tijuana, Mexico. PARTICIPANTS: All hospital employees who developed TB during the 5-year period. RESULTS: From 1 January 1999 through 31 December 2003, 18 TB cases were diagnosed among the hospital personnel. During that period, the mean (+/- standard deviation) annual work force of the hospital was 819+/-21.7 employees. The TB incidence rate was 439.56 cases per 100,000 employees; this rate was 10.98 times higher than the rate for the general population of the city. The TB incidence rate for physicians was 860.21 cases per 100,000 employees, that for nurses was 365.85 cases per 100,000 employees, and that for physicians in training was 1,846.15 cases per 100,000 employees. Physicians in training had a higher risk of acquiring TB than did either physicians (relative risk, 2.14 [95% confidence interval, 1.34-35.66) or nurses (relative risk, 5.04 [95% confidence interval, 3.16-83.33). Three of the HCWs with TB disease were infected with a drug-resistant strain of Mycobacterium tuberculosis, and one of the infecting strains was multidrug resistant. Asymptomatic TB infection among HCWs was not addressed during this study. CONCLUSIONS: The TB incidence rate among the HCWs at the hospital is extremely high, compared with that in the general population. The implementation of infection control measures is an urgent priority, to reduce this occupational hazard.     

Renewing the model employer. Changing employment relations and "partnership" in the health and private sectors

Drawing from original empirical data this paper compares the changing nature of employment relations in the health and private sectors. A key concern is to assess the extent to which the emergence of partnership-type arrangements between employers and trade unions lays the basis for the "renewal" of the traditional public sector concept of the model employer. Empirically, the paper draws on a survey of trade union representatives from 238 workplaces and a case study of a hospital trust. The data reveal that employment relations in the NHS are more collectivist when compared with the private sector. However, the development of partnership in the NHS is hamstrung by ongoing training and involvement gaps and widespread work intensification.     

After the downsizing. How to build loyalty and productivity in the wake of restructuring

The restructuring forced on many healthcare organizations today increases employees' stress and threatens their loyalty and productivity. To restore trust and improve morale, and maintain hope, healthcare leaders can implement six strategies: Clearly communicate decisions that affect employees, using verbal and written methods, and show compassion to displaced workers and acknowledge their contributions. Support remaining employees. Tell them why they survived and provide them with new challenges. Allow employees to participate in developing a shared vision of the organization's future. Empower employees by rewarding their accomplishments appropriately. Workers perform better when they develop their "personal power" and believe they are part of a team facing new challenges. Focus on learning and professional growth. New knowledge sparks workers' imaginations and helps them find better ways to accomplish their goals. Ask employees to reflect on their professional legacies-what they wish to be remembered for.     

Trust between managers and physicians in community hospitals: the effects of power over hospital decisions

Trust is a key element of effective work relationships between managers and physicians. Despite its importance, little is known about the factors that promote trust between these two professional groups. We examine whether manager and physician power over hospital decisions fosters manager-physician trust. We expect that with more power, managers and physicians will have greater control to enforce decisions that benefit the interests of both groups. Subsequently, they may gain confidence that their interests are supported and have more trust for each other. We test proposed hypotheses with data collected in a national study of chief executive officers and physician leaders in community hospitals in 1993. Findings indicate that power of managers and physicians over hospital decisions is related to manager-physician trust. Consistent with our expectations, physicians perceive greater trust between the two groups when they hold more power in four separate decision-making areas. Our hypotheses, however, are only partially supported in the manager sample. The relationship between power and trust holds in only one decision area: cost/quality management. Our findings have important implications for physician integration in hospitals. A direct implication is that physicians should be given the opportunity to influence hospital decisions. New initiatives, such as task force committees with open membership or open forums on hospital management, allow physicians a more substantial involvement in decisions. Such initiatives will give physicians more "voice" in hospital decision making, thus creating opportunities for physicians to express their interests and play a more active role in the pursuit of the hospital's mission and objectives.     

Promoting employee voice and upward communication in healthcare: the CEO's influence

As noted by the Institute of Medicine (2004), a lack of critical upward feedback in the hospital setting has adverse effects on direct patient care and health outcomes. Employees are oftentimes reluctant to share information, as those above them might interpret the information to be negative or threatening. Leaders then may make important decisions based on assumptions or inaccurate feedback. The situation is especially significant in the healthcare setting, where hierarchical structures (Nembhard and Edmondson 2006), divisions between administrators and clinicians, and lack of collaboration across teams reinforce employee silence and undermine organizational learning (Ramanujam and Rousseau 2006). Chief executive officers play a key role in developing a culture that fosters employee voice and upward communication (Ashford, Sutcliffe, and Christianson 2009). Hospitals winning performance excellence awards, such as those utilizing the Malcolm Baldrige National Quality Award Criteria for Performance Excellence, present a model of high performance with demonstrated results. The purpose of this study was to understand specific CEO behaviors and actions promoting employee voice and upward communication in performance excellence award-winning healthcare organizations. Results suggested the award-winning CEOs facilitated employee voice by being approachable, mainly achieved through their regular presence throughout the organization. By being consistently visible and available to employees these CEOs fostered relationships, built trust, and promoted open communication. Leaders in the study created a cultural focus on continuous improvement largely built around transparency of information, particularly looking for the bad news from their employees. Voice invitation and positive voice response from leaders reinforced that critical upward feedback is not only welcome, but expected.     

Quality circles in a hospital environment.

Much has been written about the role conflict, job tension, and high turnover among hospital employees. There is no doubt that the healthcare environment provides a complex and frustrating working climate for the most dedicated professional employee, and the cost of absenteeism and turnover is a serious problem for healthcare administrators. This report reviews a one-year intervention project at a major western hospital that utilized the Quality Circle process to improve employee withdrawal precursors and behavior.     

Psychometric properties of the Confidence and Trust in Delivery Questionnaire (CTDQ): a pilot study

ABSTRACT: BACKGROUND: Assessing expecting mother's opinions prior to birth draws a comprehensive picture for the caregivers about their emotional state and their expectations. Some questionnaires to cover these aspects do exist. This study aims to present the psychometric properties of a new instrument, the Confidence and Trust in Delivery Questionnaire (CDTQ) a short but reliable a self-report instrument that focuses on confidence and trust as meaningful dimensions for expectant mothers. METHODS: A pilot validation study of 221 women 6 weeks before childbirth was conducted in Germany between October 2007 and June 2008. To detect structural relations between the items, factor and reliability analyses were applied to the CTDQ items. Factor analysis was performed by means of principal components analysis and varimax rotation. Internal reliability was assessed by Cronbach's alpha. External validation was performed using the sense of coherence (SOC) scale. RESULTS: The CTDQ comprises of 11 items. We found a 4-factor structure. The internal consistency of the whole item pool (Cronbach's alpha = 0.79) and the 4 subscales [confidence in labor (alpha = 0.82); partner's support (alpha = 0.62); trust in medical competency (alpha = 0.68); being informed (alpha = 0.60)] can be regarded as sufficient or even excellent. The 4 factors explained 69.6% of total variance. Except for a high intercorrelation (0.70) between "partner's support" and "trust in medical competence", the subscales show low intercorrelations, indicating an adequate independence of the respective subscales. Regarding the external validity we found minor respective moderate correlations with the SOC scale. CONCLUSIONS: Our data suggest that the CTDQ is a useful instrument to assess confidence and trust in delivery. With 4 clinically relevant dimensions, the CTDQ is now open for further studies in the field of labor.