Search results

The purpose of this paper is to assess the relationship between patient satisfaction and a variety of clinical quality measures in an ambulatory setting to determine if there is significant overlap between patient satisfaction and clinical quality or if they are separate domains of overall physician quality. Assessing this relationship will help to determine whether there is congruence between different types of clinical quality performance and patient satisfaction and therefore provide insight to appropriate financial structures for physicians.

Ordered probit regression analysis is conducted with overall rating of physician from patient satisfaction responses to the Clinician and Groups Consumer Assessment of Healthcare Providers and Systems survey as the dependent variable. Physician clinical quality is measured across five composite groups based on 26 Healthcare Effectiveness Data and Information Set (HEDIS) measures aggregated from patient electronic health records. Physician and patient demographic variables are also included in the model.

Better physician performance on HEDIS measures are correlated with increases in patient satisfaction for three composite measures: antibiotics, generics, and vaccination; it has no relationship for chronic conditions and is correlated with decrease in patient satisfaction for preventative measures, although the negative relationship for preventative measures is not robust in sensitivity analysis. In addition, younger physicians and male physicians have higher satisfaction scores even with the HEDIS quality measures in the regression.

There are four primary limitations to this study. First, the data for the study come from a single hospital provider organization. Second, the survey response rate for the satisfaction measure is low. Third, the physician clinical quality measure is the percent of the physician’s relevant patient population that met the HEDIS measure rather than if the measure was met for the individual patient. Finally, it is not possible to distinguish if the significant coefficient estimates on the physician age and gender variables are capturing systematic differences in physician behavior or capturing patient bias.

The results suggest patient satisfaction and physician clinical quality may be complementary, capturing similar aspects of overall physician quality, across some clinical quality measures but for other measures satisfaction and clinical quality are unrelated or negatively related. Therefore, for some clinical quality metrics, it will be important to separately compensate clinical quality and satisfaction and understand the relationship between metrics. Finally, the strong relationship between the level of patient satisfaction and physician age, physician gender, and patient age are important to consider when designing a physician compensation package based on patient satisfaction; if these differences reflect patient bias they could increase inequality among medical staff if compensation is based on patient satisfaction.

This study is the first to use physician organization data to examine patient satisfaction and physician performance on a variety of HEDIS quality metrics.

In this paper, we provide an assessment of the intertemporal economic well-being of a representative sample of females who became new Social Security Disability Insurance (SSDI) beneficiaries in 1982. We compare their economic circumstances over the 1982 to 1991 period with those of both disabled men who became new SSDI beneficiaries in 1982, and a matched sample of nondisabled females who had sufficient work experience for benefit eligibility should they have become disabled. In 1982, the new SSDI women beneficiaries were a relatively poor segment of U.S. society. One quarter of them lived in poverty, and 48 percent had incomes below 150 percent of the poverty line. Over the subsequent decade, some of those married in 1982 lost husbands and the income contributed by their husbands. Yet, as of 1991, over one half of these disabled women lived in families with income below 150 percent of the poverty line. Social Security benefits to disabled women have played an important, and growing, role in sustaining economic status. Nevertheless, the level of well-being of these women lies substantially below that of the comparison groups, and for some groups of the women, well-being trends were negative both absolutely and relative to the comparison groups. We statistically relate the poverty status of these new female recipients to sociodemographic factors that would be expected to contribute to low well-being, and simulate the effect of Social Security benefits in reducing poverty and replacing earnings. We suggest a number of SSDI-related policy changes that could, at low cost, reduce poverty among those women with the highest incidence rates.

In the present chapter, we present the case study of the only woman film director who has ever won an Academy Award for Best Director, Kathryn Bigelow. We analyzed 43 written interviews of Kathryn Bigelow that have appeared in the popular press in the period 1988–2013 and outlined eight main themes emerging regarding her exercise of leadership in the cinematic context. We utilize three theoretical frameworks: (a) paradoxical leadership theory (Lewis, Andriopoulos, & Smith, 2014; Smith & Lewis, 2012); (b) ambidextrous leadership theory (Rosing, Frese, & Bausch, 2011), and (c) role congruity theory (Eagley & Karau, 2002) and show how Bigelow, as a woman artist/leader working in a complex organizational system that emphasizes radical innovation, exercised paradoxical and ambidextrous leadership and challenged existing conventions about genre, gender, and leadership. The case study implications for teaching and practice are discussed.

A method to engage salient organisational stakeholders in identifying and ranking measures of healthcare improvement programs is described. The method is illustrated using Executive WalkRounds (EWRs) in a multi-site Australian Health District.

Subject matter experts (SMEs) conducted document analysis, identified potential EWRs measures, created driver diagrams and then eliminated weak measures. Next, a panel of executives skilled in EWRs ranked and ratified the potential measures using a modified Delphi technique.

EWRs measurement selection demonstrated the feasibility of the method. Of the total time to complete the method 79% was contributed by SMEs, 14% by administration personnel and 7% by executives. Document analysis revealed three main EWRs aims. Ten of 28 potential measures were eliminated by the SME review. After repeated Delphi rounds the executive panel achieved consensus (75% cut-off) on seven measures. One outcome, one process and one implementation fidelity metric were selected to measure and monitor the impact of EWRs in the health district.

Perceptions of weak relationships between measures and intended improvements can lead to practitioner scepticism. This work offers a structured method to combine the technical expertise of SMEs with the practical knowledge of healthcare staff in selecting improvement measures.

This research describes and demonstrates a novel method to systematically leverage formal and practical types of expertise to select measures that are strongly linked to local quality improvement goals. The method can be applied in diverse healthcare settings.

Since the development of the COVID-19 vaccinations, questions surrounding race have been prominent in the literature on vaccine uptake. Early in the vaccine rollout, public health officials were concerned with the relatively lower rates of uptake among certain racial/ethnic minority groups. We suggest that this may also be patterned by racial/ethnic residential segregation, which previous work has demonstrated to be an important factor for both health and access to health care.

In this study, we examine county-level vaccination rates, racial/ethnic composition, and residential segregation across the U.S. We compile data from several sources, including the American Community Survey (ACS) and Centers for Disease Control (CDC) measured at the county level.

We find that just looking at the associations between racial/ethnic composition and vaccination rates, both percent Black and percent White are significant and negative, meaning that higher percentages of these groups in a county are associated with lower vaccination rates, whereas the opposite is the case for percent Latino. When we factor in segregation, as measured by the index of dissimilarity, the patterns change somewhat. Dissimilarity itself was not significant in the models across all groups, but when interacted with race/ethnic composition, it moderates the association. For both percent Black and percent White, the interaction with the Black-White dissimilarity index is significant and negative, meaning that it deepens the negative association between composition and the vaccination rate.

The analysis is only limited to county-level measures of racial/ethnic composition and vaccination rates, so we are unable to see at the individual-level who is getting vaccinated.

We find that segregation moderates the association between racial/ethnic composition and vaccination rates, suggesting that local race relations in a county helps contextualize the compositional effects of race/ethnicity.

Describes the efforts of the owner/directors of a private limited company to put into place a succession strategy. Considers three major themes: second generation entrepreneurs/management succession; action learning as a human resource development strategy and philosophy; and the learning organization. Concludes that people (and organizations) “learn” best from the priorities of the business, once they have been identified, and that organizational learning is really based on institutionalization of what has been learned – requisite learning.

The aim of this paper is to examine gendered identities of women academics by exploring the interplay and exploitation of internal and external, personal and academic, identities. The paper also considers the relative prioritisation of the three main academic activities of teaching, research, and administration, in which an enhanced emphasis on research performance, as opposed to teaching and administration, is what is often deemed to represent “success” in academia.

Drawing on autoethnographical detail, the paper reflects on the complexities of identities as they are constructed, developed, experienced and understood both by themselves and by others. By presenting several short autobiographical vignettes, the paper examines perceptions of the gendered identity of women in academia as caring, “motherly” and nurturing, and demonstrates attempts to exploit so‐called “natural” feminine, mothering traits as a means of fulfilling the pastoral and administrative components of universities.

In considering such stereotypes, the paper addresses examples of their self‐fulfilment, whilst considering how academic structures and practices also impose such distinctions, in a context where academic “success” is often typified by research, publications and academic networking.

The paper considers both possibilities for resistance and the negative implications for the career success of women academics, arguing that, until these gendered stereotypes are challenged, women academics will continue to be disadvantaged within academic institutions.

Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated.

This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospital’s ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm.

This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends.

This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patients’ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individual’s function of self-harm.

This paper is the first, to the authors’ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic.

While known by many names, qualifying exams function as gatekeepers to graduate student advancement to PhD candidacy, yet there has been little formal study on best qualifying exam practices particularly in biomedical and related STEM PhD programs. The purpose of this study is to examine the current state of qualifying exams through an examination of the literature and exploration of university-wide policies.

The authors conducted a literature review of studies on qualifying exams and completed an external evaluation of peer institutions’ and internal institutional qualifying exam requirements to inform our discussion of qualifying exams practices in PhD training at a research-intensive US institutions.

This study identified the need for more research on qualifying exams to establish evidence-based best practices. The authors found a wide variety of qualifying exam formats, with little evidence in support for specific formats. The authors also found little evidence that student expectations are made clear. The lack of evidence-based best practices coupled with insufficient clarity for students has a real potential to disadvantage PhD students, particularly first generation, underrepresented minority, international and/or other trainees who are not privileged or socialized to navigate training environments with vague landmarks such as the qualifying exams.

There are very few studies that evaluate qualifying exams in US doctoral education, particularly in STEM fields, and to the authors’ knowledge, there has been no analysis of campus-wide policies on qualifying exams reported. The lack of evidence for best practices and the need for to evaluate the implementation and effectiveness of qualifying exams are discussed.