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PubMedDate not supplied

The three keys to quality customer service: opening the doors to exceptional performance.

Excellence in customer service requires three things. The first is a commitment to a set of principles. These principles reflect beliefs and assumptions that people are valuable and deserve to be treated with dignity and respect. This commitment is expressed to customers by an adherence to six customer-friendly processes and by personnel who possess a high level of skill in the behaviors that make up customer service. When these three requirements are met, laboratorians not only maintain a competitive edge but also fulfill their mission as health-care professionals.

Benchmarking↗

PubMedDate not supplied

Patient reactions to nutrition education for cholesterol reduction.

The purpose of this study was to assess the perceptions of patients with elevated cholesterol who participated in a physicians' office-based cholesterol management program and to compare patient reports with clinic counseling records. We conducted telephone interviews with 94 patients from five family practice clinics participating in the Physician-Based Nutrition Program (PBNP) between January and March 1988. Within two weeks after a cholesterol counseling visit, interviewers asked patients what happened during the cholesterol management process, queried their understanding of their health risk and recommended dietary changes, and assessed their attitudes toward the educational process and recommended nutrition behavior changes. Results indicate that a large majority of patients understood the problem of high cholesterol and the needed behavior changes and were highly satisfied with the cholesterol management process. However, patients' memory of specific facts, such as their cholesterol levels and behavioral goals, was often incorrect. We discuss the implications of these findings for developing and providing patient cholesterol education.

Adult↗

PubMed1989

[Difficult patient in dentistry. Construction of a model of personal attributes for identification].

The communication between the dentist and the patient, or what we have called dentist-patient relationship constitute itself a clue to solve primary problems derived of the professional practice. In this relationship with patients, the dentist may face what we have called difficult patient. This difficult patient have several behavioral characteristics which can alter the dentist emotional equilibrium, the capacity of making proper diagnosis and finally a successful treatment may not be obtain as an end result. The difficult patient behavior may be explained by a variety of factors such as: the type of pathology, the office environment, the community and/or institution to which the patient belongs, the dentist emotional circumstance and at last the patient life style. In this research work, we interview 50 professionals from the metropolitan area with an average of 18 years in practiCe, each dentist explained situations in which the patient behavior could be typified as difficult. A number of 202 difficult patient cases were obtained and they were classified into 14 categories. 5 categories presented a higher frequency: a) Schedule and/or appointment timing. b) Patients not following instructions and/or altering treatment. c) Anxious patients. d) Patients unhappy with their treatment. e) Authoritarian patients or patients without good manners. This 5 categories were present in the 60% of the situations and can be taken as a model with specific behavioral characteristics as to identify the difficult patient. This is valuable in order to manage this type of patients and be successful.

Adolescent↗

PubMed1992

Physician peer review surveys: a management tool for improving quality of patient care.

An increasing number of patients are presenting multiple medical problems requiring the collaboration of two or more physician specialists or subspecialists for effective treatment. The quality of care delivered to multiple-problem patients depends greatly on how well the physician specialists interact with one another. The Cleveland Clinic Foundation (CCF) has developed and implemented a physician peer review survey that enables physicians to receive anonymous feedback on the service they provide to their colleagues. The survey has been implemented in both medical and surgical departments. Colleagues have identified areas for improvement to increase collaboration and enhance effectiveness in treating multiproblem patients. The data have led to a variety of specific service-related improvements and changes in physician behavior. Though originally conceived as a quality improvement technique, the physician review survey has become an internal marketing and management tool for physician managers.

Consumer Behavior↗

PubMed2003

Maximum information approach to scale description for affective measures based on the Rasch model.

Using the Rasch model for ordered categories, this paper provides a method for qualitative interpretations of data from an affective measure such as an attitude scale or survey instrument. The Bock procedure is first used to partition the total item information to each response category. The location of each response category is determined by maximizing the information associated with this category. The response categories that cluster around a given point on the latent trait are then used to provide a qualitative description of this point. The description is explicit in terms of the behaviors or activities that are likely to be displayed by a respondent at this point. An illustration is provided using an alumni survey used at a large university in the southeast.

Attitude↗

PubMed1983

Patient selection and patient satisfaction.

Patient selection is difficult. Modern-day plastic surgeons are becoming increasingly aware that patient selection is an important aspect of a successful surgical practice. Evaluation of the patient as a whole rather than just the deformity is necessary to avoid dissatisfied patients. Surgeons should, during the initial interview, consider the acronym SAFE, asking open-ended questions and evaluating the patient. Patient selection rules for outpatient facilities are an extension of patient selection in general. Either patient or surgeon may have reasons for choosing the hospital over the outpatient facility for the procedure. The importance of patient selection extends to patient management as a whole. Appropriate management is even more important in the office-based setting because the stress may have more of an impact on the patient than for hospitalized procedures. Awareness of the stress state in surgery and the patient's personality style allows for a knowledgeable surgeon and staff to anticipate behaviors and emotions and use appropriately their power and nurturance to lead the patient to the ultimate goal, a feeling of satisfaction with the surgical result.

Ambulatory Surgical Procedures↗

PubMed1986

Patients who leave without being seen.

We conducted this study because very little is known about patients who leave without being seen. A total of 4,868 patients were registered in an emergency department during a six-week study period. Sixty-eight (1.4%) left before treatment was completed; 97% (66 patients) left before ever being seen by a physician. Thirty of the 68 patients were interviewed later in followup A comparison group of 23 patients who did not leave prematurely was also selected and matched for age, sex, urgency of chief complaint, and time of presentation. Fourteen of these patients were interviewed later. Patients who left without being seen (LWBS) and nonLWBS patients did not differ in waiting time in the ED. The two groups also did not differ in the spectrum of chief complaints. Twenty-two of 30 LWBS patients were suffering from acute psychological distress at the time of their visit, however, compared to only one of the comparison group (P = .0005). The walkouts reported recent deaths of relatives or friends, recent bouts of alcoholism, acute financial problems, suicidal thoughts and behavior, court appearances, pregnancies and miscarriages, new people in the home, acute illnesses in relatives, and other psychological and social crises.

Adolescent↗

PubMed2004

Medicaid behavioral health care plan satisfaction and children's service utilization.

This study examines associations between caregivers' satisfaction with children's Medicaid-funded behavioral health care plans and the likelihood that children with severe emotional disturbance receive mental health services. Data are from a multisite study of managed care versus fee-for-service (FFS) settings. In multivariate logistic regression analyses controlling for demographic, environmental, site, and clinical characteristics, plan satisfaction was associated with greater likelihood of subsequent service use regardless of managed care versus FFS setting. Children in managed care plans were less likely to use intensive residential and non-traditional outpatient services. Efforts to increase plan satisfaction may encourage service use, consequently, improving children's behavioral health outcomes.

Caregivers↗

PubMed1998

Fishing, consumption, and risk perception in fisherfolk along an east coast estuary.

Increasingly public and governmental agencies are concerned about the safety of fish and shellfish that recreational fishermen consume. Fishing behavior, consumption patterns, and risk perceptions were examined for people flashing and crabbing in Barnegat Bay, NJ. Women fished in significantly larger groups than men, and their groups included more children. Subjects fished an average of seven times per month and crabbed three times per month; they caught fish on most outings, and 80% ate their catch. Subjects consumed fish an average of five times a month, eating just under 10 oz (ca. 280 g) per meal. Only 25% of the fish consumed by women, and 49% of the fish consumed by men, are self-caught. Nearly 90% of the people believe the fish and crabs from Barnegat Bay are safe to eat, although about 40% have heard some warnings about their safety. Most people heard about advisories from newspapers or television. Most subjects believe that saltwater fish are safer than freshwater fish and that fish they catch themselves or buy in a bay store are safer than those from a supermarket. People generally do not have a clear understanding of the relationship between contaminants and fish size or trophic level, suggesting an avenue for risk reduction.

Adolescent↗

PubMed1999

Introduction of a recorded health information line into a pediatric practice.

OBJECTIVE: To examine the utilization, satisfaction, and parental health-seeking behavior associated with the introduction of the Parent Advice Line (PAL), a collection of 278 recorded health-related messages accessible by telephone, into a private practice. DESIGN: Booklets listing PAL topics were mailed to eligible families, and utilization data were collected for all incoming PAL calls from June to August 1996. Satisfaction and effect on health-seeking behavior were assessed using a recorded questionnaire appended to each call (n = 561) and a randomized telephone questionnaire (n = 821). SETTING: A suburban, 7-pediatrician practice in Colorado. PATIENTS: Families with children younger than 12 years seen in the practice within 2 years (N = 8365). RESULTS: Of families who reported receiving the mailed PAL booklet, 32% used PAL. Sixty percent of PAL calls were placed during office hours, 21% from 5 PM to 9 PM, and 8% after midnight; call volume was higher on weekdays than on weekend days (25 calls per day vs 10 calls per day, respectively; P<.05 by chi2 test). The 5 most commonly requested topic categories were toilet training, sexual development, discipline problems, sleep problems, and teenage behavior. Preventive care topics predominated in infants, behavioral topics in preschool children, and acute illness topics in school-aged children. Of users, 88% were satisfied or very satisfied and 98% said that they would use PAL again. Respondents to the 2 questionnaires reported that use of PAL made a call or visit to their child's physician unnecessary 58% to 69% and 61% to 70% of the time, respectively. CONCLUSIONS: The PAL was used primarily to access information about behavioral and developmental issues during office hours. Its use was associated with high rates of satisfaction and, by parental report, decreased calls or visits to a physician.

Adult↗

PubMed1985

A comprehensive quality assurance system for practicing dentists.

A comprehensive outcome-oriented quality assurance methodology manual has been developed for use by practicing dentists. The audit consists of four parts. Provision for immediate feedback to providers in order to monitor behavior change is a critical part of the review process as is the emphasis on the appropriateness of care dimension, a relatively unexplored area of quality assurance activity.

Clinical Competence↗

PubMed2005

Deficits in amygdaloid cAMP-responsive element-binding protein signaling play a role in genetic predisposition to anxiety and alcoholism.

We investigated the role of cAMP-responsive element-binding protein (CREB) in genetic predisposition to anxiety and alcohol-drinking behaviors using alcohol-preferring (P) and -nonpreferring (NP) rats. The levels of CREB, phosphorylated CREB, and neuropeptide Y (NPY) were innately lower in the central amygdala (CeA) and medial amygdala (MeA), but not in the basolateral amygdala (BLA), of P rats compared with NP rats. P rats displayed higher baseline anxiety-like behaviors and consumed higher amounts of alcohol compared with NP rats. Ethanol injection or voluntary intake reduced the higher anxiety levels in P rats. Ethanol also increased CREB function in the CeA and MeA, but not in the BLA, of P rats. Infusion of the PKA activator Sp-cAMP or NPY into the CeA decreased the alcohol intake and anxiety-like behaviors of P rats. PKA activator infusion also increased CREB function in the CeA of P rats. On the other hand, ethanol injection or voluntary intake did not produce any changes either in anxiety levels or on CREB function in the amygdaloid structures of NP rats. Interestingly, infusion of the PKA inhibitor Rp-cAMP into the CeA provoked anxiety-like behaviors and increased alcohol intake in NP rats. PKA inhibitor decreased CREB function in the CeA of NP rats. These novel results provide the first evidence to our knowledge that decreased CREB function in the CeA may be operative in maintaining the high anxiety and excessive alcohol-drinking behaviors of P rats.

Alcoholism↗

PubMed1987

Effects of modeling on patient communication, satisfaction, and knowledge.

This experimental study investigated the efficacy of two modeling procedures on enhancing patient communication. A pretreatment interview assessed knowledge, assertiveness, and other concomitant variables. A total of 150 subjects were randomly assigned to one of three treatment conditions. The two modeling conditions were videotaped presentations of a health educator interacting with a patient (i.e., model) who either asked questions or revealed problems. The control videotape included only the educator's presentation; no patient was shown. A subsequent standardized face-to-face patient education session was used to assess the impact of the intervention on patient communicative behaviors. A posttreatment interview assessed knowledge and satisfaction. Subjects who viewed a modeling videotape spoke more than subjects who viewed a control videotape. The bulk of our findings indicated that a question-asking model was generally more effective than a disclosive model in eliciting communicative behaviors. Knowledge scores were found to increase after the intervention, regardless of subjects' verbal participation. Subjects in either of the modeling conditions who spoke more indicated higher affective satisfaction.

Adult↗

PubMed1982

The effect of medical institutions on doctor-patient interaction in Costa Rica.

The nature and quality of interaction and communication between doctor and patient is an important determinant in adequacy of health care. But patient behavior and physician performance are themselves influenced by the institutional and political setting. Study of two Costan Rican medical care systems reveals how historical differences in ideology and expectation can shape institutions and their services.

Attitude to Health↗

PubMed2004

Engaging employees in health care can contain costs and improve quality.

Employers need to do much more to change some of the deep-seated employee attitudes and behaviors that are driving health care costs. This article debunks common employer misconceptions about employees' attitudes and behaviors with regard to health care. It then discusses the results employers can obtain by taking specific initiatives that provide employees with the motivation and resources they need to effectively manage health risks and make informed health care decisions.

Adult↗

PubMed1990

Dentists' technical competence, communication, and personality as predictors of dental patient anxiety.

Previous research has found that many factors influence patients' dental anxiety, many of which are related to the practitioner's technical and interpersonal skill. Unfortunately, a confirmatory factor analysis of scales used in dental anxiety research revealed numerous problems with the measurement devices. The Spielberger State-Trait Anxiety Inventory (STAI) split into two subscales: calmness and anxiety. The Corah Dental Anxiety Scale (CDAS) was unidimensional but was unable to detect relationships between anxiety and interpersonal or communication factors. Interestingly, patient satisfaction, dentist behavior, and empathy items did not load on independent scales, as previously reported in the literature. Instead, five clusters were detected: positive and negative communication, positive and negative interpersonalness, and perceived technical competence.

Anxiety↗

PubMed1989

Families' experiences in psychiatric emergencies.

Sixty families from three self-help, psychoeducational groups in western New York State were interviewed about their experiences during recent psychiatric emergencies involving their mentally ill relatives. Twenty-six hospital-based emergency mental health service providers were compared with the families on key attitudes toward emergency services. Families reported that emergencies were complicated and traumatic and that they involved contacts with numerous agencies, sometimes over several months. Satisfaction with the emergency service system was generally low among both families and hospital service providers. Service providers were less likely than families to believe that families' assessments of their ill relatives' need for treatment were credible. The author suggests that apparently "crazy" behavior of families may make sense in the context of serious patient pathology and a general lack of emergency assistance. Much effort is needed to develop coordinated emergency mental health treatment that is sensitive to families' needs.

Adaptation, Psychological↗

PubMed1989

A path analysis of an adolescent drinking behavior model derived from problem behavior theory.

The interrelationships between composite variables comprised of demographics, socialization, personality, perceived environment, conventional and problem behaviors, and their combined mediational influences on adolescent drinking behavior are examined. Students randomly sampled from four suburban, metropolitan-area high schools (N = 499) were administered the 250-question Survey of Underage Drinking Styles. All 12 composite variables, derived from the survey, were arranged in a causal model and submitted to a confirmatory path analysis. Data were analyzed by multiple regression procedures. According to the present model, a powerful pathway through to drinking may begin with family interaction problems, which may lead to a reduction in the adolescent's social coping skills. A reduction in the adolescent's coping skills may lead to a compensatory belief that alcohol improves mental and physical functions and an increased affiliation with and acceptance of the peer group's attitude and behavior toward consuming alcohol as a replacement coping skill. The adolescent's drinking may then increase as a result of the affiliative need to conform to peer group pressure.

Adolescent↗