The Impact of Physician Job Satisfaction on the Sustained Competitive Advantage of Health Care Organizations

This paper employs the resource-based theory of the firm to explain the influence of human resources on the sustained competitive advantage of an organization. Based on previous conceptual and empirical literature, we posit that the presence of a high potential employee workforce, coupled with adequate human resource management policies, can result in improved profit generating potential. We developed a conceptual framework with several propositions that illustrate the associations between job satisfaction and organizational productivity. We apply this concept in the health care field, suggesting that the satisfaction of physicians’ needs leads to greater organizational productivity and sustained competitive advantage

Who Is a Hospital’s “Customer”?

The Centers for Medicare & Medicaid Services (CMS) now includes the patient experience in calculating a hospital's reimbursement for services rendered. CMS's addition has led hospitals to incorporate customer service initiatives whose goal is to improve the patient experience, with varying degrees of success. A possible reason for the less-than-successful outcomes may be organizations' failure to identify who the customer is and what is important to that customer. This study used focus groups at an acute care, for-profit hospital in the southwestern United States to gather the perspectives of healthcare team members and patients on who should be labeled a hospital's customer and what factors influence customer satisfaction. The data reveal that neither patients nor physicians considered patients to be customers, with the possible exception of elective surgery patients. In contrast, administrators viewed patients as customers, regardless of the circumstances surrounding the patient's admission. Nursing and other service staff often applied both the customer and the patient labels to their patients. Most participants viewed physicians as a hospital's customers. The following were found to be important predictors of patient satisfaction: effective interdisciplinary relationships, adequate nurse staffing levels, high-quality and good-tasting food, minimal wait times, and hospital cleanliness. The study further determined that physician satisfaction is influenced by having a permanent healthcare team (nurses, hospitalists) taking care of their patient, good communication and care coordination, operating room readiness, and hospital staff recognizing the physician by sight throughout the facility. This study's results may be useful for hospital administrators interested in using customer service initiatives to improve the overall patient experience in their organization

The Relationship between External Environment and Physician E-mail Communication: The Mediating Role of Health Information Technology (HIT) Availability

Background: Physician e-mail communication, with patients and other providers, is one of the cornerstones of effective care coordination but varies significantly across physicians. A physician's external environment may contribute to such variations by enabling or constraining a physician's ability to adopt innovations such as health information technology (HIT) that can be used to support e-mail communication. Purpose: The aim of the study was to examine whether the relationship of the external environment and physician e-mail communication with patients and other providers is mediated by the practice's HIT availability. Methodology: The data were obtained from the Health Tracking Physician Survey (2008) and the Area Resource File (2008). Cross-sectional multivariable subgroup path analysis was used to investigate the mediating role of HIT availability across 2,850 U.S. physicians. Findings: Solo physicians' perceptions about malpractice were associated with 0.97 lower odds (p < .05) of e-mail communication with patients and other providers, as compared to group and hospital practices, even when mediated by HIT availability. Subgroup analyses indicated that different types of practices are responsive to the different dimensions of the external environment. Specifically, solo practitioners were more responsive to the availability of resources in their environment, with per capita income associated with lower likelihood of physician e-mail communication (OR = 0.99, p < .01). In contrast, physicians working in the group practices were more responsive to the complexity of their environment, with a physician's perception of practicing in environments with higher malpractice risks associated with greater information technology availability, which in turn was associated with a greater likelihood of communicating via e-mail with patients (OR = 1.02, p < .05) and other physicians (OR = 1.03, p < .001). Practical Applications: The association between physician e-mail communication and the external environment is mediated by the practice's HIT availability. Efforts to improve physician e-mail communication and HIT adoption may need to reflect the varied perceptions of different types of practices

Considering shared power and responsibility: Diabetic patients’ experience with the PCMH care model

The patient-centered medical home (PCMH), an innovative primary care model that fosters a stronger, more personal patient-doctor relationship than traditional health care models, should be particularly well suited for the treatment of chronic conditions such as diabetes that require ongoing management by both patients and providers. Despite growing research on the effectiveness of PCMHs in diabetes care, relatively little attention has been given to diabetic patients’ experiences. This qualitative study examines diabetic patients’ experiences at one PCMH setting, using in-depth interviews to understand patients’ perspectives of the shared power and responsibility between patient and provider in their diabetes care. Our results suggest that even when patients feel comfortable and cared for by the physician, they may choose to take a more passive role in discussions about their diabetes in the clinical encounter because 1) they may see diabetes as a secondary concern, or 2) they may be consciously differentiating between their physician’s responsibility over the physical domain of the illness and the patient’s responsibility over the lifestyle domain of the illness. Thus, in order to build a relationship that is characterized by shared power and responsibility between patient and provider, physicians should not only strive to create an atmosphere in which the patient feels both cared for and listened to, they also need to be aware of patient’s preconceptions about the clinical encounter. This awareness would allow physicians to encourage more active patient participation in the clinical encounter and support patients more effectively in their self-management journey

Balancing patient-centered and safe pain care for non-surgical inpatients: clinical and managerial perspectives

Background: Hospitals and clinicians aim to deliver care that is safe. Simultaneously, they are ensuring that care is patient-centered, meaning that it is respectful of patients’ values, preferences, and experiences. However, little is known about delivering care in cases where these goals may not align. For example, hospitals and clinicians are facing the daunting challenge of balancing safe and patient-centered pain care for nonsurgical patients, due to lack of comprehensive care guidelines and complexity of this patient population. Methods: To gather clinical and managerial perspectives on the importance, feasibility, and strategies used to balance patient-centered care (PCC) and safe pain care for nonsurgical inpatients, we conducted in-depth, semi-structured interviews with hospitalists (n=10), registered nurses (n=10), and health care managers (n=10) from one healthcare system in the Midwestern United States. We systematically examined transcribed interviews and identified major themes using a thematic analysis approach. Results: Participants acknowledged the importance of balancing PCC and safe pain care. They envisioned this balance as a continuum, with certain patients for whom it is easier (e.g., opioid-naïve patient with a fracture), versus more difficult (e.g., patient with opioid use disorder). Participants also reported several strategies they use to balance PCC and safe pain care, including offering alternatives to opioids, setting realistic pain goals and expectations, and using a team approach. Conclusions: Clinicians and health care managers use various strategies to balance PCC and safe pain care for nonsurgical patients. Future studies should examine the effectiveness of these strategies on patient outcomes

Clinical perspectives on hospitals’ role in the opioid epidemic

Policymakers, legislators, and clinicians have raised concerns that hospital-based clinicians may be incentivized to inappropriately prescribe and administer opioids when addressing pain care needs of their patients, thus potentially contributing to the ongoing opioid epidemic in the United States. Given the need to involve all healthcare settings, including hospitals, in joint efforts to curb the opioid epidemic, it is essential to understand if clinicians perceive hospitals as contributors to the problem. Therefore, we examined clinical perspectives on the role of hospitals in the opioid epidemic

An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy

Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis (n = 10), spondylosis (n = 6), and low back pain (n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits

Poly[[diaqua[μ5-(R,S)-2-({2-[(1,2-di­carboxyl­atoeth­yl)amino]­eth­yl}amino)­butane­dioato]cobaltate(III)sodium] di­hydrate]

In the asymmetric unit of the title coordination polymer, {[CoNa(C10H12N2O8)(H2O)2]·2H2O}n, the CoII ion is coord­inated in a distorted octa­hedral environment, defined by two N atoms and four carboxyl­ate O atoms. Two CoII ions and two 2-({2-[(1,2-dicarboxyl­atoeth­yl)amino]­eth­yl}amino)­butane­dio­ate (EDDS) ligands form a dimeric complex dianion [Co2(EDDS)2]. These dimeric units are connected via Na+ ions, forming a three-dimensional polymeric structure. In the crystal, the ligand N—H groups and the coordinated and solvent water mol­ecules are involved in inter­molecular N—H⋯O and O—H⋯O hydrogen bonding, reinforcing the three-dimensional polymeric structure

Environmental Market Factors Associated with Physician Career Satisfaction

Previous research has found that physician career satisfaction is declining, but no study has examined the relationship between market factors and physician career satisfaction. Using a theoretical framework, we examined how various aspects of the market environment (e.g., munificence, dynamism, complexity) are related to overall career satisfaction. Nationally representative data from the 2008 Health Tracking Physician Survey were combined with environmental market variables from the 2008 Area Resource File. After controlling for physician and practice characteristics, at least one variable each representing munificence, dynamism, and complexity was associated with satisfaction. An increase in the market number of primary care physicians per capita was positively associated with physician career satisfaction (OR = 2.11, 95% CI: 1.13 to 3.9) whereas an increase in the number of specialists per capita was negatively associated with physician satisfaction (OR = 0.68, 95% CI: 0.48 to 0.97). Moreover, an increase in poverty rates was negatively associated with physician career satisfaction (OR = 0.95, 95% CI: 0.91 to 1.01). Lastly, physicians practicing in states with a malpractice crisis (OR = 0.81, 95% CI: 0.68 to 0.96) and/or those who perceived high competition in their markets (OR = 0.76, 95% CI: 0.61 to 0.95) had lower odds of being satisfied. A better understanding of an organization\u27s environment could assist healthcare managers in shaping their policies and strategies to increase physician satisfaction

Environmental Factors Associated with Physician\u27s Engagement in Communication Activities

BACKGROUND: Communication between patients and providers is a crucial component of effective care coordination and is associated with a number of desired patient and provider outcomes. Despite these benefits, physician-patient and physician-physician communication occurs infrequently. PURPOSE: The purpose of this study was to examine the relationship between a medical practice\u27s external environment and physician engagement in communication activities. METHODOLOGY/APPROACH: This was a cross-sectional examination of 4,299 U.S. physicians\u27 self-reported engagement in communication activities. Communication was operationalized as physician\u27s time spent on communication with patients and other providers during a typical work day. The explanatory variables were measures of environmental complexity, dynamism, and munificence. Data sources were the Health Tracking Physician Survey, the Area Resource File database, and the Dartmouth Atlas. Binary logistic regression was used to estimate the association between the environmental factors and physician engagement in communication activities. FINDINGS: Several environmental factors, including per capita income (odds ratio range, 1.17-1.38), urban location (odds ratio range, 1.08-1.45), fluctuations in Health Maintenance Organization penetration (odds ratio range, 3.47-13.22), poverty (odds ratio range, 0.80-0.97) and population rates (odds ratio range, 1.01-1.02), and the presence of a malpractice crisis (odds ratio range, 0.22-0.43), were significantly associated with communication. PRACTICE IMPLICATIONS: Certain aspects of a physician\u27s external environment are associated with different modes of communication with different recipients (patients and providers). This knowledge can be used by health care managers and policy makers who strive to improve communication between different stakeholders within the health care system (e.g., patient and providers)