Understanding patients' satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England.

BACKGROUND: Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients' satisfaction with PA acute hospital encounters through PA-patient communication experiences. METHODS: A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication. RESULTS: Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion. CONCLUSIONS: PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient's perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles

Enhanced performance measurement using OR: a case study

The case study described in this paper aims to illustrate how qualitative and quantitative system dynamics modelling and multicriteria analysis can be used in an integrated way to enhance the process of performance measurement and management in the radiotherapy department of a major UK cancer treatment centre. The complexity of the radiotherapy process and its significance for patients present particular challenges for performance measurement and management. The paper discusses the benefits arising and the practical difficulties faced in the study

Predator-prey encounter rates in freshwater piscivores: effects of prey density and water transparency

One of the most fundamental components of predator-prey models is encounter rate, modelled as the product of prey density and search efficiency. Encounter rates have, however, rarely been measured in empirical studies. In this study, we used a video system approach to estimate how encounter rates between piscivorous fish that use a sit-and-wait foraging strategy and their prey depend on prey density and environmental factors such as turbidity. We first manipulated prey density in a controlled pool and field enclosure experiments where environmental factors were held constant. In a correlative study of 15 freshwater lakes we then estimated encounter rates in natural habitats and related the results to both prey fish density and environmental factors. We found the expected positive dependence of individual encounter rates on prey density in our pool and enclosure experiments, whereas the relation between school encounter rate and prey density was less clear. In the field survey, encounter rates did not correlate with prey density but instead correlated positively with water transparency. Water transparency decreases with increasing prey density along the productivity gradient and will reduce prey detection distance and thus predator search efficiency. Therefore, visual predator-prey encounter rates do not increase, and may even decrease, with increasing productivity despite increasing prey densities

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SIGLEAvailable from INIST (FR), Document Supply Service, under shelf-number : RP 15877 (1); RP 15877 (2) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc