Measuring Patient and Staff Satisfaction Before and After Implementation of a Paperless Registration System.

EXECUTIVE SUMMARY: While many aspects of patient care have transitioned to digital technology, the patient registration process often is still paper based. Several studies have examined the effects of changes in clinic workflows and appointment scheduling on patient satisfaction, but few have investigated changes from a paper-based to a paperless registration process. The authors measured patient and staff satisfaction before and after implementation of a new, tablet-based registration process at NYU Langone Health's Center for Women's Health in New York City. Mean preimplementation patient satisfaction scores on the six questions related to the registration process (1-5 scale, with 5 being the highest score) ranged from 4.0 to 4.5. Postimplementation satisfaction scores on the nine questions (six premeasure questions and three additional questions related to the tablet-based process) ranged from 4.4 to 4.6, with four of the six premeasures showing statistically significant improvement in patient satisfaction. Staff satisfaction was generally lower (2.8-3.6 preimplementation and 2.8-4 postimplementation), with no statistically significant difference between time frames. Patient satisfaction was relatively high under the paper registration process, and it improved significantly in some respects under the paperless process, while staff satisfaction did not change. The convenience and ease of use of a paperless registration system can help maintain or increase patient and staff satisfaction while introducing new workflows and improving the efficiency of the outpatient registration process. In adopting technology that can lead to changing workflows, organizations should train staff members and support them during the process.

[Hearing Aid Fitting in Adults]. / Hörgeräteversorgung für Erwachsene.

The identification and treatment of hearing disorders belong to the fundamental tasks of an ENT-specialist. In this context the fitting of hearing aids has a special relevance. To verify a highly qualified medical care the knowledge of the audiological threshold values for the indication of the fitting of hearing aids and the detection of early signs for impaired communication are essential. The current quality assurance agreement defines technical and steric conditions pertaining to hearing aid fitting in the context of statutory health insurance. Only after approval of these postulated requirements the attending physician is allowed to bring to account his effort. The current regulations on medical devices specify both the basic requirement for a medical prescription and the expenses for hearing aids that are covered by the healthy insurances. A qualified hearing aid fitting is only possible if the ENT-specialist not only prescribes the device, but also conscientiously checks the comparative adjustments made by the hearing aid acoustician. Beside the knowledge about the general mode of operation and the different types of hearing aids ENT-specialist should know audiological and anatomic limits for the fitting of hearing aids.

Listening to Improve: Transforming Patient Relations Measurement and Reporting in Ontario.

Effective patient relations are important to improve patient experience and deliver better care. Policy and legislative changes in Ontario have increased accountabilities for patient relations and expanded Health Quality Ontario (HQO)'s mandate. In response, HQO collaborated with patients, health sector organizations, associations and the Ministry of Health and Long-Term Care to co-design a patient relations measurement and reporting approach. Informed by an environmental scan, broad consultations, a multi-sector survey and a provincial advisory group, the approach includes standardized patient relations indicators to support measurement and public reporting across the hospital, home and long-term care sectors. Pilot testing with 29 sites across three sectors will inform province-wide implementation.

The Relationship Between Nurse-Reported Safety Culture and the Patient Experience.

OBJECTIVE: The purpose of this study was to better understand the relationship between nurse-reported safety culture and the patient experience in a multistate sample of nurses and patients, matched by hospital unit/service line and timeframe of care delivery. BACKGROUND: Nurses play a key role in the patient experience and patient safety. A strong safety culture may produce positive spillover effects throughout the nurse caregiving experience, resulting in patient perception of a high-quality experience. METHODS: Multivariate mixed-effects regression models were specified using data from a multistate sample of hospital units that administered both the Agency for Healthcare Research and Quality (AHRQ) staff safety culture survey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey over a 12-month period. Survey response variables are measured at the unit (service line) and hospital level. RESULTS: Key variables in the HCAHPS and AHRQ surveys were significantly correlated. Findings highlight the relationship between 3 safety culture domains: teamwork, adequate staffing, and organizational learning on the achievement of a positive patient experience. CONCLUSION: Modifiable aspects of hospital culture can influence the likelihood of achieving high HCAHPS top box percentages in the nursing and global domains, which directly impact hospital reimbursement.

The patient experience: mining the data to improve your score.

As part of Minnesota's 2008 health care reform legislation, the Minnesota Department of Health was required to identify a standard set of measures of clinics' and physicians' quality, one of which was patient experience. In 2012, the first statewide patient experience survey was conducted. The results were made public the following year. This article discusses how clinics and physician groups can use the data from the survey to improve their patient experience scores.

[Dentistry and healthcare legislation 10. The law governing complaints: readily accessible filing procedures]. / Tandheelkunde en gezondheidsrecht. 10. De Wet klachtrecht: laagdrempelig klagen.

The law promises patients a readily accessible means of filing complaints. Healthcare providers are therefore required to adopt regulations governing complaints which satisfy a number of conditions. Most dentists choose to adopt the regulations which have been established by their professional organization. In addition to handling complaints, there is also a provision for mediation, which is often used by patients. Mediation appears, then, to be a successful provision. Many complaints have their origin in insufficient knowledge of healthcare legislation and patients' rights legislation. This demonstrates that more attention should be given to these subjects in educational programmes and programmes in continuing education. The present law governing complaints is expected to be replaced this year by a new, more comprehensive law in which considerable attention will be devoted to the quality of care as well as to complaints. It seems likely, however, that the new law governing complaints will damage the effective manner in which patients' complaints are dealt with in dentistry today.

[Faults and failure: aesthetic rhinoplasty plus brow, eyelid and conchal surgery]. / Fehler und Gefahren: Die ästhetische Rhinoplastik sowie Brauen-, Lid- und -Ohrmuschelkorrektur.

Within the last years aesthetic surgery enjoys greater popularity and acceptance. One of the most frequently asked operations has been the aesthetic rhinoplasty. Hardly any other field of surgery is exposed to such a critical analysis than aesthetic rhinoplasty because the results are so obvious. According to the "International Society of Aesthetic Surgery" (ISAPS) over 980 000 cosmetic rhinoplasties have been performed in 2010. This corresponds to 10.4% of all registered aesthetic procedures worldwide. Complications can not be eliminated in such a large number of nasal operations. Up to 15% of all patients re-consult a doctor for a revision because they are dissatisfied with their final rhinoplasty result. Findings of the tip followed by functional problems and irregularities of the nasal dorsum are named most frequently. The responsible rhinosurgeon has to regard all anatomical and physiological details and to consider ethical and psychological aspects in the preselection and postoperative care of the patient. Aesthetic surgeons should be acquainted with terms and definitions like body image, dysmorphophobia or Thersites complex. Acronyms, like "SIMON" or "SYLVIA", support the physician additionally to analyze and assess the patient. The following article describes the most frequent faults, complications and pitfalls after aesthetic rhinoplasty listed by the anatomical structure. Results will be analyzed, strategies and techniques will be suggested to correct the faults and to prevent them in the future. Furthermore psychologic, social and psychiatric aspects will be discussed and handling with aesthetic patients explained.

A new beginning for health complaints in Queensland: the Health Ombudsman Act 2013 (QLD).

The Queensland Government has recently passed the Health Ombudsman Act 2013 (Qld) which will render Queensland a co-regulatory jurisdiction for the purpose of complaints in relation to all regulated health practitioners. The Act also establishes a single entry complaints management system which will apply not only to regulated health practitioners but also unregulated practitioners and health service facilities and organisations. This column considers the legislatively created positions and processes aimed at strengthening the capacity of the health complaints system to protect the public, ensure safe and competent practice, maintain high standards of service delivery and public confidence in both the practitioners and the system.

Patients' rights and the National Health Service in Britain, 1960s-1980s.

The language of rights has long permeated discussions about health care in Britain, but during the latter half of the 20th century, patients' rights achieved a level of unprecedented prominence. By the end of the 1980s, the language of entitlement appeared to have spread into many areas of the National Health Service: consent to treatment, access to information, and the ability to complain were all legally established patients' rights. Patient organizations played a critical role in both realizing these rights and in popularizing the discourse of rights in health care in Britain. "Rights talk," however, was not without its drawbacks, as it was unclear what kinds of rights were being exercised and whether these were held by patients, consumers, or citizens.

Questions of copyright.

The Berne Convention and the national laws on intellectual property fully apply to PRO instruments. The identification of and access to an original PRO instrument is often associated with copyright ownership. This is the copyright holder of the instrument who will control its access (distribution and reproduction), its adaptation or modification, and its translation. Copyright is a means to protect the integrity of an instrument. The ownership of an instrument should be defined in the beginning between all parties involved, and each step of the instrument's life, including distribution, should be anticipated for purpose of copyright.

To be strategically struggling against resignation: the lived experience of being cared for in forensic psychiatric care.

To be referred to care in forensic psychiatric services can be seen as one of the most comprehensive encroachments society can impose upon a person's life, as it entails a limitation of the individual's freedom with no time limit. This study focuses upon patients' experiences of their life situation in forensic psychiatric wards. Using a Reflective Lifeworld Research approach founded in phenomenology, we analysed 11 qualitative interviews with patients cared for on a maximum security unit in a Swedish forensic psychiatric service. Results show how forensic psychiatric care can be non-caring with only moments of good care, from the patient's perspective. By using different strategies, the patients attempt to adapt to the demands of the caregivers in order to gain privileges. At the same time the patients are lacking meaningful and close relationships and long to get away from the system of forensic care. Being cared for entails struggling against an approaching overwhelming sense of resignation.

Using patient satisfaction as a basis for reimbursement: political, financial, and philosophical implications.

Patient satisfaction has always been important; however, basing monetary value on patients' perceptions is causing a strenuous debate in health care. Hospital administrators and providers alike are scrambling to implement measures to improve patients' experiences of care and avoid cuts in revenue.

College complaints against resident physicians in Canada: a retrospective analysis of Canadian Medical Protective Association data from 2013 to 2017.

BACKGROUND: An understanding of regulatory complaints against resident physicians is important for practice improvement. We describe regulatory college complaints against resident physicians using data from the Canadian Medical Protective Association (CMPA). METHODS: We conducted a retrospective analysis of college complaint cases involving resident doctors closed by the CMPA, a mutual medicolegal defence organization for more than 100 000 physicians, representing an estimated 95% of Canadian physicians. Eligible cases were those closed between 2008 and 2017 (for time trends) or between 2013 and 2017 (for descriptive analyses). To explore the characteristics of college cases, we extracted the reason for complaint, the case outcome, whether the complaint involved a procedure, and whether the complaint stemmed from a single episode or multiple episodes of care. We also conducted a 10-year trend analysis of cases closed from 2008 to 2017, comparing cases involving resident doctors with cases involving only nonresident physicians. RESULTS: Our analysis included 142 cases that involved 145 patients. Over the 10-year period, college complaints involving residents increased significantly (p = 0.003) from 5.4 per 1000 residents in 2008 to 7.9 per 1000 in 2017. While college complaints increased for both resident and nonresident physicians over the study period, the increase in complaints involving residents was significantly lower than the increase across all nonresident CMPA members (p < 0.001). For cases from the descriptive analysis (2013-2017), the top complaint was deficient patient assessment (69/142, 48.6%). Some patients (22/145, 15.2%) experienced severe outcomes. Most cases (135/142, 97.9%) did not result in severe physician sanctions. Our classification of complaints found 106 of 163 (65.0%) involved clinical problems, 95 of 163 (58.3%) relationship problems (e.g., communication) and 67 of 163 (41.1%) professionalism problems. In college decisions, 36 of 163 (22.1%) had a classification of clinical problem, 66 of 163 (40.5%) a patient-physician relationship problem and 63 of 163 (38.7%) a professionalism problem. In 63 of 163 (38.7%) college decisions, the college had no criticism. INTERPRETATION: Problems with communication and professionalism feature prominently in resident college complaints, and we note the potential for mismatch between patient and health care provider perceptions of care. These results may direct medical education to areas of potential practice improvement.

[Rhinoplasty: indication and planning]. / Rhinoplastik: Indikation und Planung.

A plethora of publications addresses surgical techniques in rhinoplasty, whereas substantially less has been published on psychological aspects and the planning of the procedure. This review covers the psychology of the rhinoplasty patient, risk factors for postoperative dissatisfaction, the surgeon-patient relationship, planning of the procedure using computer imaging and obtaining informed consent.

Managing complaints in health and social care.

An important aspect of allowing patients to take control of their health care is the introduction of new procedures for dealing with complaints. This article examines the concepts that underpin the new Department of Health regulations on complaints management and what they will mean for health and social care professionals. It also explains why these regulations focus on restorative justice rather than blame when adverse events occur.

What are the variables that are associated with the patient's wish to sue his physician in patients with acute and chronic pain?

OBJECTIVES: Although there is limited research on patient attributes that may be related to reasons for launching a malpractice suit, no such research has been performed in acute pain patients (APPs) or chronic pain patients (CPPs). The objective of this study was then to develop some statistical models that would describe such patients' attributes. METHODS: A statement about having thoughts of suing a physician (sue medical doctor [MD]) is the focus of this study, and was contained within the Battery for Health Improvement (BHI) research version (BHI-R). The BHI-R was administered to 1,487 community subjects (1,329 healthy and 158 nonhealthy) and 777 patients in rehabilitation of whom 326 were APPs, 341 were CPPs, and 110 had no pain. In addition, descriptive data, such as whether the patient had an attorney for a worker's compensation claim, was collected. The sue MD Likert scale responses were dichotomized, and the relative risks for the sue MD wish were calculated for the aforementioned groups utilizing the healthy community group as the reference group. With APPs and CPPs, those patients responding alternatively affirmatively to the sue MD statement were compared with those patients responding negatively on all available categorical variables and BHI 2 scales via appropriate statistics. If a BHI 2 scale was statistically significant at P < 0.001, then all the questions from this scale were analyzed for significance by chi-square. Significant categorical variables (P < 0.001) and significant BHI 2 questions were then utilized as independent variables in a logistic regression model to assess the predictability of the independent variables for sue MD. SETTING: Variety of settings. RESULT: The relative risks for affirming the sue MD statement relative to the healthy community sample for various groups were as follows in order of ascending risk: APPs in rehabilitation; nonhealthy community members; rehabilitation patients in general; rehabilitation patients without pain; CPPs in rehabilitation; and with the highest risk being rehabilitation patients with worker's compensation litigation. For APPs, the logistic regression model utilized three variables: trusting physicians (protected against sue MD); physicians appearing to be motivated by financial incentives; and being upset over one's health (depression variable). This model classified 96% of the patients correctly. For CPPs, the logistic regression model also utilized three variables: being in worker's compensation litigation; being coerced to see a distrusted physician; and being angry with the physician. This model classified 93% of the patients correctly. CONCLUSIONS: CPPs are at a greater risk than patients without pain and APPs for harboring the sue MD wish. Some patient attributes and the referral/treatment situation appear to be important predictors for harboring the sue MD wish, but differ between APPs and CPPs.

Why Do Medical Professional Regulators Dismiss Most Complaints From Members of the Public? Regulatory Illiteracy, Epistemic Injustice, and Symbolic Power.

Drawing on an analysis of complaint files that we conducted for the Irish Medical Council (Madden and O'Donovan 2015), this paper offers three possible explanations for the gap between the ubiquity of official commitments to taking patients' complaints seriously and medical professional regulators' dismissal-as not warranting an inquiry-of the vast majority of complaints submitted by members of the public. One explanation points to the "regulatory illiteracy" of many complainants, where the remit and threshold of seriousness of regulators is poorly understood by the general public. Another points to possible processes of "institutional epistemic injustice" (Fricker 2007; Anderson 2012) that unjustly undermine the credibility of certain complainants, such as those with low levels of formal education. A third explanation highlights the marginalization of the general public from "symbolic power" (Bourdieu 1989) to define what matters in medical professional regulation. The paper is offered in a spirit of ideas in progress and raising questions rather than definitive insights into the regulatory process.

The recognition and expectations of ex-inpatients of mental health services: A web-based questionnaire survey in Japan.

Concern about mental health issues and the treatment of mentally disordered offenders attracts considerable public attention. This study aimed to gather the experiences and opinions of people who have experienced admission to a psychiatric ward in order to grasp their reaction to, and understanding of, the legislation behind the involuntary admission of psychiatric patients. A web-based questionnaire survey was conducted with a total of 379 participants, using a cross-sectional, exploratory design. The data were analyzed using a chi-squared test, Fisher's exact test, and a logistic regression analysis. According to the results, many patients were satisfied with their treatment during psychiatric admission; however, only few participants said that they had been given an adequate explanation for their involuntary treatment. Most participants expected qualified assistance after discharge, although the prospect of a regular visit from an official was not entirely supported by the participants. Patient satisfaction was relevant to the discussion of their needs after discharge and in developing a crisis plan during admission. These findings suggest that psychiatric patients accept inpatient treatment as long as they receive an adequate explanation. More qualified care such as relapse prevention would be expected to lead to better satisfaction. For them to welcome regular visits from an official, patients may need more information and discussion.

THE VICTORIAN NEW HEALTH COMPLAINTS ACT 2016 -- WHAT ARE THE CHANGES?

The Health Complaints Act 2016 (Vic) commenced on 1 February 2017, bringing into operation a new office of the Health Complaints Commissioner (HCC). This article outlines the changes nurses and midwives are likely to see under the new Act.