The Impact of Performance Enhancement on Value of Care in Hospitals.

Hospitals are facing big challenges: decreasing reimbursements are going alongside increasing costs and the necessity of investments. At the same time occurring, excellent quality of care, and high-patient satisfaction have to be assured. The dilemma of providing both with decreasing rather than increasing resources cannot be solved only by striving for economies of scale, but by optimizing supply chain management, or reduction of overhead. Possible effects of these measures most often are already exhausted and seldom have a positive impact on the quality of care or patient satisfaction. Management is tempted to use its best-known instruments to reduce costs, while medical staff's focus is on quality of care and often battle against management as a perceived enemy. The solution to this dilemma lies in focusing on medical core processes that are directly linked to patients' treatments and, thereby improving all the parameters of Michael Porter's value equation: costs, outcome, and patient satisfaction. This approach of performance enhancement presumes understanding, acceptance, and constructive collaboration of two usually separated worlds: The medical-scientific world involved in patient care and the financial world of management. In this article, the authors explain performance enhancement for optimized delivery of care and how the dilemma mentioned above can be solved. The authors explain how performance enhancement can be achieved in daily clinical practice, which kind of obstacles have to be overcome, which changes are necessary within a hospital, how medical staff can be motivated, and how the value of care equation can be influenced.

Direct communication between radiologists and patients following imaging examinations. Should radiologists rethink their patient care?

OBJECTIVES: To investigate patients' perception of the radiology service when the radiologist communicates the findings to patients. METHODS: After routine MRI, patients in group 1 (n = 101) were given the opportunity to discuss the findings with the radiologist. Patients in group 2 (n = 101) left the radiology department without any personal communication. Subsequently, by means of a questionnaire designed by an expert psychologist, both groups were asked regarding their anxiety, emotional attachment to the institute and subjective assessment of competence. RESULTS: Overall 76 % of all patients were concerned about their imaging findings without significant difference between both groups (p = 0.179). Significantly more patients in group 1 (81%) versus group 2 (14%; p < 0.001) perceived the opportunity to discuss their imaging findings with a radiologist to be a characteristic of a good radiology consultation. A larger number of patients in group 1 experienced significantly higher bonding and only wanted in the future to be examined in the department with communication (p = 0.001) (93%/75%). Significantly more patients in group 1 regarded the radiology department they attended as being more competent (mean score 4.72/4.09, p < 0.001). CONCLUSION: Direct communication of imaging findings from radiologists to patients after an MRI examination leads to increased confidence in the radiology service and higher bonding between the patient and radiologist. Radiologists who refrain from direct communication have a lower bonding to patients and are assessed to have lower competence from the patient's point of view. KEY POINTS: • Communication between radiologists and patients leads to an increased bonding affinity. • Direct communication leads to increased patient confidence in the radiology service. • Patients perceived discussion with a radiologist of high value.