Looking at hospital patients' responses on patient satisfaction surveys, Nicole R. Santuzzi, Melanie Brodnik, Laurie Rinehart-Thompson, and Maryanna Klatt found that while most of the qualitative comment categories validated the quantitative results, there were no reported research results supporting the positive association between qualitative comments and quantitative scores. This study was designed to determine whether there are differences in how patients quantitatively rate their inpatient service in a given section of a patient satisfaction survey based on the types of qualitative comments they make about that given section. The study results offer empirical evidence that there are differences in how patients quantitatively rate the services received in a hospital based on patient comment types. Hospital staff interpreting patient satisfaction survey results could say that negative comments produce lower quantitative ratings than do positive comments.
Fayez F. Hejaili and his coauthors used a Kano model in their study of a fascinating subject-cultural influences on the expectations of patients. They employed a questionnaire covering 20 service attributes, collecting responses from dialysis patients from the Kingdom of Saudi Arabia, Syria, the United Arab Emirates, and Austria. Their article includes an authoritative description of the origins and structural characteristics of Kano's research designs. The authors suggest that differences in education levels as well as in experience with contemporary market interactions probably play a significant part in the observed differences in the responses of the patients in their samples.
James E. Rohrer, Kurt B. Angstman, and Joseph W. Furst studied the role of "retail walk-in clinics" in place of office and emergency department visits in increasing access to care without diluting the quality of care. Performing a retrospective analysis of medical records, they analyzed the incidence of return visits within 2 weeks for low-acuity diagnoses by patients making office or emergency department visits in comparison with those using a retail walk-in clinic. They concluded that the use of the retail convenience clinic did increase access without increasing early return visits. Their findings also suggest that the patient's previous pattern of utilizing care may be a stronger predictor of the number of early return visits.
The establishment of rapid response teams (RRTs) represents a fairly new strategy designed to facilitate prompt skilled intervention in a potential crisis. Joan D. Wynn, Martha K. Engelke, and Melvin Swanson analyze the factors that play a role in prompting nurses to initiate a call for the RRT. Among other things they found that the nurse's level of professional education strongly influenced the decision to call for an RRT upon the patient's exhibiting the criteria for calling the RRT. Another correlate of the decision to call for an RRT was the promptness of the physician's arrival at the bedside on an earlier call from the nurse.
Carol VanDeusen Lukas, David Mohr, and Mark Meterko point out that although research programs have developed many approaches for improving clinical care, many of these improvement strategies are never widely applied in routine patient care. They describe the ways in which health care providers and researchers are working to understand the factors that contribute to the successful implementation of improved clinical practices. The coauthors present a study on the effect of team collaboration, rather than unidirectional individual effort, in implementing the introduction of clinical improvements.
Under rules implemented a few weeks ago, Medicare will no longer reimburse hospitals for preventable conditions. Thomas J. Hendrix, Maureen O'Malley, and Kristine A. Karlsen explore the implications of mandated error reporting on the role and responsibilities of nurses. They point out that complying with the new rules makes it essential that the hospital coordinate all departments involved in patient care, as well as provide the needed training. Given nursing's role in shaping patient care quality, this means that hospital management must provide nurses with the training required by the responsibilities they carry under the new rule.
There has been widely published evidence that tested evidence-based clinical guidelines, while available, often are not followed by physicians. David W. Scotton, H. Wierman, A. Coughlin, M. Nicholson, and C. B. Kuhn, following up on the observed failure to follow guidelines for the administration of metformin, studied the effect of passive pharmacy intervention in the form of electronic safety alerts on the pattern of guideline violations to metformin use in inpatients. They conclude that passive pharmacy intervention is ineffective in curbing such violations.
Remember that butterfly flapping its wings somewhere in India, and how it starts a breeze that travels across the world to become a gale on Lake Michigan? Or your pessimistic friend who likes to say: "Whatever can go wrong, will?" Colleen Conway-Welch has contributed a sparkling review of a new book, On the Edge: Nursing in the Age of Complexity, that provides some examples of the effects of the law of unintended consequences.
Jean Gayton Carroll, PhD, Editor