Patient satisfaction
Introduction;
Many of the regional and national health care accrediting
organizations require the health care organizations that they accredit to
collect and share customer satisfaction information. There is anecdotal
information to suggest that the correlation might not be as high as one
would expect it.
Service Recovery;
Dissatisfied patients have the potential not only to go to a
competitor, but also have the potential to spread negative word
– of – mouth about the organizations services.
Instead of being a missionary ( one who speaks enthusiastically
in favor of the organization and recommends it to others), a
dissatisfied patient is more likely to be a terrorist ( one who
says negative things about the organization and tries to
dissuade people from using its services).
Keeping patients happy is not merely a matter of providing the
routinely good service3 that patient expect.
No organization is perfect, all organizations sooner or later
make a mistake or inadvertently provide poor services.
Management must decide in advance the amount of flexibility
that employees should have to solve patient problems the spot
and the amount of resources that should be available to
employees for the purposes of service recovery.
Some organizations do not believe that their employees are
capable of responding to service problems appropriately.
The patients who feels that a service has been of poor quality
must tell not only the front line employee, of the problem, but
also the employee’s immediate superior and any one else who
must be part of the problem resolution effort.
Any person who has suffered through this process is ripe to
become a terrorist in communicating about this organization.
Measurement of patient satisfaction;
Ways of measuring customer satisfaction vary, as do the
reasons for measuring satisfaction.
a) First, many health care providers have started to measure
customer satisfaction more aggressively because of the
requirements of accrediting organizations and employers.
( e.g) A poor rating on a patient survey for the joint commission on
accreditation of health care organization hospital.
b) Second, satisfaction is known to be in part a function of the
amount of choice the customer had in the purchase decision.
c) Third, the interpretation of patient satisfaction research often
focuses on the nature of the patients. ( e. g) Medical managed care
plans which have recently been prone to explain their low patient
satisfaction ratings as a function of the age of the people who are
the subjects of the research.
d) Fourth, some satisfaction studies in the health care industry
have biased the response categorized by loading them too heavily
in the positive direction.
The public has become cynical about the multitude of managed
care plan advertisements claming 94 % 95 percent, 98 percent
customer satisfaction.
Utilization review;
The management of utilization may be divided broadly into tree
categories,
i. Prospective, or before the events occurs
ii. Concurrent or while the events is occurring.
iii. Retrospective or after the events has occurred.
i) Prospective, or before the events occurs;
Prospective management of utilization applies to several major
categories,
Health risk appraisals
Demand management
Referral services and
Institutional services
a) Health risk appraisals;
It is not new to most physicians, especially PCPs.
HRAs traditionally have used to perform an overall
assessment of a new patient’s medical condition and
risk factors.
These appraisal also may be focused on specific lines of
business such a commercial members, Medicare
members and Medicaid members.
b) Demand management;
Demand management refers to managing the demand
for medical services before such services are incurred.
The most common methods of doing this include
providing home care manuals, access to preventive
services, and convenient hours of operation by provides.
The provision of 24 hrs/ day nurse advice lines. These
advice lines provide access to a trained nurse on a 24hrs
/ day, 7 days / week basis on a toll free number.
Many plans that use this service find that use of the
emergency department is reduced.
c) Referral services;
Management of referral services is principally confined to
HMOs and to those HMOs that use a PCP to co-ordinate
care ( the gatekeeper model as discussed above).
The only physician the member may see without
authorization is the PCP, although many plans make
exceptions for obstetrics and gynecology for women and
occasionally for mental health and substance abuse
services.
The authorization is rarely open – ended , but rather for a
limited number of visits ( e. g one to three) except in
defined circumstances ( e. g chemotherapy may be fully
authorized for all visits).
The plan should provide periodic reports to the PCP with
data regarding referral rates and costs and reports
regarding referral rates and costs and reports regarding
the PCPs capitation pool or with hold if that is
appropriate.
d) Institutional services;
Prospective management of institutional services, both inpatient
and outpatient, is a staple of managed care in all types of plans. The
procedure is simple; some one calls the plan to request authorization
for an elective admission or outpatient procedure; the plan checks it
against clinical criteria and authorizes ( or denies, though that is
unusual) the procedure and a set amount of inpatient days as
appropriate.
ii) concurrent review ;
This topic applies almost solely to inpatient care and large case
management.
Inpatient care and continued stay review;
This refers to the plans monitoring and active inpatient case. Some
plans such as indemnity or service plans or PPOs perform this activity
from a remote site via telephone. The plans utilization management
(UM) nurse calls the hospital to ascertain the status of the case. Many
HMOs send their UM nurses on – site to the hospital. This allows the
nurse to obtain more detailed and timely information and to more
actively help manage the case.
Large case Management;
Large case management refers to those catastrophic or chronic
cases that exceed routine costs by several orders of magnitude and in
which active intervention by trained nurses at the plan can have a
significant effect.
(e.g) AIDS
Transplants
Serious trauma
Brittle diabetes
The nurse at the plan are able to co ordinate many aspects of care
such as rehabilitation, home care and health education, in order to
better manage the case.
Disease management;
In this instance, the plan focuses on a handful of selected clinical
conditions and works very proactively with the patient to control the
course of the disease. This provides for greater continuity and better
outcomes, attention to ( eg) AIDS, childhood asthma, CHF and DM.
Disease management differs from many preventive care activities
in that the diagnosis is clear and cost savings occur concomitantly with
improved outcomes.
iii) Retrospective;
Retrospective management refers to managing utilization after the
utilization has actually occurred. It falls into two broad categories, case
review and pattern analysis.
Case review;
In this type of management, individual cases are reviewed to look
for appropriateness of care, billing errors, or other problems associated
with an individual case. In some cases, a plan may place a provider on
regular review if there is some suspicion of regular improprieties.
Pattern analysis;
Pattern analysis refers to amassing significant amounts of
utilization data in order to determine if patterns exist. These patterns
may be provider specific, such as over – or underutilization, or they
may be plan wide, such as an unanticipated increase in cardiac testing
costs. After the pattern has been found, the reasons for it must be
investigated so that action may be taken.
Managed care plans now are attempting to provide greater
retrospective data to the providers in the network to allow the providers
to compare themselves to their peers and modify their own practice as
appropriate.
Conclusion;
Evaluation which helps the each individual’s satisfaction by
organizing in good manner and planning according to the bases of the
need of each services to clients care before the events, after the
events and after the events.
Bibliography;
Lighter.E.D, and Fair, C.D., (2004), Quality management in
health care principles and method, 2nd edition.
London, Jones and Bartlett publishers.
Page no; 445 – 446.
Wolper . F.L., (2004), Health care administration, 3 rd edition.
London, Jones and Bartlett publishers,
page no; 179 – 181 and 537 -539.
Seminar on;
Patient satisfaction
and
Utilization review
Submitted to; Submitted by;
Mrs. [Link] , [Link] (Nsg) G. Vimala
Asso .professor II year [Link] (Nsg)
VMACON VMACON
Salem Salem.
Submitted on;
06 – 07 - 09
INDEX
[Link] Content Page no
1 Introduction
2 Service Recovery
3 Measurement of patient
satisfaction
4 Utilization Review
-Prospective
-Concurrent review
-Retrospection
5 Conclusion
6 Bibliography
