Kamal R. Desai

Patient Satisfaction With Hospital Care: Effects of Demographic and Institutional Characteristics

BACKGROUND There are a growing number of efforts to compare the service quality of health care organizations on the basis of patient satisfaction data. Such efforts inevitably raise questions about the fairness of the comparisons. Fair comparisons presumably should not penalize (or reward) health care organizations for factors that influence satisfaction scores but are not within the control of managers or clinicians. On the basis of previous research, these factors might include the demographic characteristics of patients (eg, age) and the institutional characteristics (eg, size) of the health care organizations where care was received. OBJECTIVES The goal of this study was to examine the extent to which a patients satisfaction scores are related to both his/her demographic characteristics and the institutional characteristics of the health care organization where care was received. METHODS We conducted an analysis of secondary data from the Veterans Health Administration (VHA), US Department of Veterans Affairs. The database contained patient responses to self-administered satisfaction questionnaires and information about demographic characteristics. Additional data from VHA were obtained regarding the institutional characteristics of the hospitals where patients received their care. RESULTS Among demographic characteristics, age, health status, and race consistently had a statistically significant effect on satisfaction scores. Among the institutional characteristics, hospital size consistently had a significant effect on patient satisfaction scores. CONCLUSIONS Study results can be interpreted as justifying the need to adjust patient satisfaction scores for differences in patient population among health care organizations. However, from a policy perspective, such adjustments may ultimately create a disincentive for health care organizations to customize their care.

Implementing Quality Improvement in Hospitals: The Role of Leadership and Culture

Many advocates of quality improvement (QI) suggest that there is a link between an organizations leadership commitment and culture and its ability to implement a QI initiative. This paper reports empirical evidence from a study of QI implementation in Veterans Health Administration (VHA) hospitals that supports this hypothesized linkage. The findings suggest that the extent to which top management becomes directly involved in QI activities determines the degree of QI implementation. Additionally, study findings suggest that a culture emphasizing innovation and teamwork provides an important foundation for implementing a QI initiative. We discuss the implications of these findings for organizational leaders interested in implementing QI.

Hospital Conversions from for-Profit to Nonprofit Status: The other Side of the Story

The authors examined, on a case-by-case basis, the community impact of 15 for-profit hospitals that converted to nonprofit status. These for-profit conversions have been occurring in numbers comparable with those of nonprofit conversions (i.e., nonprofit hospitals that convert to for-profit status), but have attracted far less attention. For each for-profit conversion, the authors compared the change in uncompensated care with the loss to the local community in property tax revenue. In 11 of the 15 cases, the conversion was followed by some level of increase in uncompensated care. However, only three of these conversions produced enough additional uncompensated care to offset the loss in property tax revenue to the community. This analysis, while only a starting point for addressing the community impact of for-profit conversions, suggests that for-profit conversions do not uniformly promote the welfare of the communities where they occur.

The Financial Experience of Hospitals with HMO Contracts: Evidence from Florida

In this paper, we report results from the first study to systematically examine trends in the financial experience of hospitals with health maintenance organization (HMO) contracts. The longitudinal analysis (1990 through 1997) focused on hospitals in Florida. Hospital operating margins for HMO contracts grew tighter toward the end of the study period when the median margin was less than 1%. Teaching hospitals had operating margins that on average were below that of their nonteaching counterparts. The continued growth of HMOs and other managed care entities may have important implications for the future financial viability of U.S. hospitals.