Petra Steffen

The Relationship between Social Capital in Hospitals and Physician Job Satisfaction

BackgroundJob satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals.MethodsThe results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables.ResultsThe first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors.ConclusionThis analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively.

Applying Principles of Good Practice for Translation and Cross-Cultural Adaptation of Sleep-Screening Instruments in Children

With the increase in the number of international projects in pediatric sleep medicine, the need to adapt sleep-screening tools for use in cross-cultural settings has rapidly grown. However, accepted procedures for translating and adapting existing measures are not uniformly and consistently incorporated in epidemiologic studies, resulting in potential measurement problems. The aims of this brief report are to (a) give an overview of principles for the translation and cultural adaptation of pediatric sleep-screening instruments and (b) illustrate these procedures in describing the translation and adaptation of two widely used pediatric sleep-screening tools for a German population. Challenges in the development of cross-cultural adaptations of parent-report sleep-screening measures for children are also discussed.

Reduced patient demands in hospitals and their determinants

Objectives:The purpose of this study was to analyze the extent to which patients have suppressed their demands during their hospital stay and to examine the factors that determine this reduction in demands.Methods:The data, which provided the basis for this study, were obtained from a postal survey utilsing the Cologne Patient Questionnaire (CPQ) that was sent to 1,548 patients who had been treated in 1 of 3 hospitals in Germany. The survey itself was conducted within the scope of the research project entitled “Organizational Governance Using Biopsychosocial Codes” (U-BIKE-Studie).Results:Eight hundred fifty-five patients completed and returned the questionnaire (55.2% response rate). Descriptive analyses showed that less than one-half of the patients surveyed had suppressed their needs and reduced their demands during their hospital stay. Multiple linear regression analyses revealed that “reduced patient demands” in hospitals are primarily determined by a general tendency on the part of patients to excuse errors and inconviences arising during the hospital stay, a tendency that is strongly associated with the (traditional) concept of the patient role. These analyses also demostrated that such a reduction is also determined by hospital services and hospital stay-related aspects.Conclusions:The analyses of this study revealed that fewer patients than initially expected had indeed reduced their demands during their hospital stay. Apart from the patient’s experiences during their most recent hospital stay, this reduction in demands depends primarily on the patient’s “tendency to excuse” and thus on the concept of the patient’s role. Taking the concept of “reduced patient demands” in hospitals into consideration can help make the hospital stay more patient-oriented and ensure that the evaluation and interpretation of the hospital stay will be interpreted in light of the concept of the patient role.

Associations between hospital and patient characteristics and breast cancer patients' satisfaction with nursing staff.

Background: Only a few studies have investigated the association between hospital characteristics and breast cancer patients’ satisfaction with nursing staff. Objective: The aim of this study was to determine whether the satisfaction of newly diagnosed breast cancer patients with nursing staff correlates with hospital characteristics after taking the relevant patient characteristics into account. Methods: Multilevel regression analysis was applied, combining survey data from newly diagnosed breast cancer patients regarding their characteristics and satisfaction with nursing staff with data on the characteristics of the hospitals in which the patients were treated. Results: Data from 2945 patients from 81 hospitals were analyzed in multilevel logistic regression models. The patients were significantly more likely to be satisfied with the nursing staff in hospitals that employed breast care nurses (BCNs) at the time of the survey. At the patient level, patients were significantly more likely to be satisfied with nursing staff if the patients were native speakers and rated their own health more highly. Cross-level interaction analysis suggested that the increased patient satisfaction with nursing staff that resulted from employing BCNs was largely limited to native German-speaking patients. Conclusions: The results demonstrate that patient satisfaction with nursing staff is higher if BCNs are employed in the treatment hospital. However, only the satisfaction of native speakers was significantly higher when BCNs were employed. Implications for Practice: These findings suggest that hospitals should invest in employing specialist nurses. Special attention should be paid to the care of non-native–speaking patients.

[Shared decision-making as a new quality indicator in nephrology: a nationwide survey in Germany].

ZusammenfassungHintergrund und Ziel:Partizipative Entscheidungsfindung (Shared Decision-Making) gewinnt als Modell der Arzt-Patienten-Beziehung auch im deutschen Gesundheitssystem zunehmend an Bedeutung. Insbesondere im Bereich chronischer Erkrankungen erwartet man sich von diesem Konzept mittel- bis langfristige Verbesserungen der Behandlungsergebnisse. Bislang liegen der deutschen Versorgungsforschung jedoch kaum empirische Daten zum Stand und zu den Entwicklungstendenzen der partizipativen Entscheidungsfindung vor. Diese Studie liefert aktuelle Ergebnisse zu dieser Fragestellung aus einer deutschlandweiten Befragung von terminal niereninsuffizienten Patienten.Methodik:Im Rahmen des Programms Qualität in der Nephrologie (QiN) wurden in einer schriftlichen, deutschlandweiten Erhebung 6 614 Patienten mit terminaler Niereninsuffizienz befragt. Der Fragebogen enthielt ein zuvor übersetztes und validiertes Instrument zur Erfassung der wahrgenommenen Einbeziehung in die Therapie (PICS).Ergebnisse:82% der Befragten fühlen sich durch ihre Ärzte für eine Beteiligung an Entscheidungen motiviert. 81% der Patienten informieren sich aktiv bei ihren Ärzten über ihre Erkrankung und Behandlungsmöglichkeiten. 69% geben an, dass eine gemeinsame Entscheidungsfindung von Arzt und Patient stattgefunden hat. Das Lebensalter, die Dialysejahre und das Geschlecht stehen im Zusammenhang mit der wahrgenommenen Einbeziehung.Schlussfolgerung:Dieser Aufsatz bietet eine valide Grundlage für die prospektive Erforschung der partizipativen Entscheidungsfindung in der Behandlung der terminalen Niereninsuffizienz. Die Ergebnisse der vorliegenden Studie deuten auf eine hohe Bereitschaft von Dialysepatienten hin, sich aktiv am Prozess der Entscheidungsfindung zu beteiligen. Spezifische Patientencharakteristika und die Präferenzen der Patienten sollten nicht nur bei der alltäglichen klinischen Interaktion mit den Patienten Berücksichtigung finden. Sie könnten darüber hinaus im Rahmen der Qualitätssicherung systematisch erfasst und als Verbesserungspotential genutzt werden.AbstractBackground and Purpose:Shared decision-making (SDM) as a model in physician-patient interaction is gaining relevance in the German health system. By applying this model, mid- and long-term improvements are expected especially in the outcomes of chronic diseases. Up to now, there has hardly been any empirical data available in German health services research regarding the state and development of SDM. This study establishes a baseline and provides actual data on this subject based on a German-wide survey of end-stage renal disease (ESRD) patients.Methods:Standardized German-wide survey of 6,614 patients with ESRD. The questionnaire included an instrument to measure the patients’ perceived involvement in care (PICS) which had been translated and validated before.Results:82% of the questioned patients feel their physicians facilitated involvement in decision making. 81% of the patients actively inform themselves concerning their disease and treatment options. 69% state that SDM has taken place. Age, years on dialysis and gender correlate with perceived involvement.Conclusion:This paper provides a valid baseline for the prospective research of SDM in ESRD. The results indicate that dialysis patients are willing to participate in the process of medical decision-making. Characteristics and preferences of the patients should be taken into account not only in everyday clinical interactions. They could be monitored systematically within the framework of quality management and used as potential for quality improvement.

Partizipative Entscheidungsfindung als neuer Qualitätsindikator in der Nephrologie

ZusammenfassungHintergrund und Ziel:Partizipative Entscheidungsfindung (Shared Decision-Making) gewinnt als Modell der Arzt-Patienten-Beziehung auch im deutschen Gesundheitssystem zunehmend an Bedeutung. Insbesondere im Bereich chronischer Erkrankungen erwartet man sich von diesem Konzept mittel- bis langfristige Verbesserungen der Behandlungsergebnisse. Bislang liegen der deutschen Versorgungsforschung jedoch kaum empirische Daten zum Stand und zu den Entwicklungstendenzen der partizipativen Entscheidungsfindung vor. Diese Studie liefert aktuelle Ergebnisse zu dieser Fragestellung aus einer deutschlandweiten Befragung von terminal niereninsuffizienten Patienten.Methodik:Im Rahmen des Programms Qualität in der Nephrologie (QiN) wurden in einer schriftlichen, deutschlandweiten Erhebung 6 614 Patienten mit terminaler Niereninsuffizienz befragt. Der Fragebogen enthielt ein zuvor übersetztes und validiertes Instrument zur Erfassung der wahrgenommenen Einbeziehung in die Therapie (PICS).Ergebnisse:82% der Befragten fühlen sich durch ihre Ärzte für eine Beteiligung an Entscheidungen motiviert. 81% der Patienten informieren sich aktiv bei ihren Ärzten über ihre Erkrankung und Behandlungsmöglichkeiten. 69% geben an, dass eine gemeinsame Entscheidungsfindung von Arzt und Patient stattgefunden hat. Das Lebensalter, die Dialysejahre und das Geschlecht stehen im Zusammenhang mit der wahrgenommenen Einbeziehung.Schlussfolgerung:Dieser Aufsatz bietet eine valide Grundlage für die prospektive Erforschung der partizipativen Entscheidungsfindung in der Behandlung der terminalen Niereninsuffizienz. Die Ergebnisse der vorliegenden Studie deuten auf eine hohe Bereitschaft von Dialysepatienten hin, sich aktiv am Prozess der Entscheidungsfindung zu beteiligen. Spezifische Patientencharakteristika und die Präferenzen der Patienten sollten nicht nur bei der alltäglichen klinischen Interaktion mit den Patienten Berücksichtigung finden. Sie könnten darüber hinaus im Rahmen der Qualitätssicherung systematisch erfasst und als Verbesserungspotential genutzt werden.AbstractBackground and Purpose:Shared decision-making (SDM) as a model in physician-patient interaction is gaining relevance in the German health system. By applying this model, mid- and long-term improvements are expected especially in the outcomes of chronic diseases. Up to now, there has hardly been any empirical data available in German health services research regarding the state and development of SDM. This study establishes a baseline and provides actual data on this subject based on a German-wide survey of end-stage renal disease (ESRD) patients.Methods:Standardized German-wide survey of 6,614 patients with ESRD. The questionnaire included an instrument to measure the patients’ perceived involvement in care (PICS) which had been translated and validated before.Results:82% of the questioned patients feel their physicians facilitated involvement in decision making. 81% of the patients actively inform themselves concerning their disease and treatment options. 69% state that SDM has taken place. Age, years on dialysis and gender correlate with perceived involvement.Conclusion:This paper provides a valid baseline for the prospective research of SDM in ESRD. The results indicate that dialysis patients are willing to participate in the process of medical decision-making. Characteristics and preferences of the patients should be taken into account not only in everyday clinical interactions. They could be monitored systematically within the framework of quality management and used as potential for quality improvement.

Partizipative Entscheidungsfindung als neuer Qualittsindikator in der Nephrologie@@@Shared Decision-Making as a New Quality Indicator in Nephrology: a Nationwide Survey in Germany: Eine bundesweite empirische Untersuchung

ZusammenfassungHintergrund und Ziel:Partizipative Entscheidungsfindung (Shared Decision-Making) gewinnt als Modell der Arzt-Patienten-Beziehung auch im deutschen Gesundheitssystem zunehmend an Bedeutung. Insbesondere im Bereich chronischer Erkrankungen erwartet man sich von diesem Konzept mittel- bis langfristige Verbesserungen der Behandlungsergebnisse. Bislang liegen der deutschen Versorgungsforschung jedoch kaum empirische Daten zum Stand und zu den Entwicklungstendenzen der partizipativen Entscheidungsfindung vor. Diese Studie liefert aktuelle Ergebnisse zu dieser Fragestellung aus einer deutschlandweiten Befragung von terminal niereninsuffizienten Patienten.Methodik:Im Rahmen des Programms Qualität in der Nephrologie (QiN) wurden in einer schriftlichen, deutschlandweiten Erhebung 6 614 Patienten mit terminaler Niereninsuffizienz befragt. Der Fragebogen enthielt ein zuvor übersetztes und validiertes Instrument zur Erfassung der wahrgenommenen Einbeziehung in die Therapie (PICS).Ergebnisse:82% der Befragten fühlen sich durch ihre Ärzte für eine Beteiligung an Entscheidungen motiviert. 81% der Patienten informieren sich aktiv bei ihren Ärzten über ihre Erkrankung und Behandlungsmöglichkeiten. 69% geben an, dass eine gemeinsame Entscheidungsfindung von Arzt und Patient stattgefunden hat. Das Lebensalter, die Dialysejahre und das Geschlecht stehen im Zusammenhang mit der wahrgenommenen Einbeziehung.Schlussfolgerung:Dieser Aufsatz bietet eine valide Grundlage für die prospektive Erforschung der partizipativen Entscheidungsfindung in der Behandlung der terminalen Niereninsuffizienz. Die Ergebnisse der vorliegenden Studie deuten auf eine hohe Bereitschaft von Dialysepatienten hin, sich aktiv am Prozess der Entscheidungsfindung zu beteiligen. Spezifische Patientencharakteristika und die Präferenzen der Patienten sollten nicht nur bei der alltäglichen klinischen Interaktion mit den Patienten Berücksichtigung finden. Sie könnten darüber hinaus im Rahmen der Qualitätssicherung systematisch erfasst und als Verbesserungspotential genutzt werden.AbstractBackground and Purpose:Shared decision-making (SDM) as a model in physician-patient interaction is gaining relevance in the German health system. By applying this model, mid- and long-term improvements are expected especially in the outcomes of chronic diseases. Up to now, there has hardly been any empirical data available in German health services research regarding the state and development of SDM. This study establishes a baseline and provides actual data on this subject based on a German-wide survey of end-stage renal disease (ESRD) patients.Methods:Standardized German-wide survey of 6,614 patients with ESRD. The questionnaire included an instrument to measure the patients’ perceived involvement in care (PICS) which had been translated and validated before.Results:82% of the questioned patients feel their physicians facilitated involvement in decision making. 81% of the patients actively inform themselves concerning their disease and treatment options. 69% state that SDM has taken place. Age, years on dialysis and gender correlate with perceived involvement.Conclusion:This paper provides a valid baseline for the prospective research of SDM in ESRD. The results indicate that dialysis patients are willing to participate in the process of medical decision-making. Characteristics and preferences of the patients should be taken into account not only in everyday clinical interactions. They could be monitored systematically within the framework of quality management and used as potential for quality improvement.