Robert A. Westbrook

Examining the link between patient satisfaction and adherence to HIV care: a structural equation model.

Introduction Analogous to the business model of customer satisfaction and retention, patient satisfaction could serve as an innovative, patient-centered focus for increasing retention in HIV care and adherence to HAART, and ultimately HIV suppression. Objective To test, through structural equation modeling (SEM), a model of HIV suppression in which patient satisfaction influences HIV suppression indirectly through retention in HIV care and adherence to HAART. Methods We conducted a cross-sectional study of adults receiving HIV care at two clinics in Texas. Patient satisfaction was based on two validated items, one adapted from the Consumer Assessment of Healthcare Providers and Systems survey (“Would you recommend this clinic to other patients with HIV?) and one adapted from the Delighted-Terrible Scale, (“Overall, how do you feel about the care you got at this clinic in the last 12 months?”). A validated, single-item question measured adherence to HAART over the past 4 weeks. Retention in HIV care was based on visit constancy in the year prior to the survey. HIV suppression was defined as plasma HIV RNA <48 copies/mL at the time of the survey. We used SEM to test hypothesized relationships. Results The analyses included 489 patients (94% of eligible patients). The patient satisfaction score had a mean of 8.5 (median 9.2) on a 0- to 10- point scale. A total of 46% reported “excellent” adherence, 76% had adequate retention, and 70% had HIV suppression. In SEM analyses, patient satisfaction with care influences retention in HIV care and adherence to HAART, which in turn serve as key determinants of HIV suppression (all p<.0001). Conclusions Patient satisfaction may have direct effects on retention in HIV care and adherence to HAART. Interventions to improve the care experience, without necessarily targeting objective clinical performance measures, could serve as an innovative method for optimizing HIV outcomes.

Identifying drivers of overall satisfaction in patients receiving HIV primary care: a cross-sectional study.

Objective This study seeks to understand the drivers of overall patient satisfaction in a predominantly low-income, ethnic-minority population of HIV primary care patients. The study’s primary aims were to determine 1) the component experiences which contribute to patients’ evaluations of their overall satisfaction with care received, and 2) the relative contribution of each component experience in explaining patients’ evaluation of overall satisfaction. Methods We conducted a cross-sectional study of 489 adult patients receiving HIV primary care at two clinics in Houston, Texas, from January 13–April 21, 2011. The participation rate among eligible patients was 94%. The survey included 15 questions about various components of the care experience, 4 questions about the provider experience and 3 questions about overall care. To ensure that the survey was appropriately tailored to our clinic population and the list of component experiences reflected all aspects of the care experience salient to patients, we conducted in-depth interviews with key providers and clinic staff and pre-tested the survey instrument with patients. Results Patients’ evaluation of their provider correlated the strongest with their overall satisfaction (standardized β = 0.445, p<0.001) and accounted for almost half of the explained variance. Access and availability, like clinic hours and ease of calling the clinic, also correlated with overall satisfaction, but less strongly. Wait time and parking, despite receiving low patient ratings, did not correlate with overall satisfaction. Conclusions The patient-provider relationship far exceeds other component experiences of care in its association with overall satisfaction. Our study suggests that interventions to improve overall patient satisfaction should focus on improving patients’ evaluation of their provider.

Customers, knowledge management, and intellectual capital

A modern business is a knowledge business. What it can do depends on what it knows, the preponderance of which resides in the skills of employees, their experiences, insights and intuitions, and their relationships. Knowledge management has therefore increasingly recognized workers as important contributors to the intellectual capital of businesses. Customers, too, can add to what companies know, but to learn from them, businesses must listen attentively to what they have to say. Unfortunately, an increasing reliance on technology impedes conversations between companies and those they serve to the detriment of both. By expanding the scope of its knowledge management effort to include its customers, however, a company can gain new knowledge to bolster its service, improve its operation, and accelerate its innovation. Much of what has been learned about gathering knowledge in the workplace can facilitate this undertaking.

Customer Engagement and Employee Engagement: A Research Review and Agenda

This chapter examines two concepts that are central to value-creating exchanges: customer engagement and employee engagement. Current research shows that customer engagement has a clear and direct positive association with firm performance. In contrast, the association of employee engagement with firm performance is mixed and indirect. Studies show (1) a positive, negative, and zero association with firm performance and (2) a direct and mediated path to firm performance. This chapter reviews several factors that moderate the association between customer engagement and employee engagement as well as their relationship with firm performance.