The East End of London experienced an explosion of its Jewish population, from 35,000 in 1881 to 120,000 in 1910. The majority were poor, of foreign birth, living in overcrowded, sub-standard housing, and engaged in unhealthy occupations. Their arrival brought problems for both the indigenous population and the existing London Jewish community, threatening a crisis which could have overwhelmed the strained general medical services and irreparably damaged the Jewish community. A further problem was the attempt by various missionary societies to provide medical assistance at the cost of religious conversion. The crisis was averted, due to the efforts of the poor themselves and the wealthy established Jews - not always in harmony; and to simultaneous advances being made in public health, medicine, national insurance, and the improving Poor Law facilities. The major triumph of the immigrants, who preferred denominational institutions, was in establishing the London Jewish Hospital after a prolonged bitter battle against Lord Rothschild and many wealthy anglicised Jews, who considered the existing hospitals sufficient and wished to avoid jeopardising concessions already gained for Jews from the London Hospital and other medical centres. London, and the East End in particular, had many medical resources superior to those elsewhere in the country. The East End Jews enjoyed the added advantage of a comprehensive network of Jewish institutions and organisations, of which the Jewish Board of Guardians was foremost, which supplemented the Poor Law and voluntary systems and which had been created and funded largely by the rich of the community. In many areas of medical care Jewish organisations led the way. The initial effect was that the poor East End Jews, and especially their children, enjoyed better health than their non-Jewish neighbours in similar circumstances; but as the anglicisation of the immigrant increased, so the differences narrowed.

<p>Hospital leaders who fail to respond to poor patient satisfaction reports may experience lower organizational performance. The purpose of this qualitative case study was to explore strategies of leaders in private health care settings to improve patient satisfaction. This study may provide strategies that health care leaders in the public setting can apply to improve patient satisfaction and organizational performance. One private health care provider operating in Vancouver, British Columbia, Calgary and Edmonton, Alberta, was selected as both private and public healthcare centers are located in these areas. Data were gathered from 12 participant interviews and from an examination of available physical artifacts such as organizational documents provided by the participants and the company website. Transformational leadership was the underlying conceptual framework for this research. Triangulation was used to ensure the rigorousness of the study. In the study, themes were identified after member checking the transcribed open-ended interview questions. The 5 themes identified were cohesive culture of employee engagement, patient-focused model of care, timely access and follow-up of results and coordination of care, continuous system quality improvement, and employee accountability. These themes underscore the importance of a culture of employee engagement; they also illuminate care that focuses on the patient-care that ensures timely access, follow-up and coordination of care, quality improvement based on patient feedback, and employee accountability. Current publicly-funded hospitals and health care centers may apply these findings to improve patient satisfaction and organizational performance. </p>

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