Patient satisfaction has a significant role in the healthcare industry, as high patient satisfaction can improve quality outcomes. Hospital leadership is responsible for the culture, outcomes, and patient experience, which can involve different leadership styles. The purpose of this quantitative study was to examine the relationship between leadership style of senior leaders and patient satisfaction in inpatient rehabilitation facilities (IRFs). Through the theoretical framework of transformational and transactional leadership theories, the research questions were designed to determine whether a statistically significant relationship existed between leadership style (transformational, transactional, and laissez-faire leadership) and patient satisfaction. The Multifactor Leadership Questionnaire was administered electronically to senior leaders in an IRF system and combined with secondary patient satisfaction data obtained from the IRF system. Senior leaders from 72 IRFs completed the online survey. Pearson's correlation and multiple linear regression revealed mixed results. The Pearson's correlation indicated small negative linear correlations between transformational leadership and laissez-faire leadership with patient satisfaction as well as a small positive linear correlation between transactional leadership and patient satisfaction. For multiple regression, none of the tests produced statistically significant results, which led to a failure to reject the null hypotheses and inconclusive findings. Through the further examination of the relationship between the leadership subscales and patient satisfaction, healthcare administrators can impact patient satisfaction through education and trainings for senior leaders.

acase@tulane.edu

Introduction The Integrated Management of Childhood Illness (IMCI) is a multicomponent health system strengthening initiative widely adopted in Sub-Saharan Africa to improve poor child health outcomes. Implementation and subsequent evaluation have largely centered on the clinical management component. This study examines the clinical component in tandem with the facility improvement component, while capturing aspects of the community component over a ten year period. Methods The study utilizes a modified Donabedian quality measurement model where expected outcomes are a function of the process and structural components of healthcare quality which corresponds respectively to the clinical management and facility improvement components of the IMCI strategy. The data source is the Demographic Health Survey-Services Provision Assessment on Kenya for years 1999, 2004 and 2010 and it consists of a sample of 3,884 children and their caretakers seeking care at 1,523 health facilities. Bivariate analyses examine the change in health quality indicators and the quality indices (aggregated quality indicators) over time. Then negative binomial models assess the effect of the process and structural quality indices on the Caretaker Perceived Quality of Care (CPQoC) over time. Results Since IMCI implementation in Kenya, the clinical management and facility improvement indicators have not followed a pattern of consistent improvement while the quality indices increased consistently over time. The technical aspects of care have a higher effect on the CPQoC than the structural aspects and some of the interpersonal aspects of care were statistically significant. Privately managed facilities showed the highest impact while access to care had no impact on the CPQoC. Conclusion The findings underscore the importance of clinical management while recognizing the importance of the facility and community components of the IMCI. Revising the strategy to encourage implementation of all components with increased emphasis on the community components as well as ownership from national governments can improve child health outcomes in the region. / 1 / Felicia Aurora Osenkor Amoah

<p>SAMMANFATTNING</p><p><strong>Bakgrund</strong>: Patienters upplevelser av att vårdas inom slutenvården med stöd av Lagen om psykiatrisk tvångsvård. Människor med en allvarlig psykisk störning eller ett oundvikligt behov av vård får med stöd av lagen tvångsvårdas. Patienterna fråntas självbestämmandet och blir tvungna att delta i vård och behandling mot sin vilja. När självbestämmandet fråntas patienterna övertar vårdpersonalen ansvaret vilket kan leda till ett lidande för patienterna (1991:1128).</p><p><strong>Syfte</strong>: Syftet var att beskriva patienters upplevelser av tvångsvård inom psykiatrisk slutenvård. </p><p><strong>Metod</strong>: Systematisk litteraturstudie, sex artiklar användes för uppnått resultat.</p><p><strong>Resultat: </strong>Både positiva och negativa upplevelser av tvångsvård påvisades. Patienterna beskrev ett möte med vården kantat av upplevelser kring människovärde, delaktighet i sin egen vård, kommunikation, relationer, synen på våld, hot och straff samt upplevt lidande.</p><p><strong>Slutsats</strong>: Om patienterna bemöttes med respekt, människovärde samt fick tillräcklig information kring vård och behandling blev upplevelserna av tvångsvården mer positiv. Brist på delaktighet i fråga om vård och behandling och kommunikationsbrister var ett problem då patienterna hade lite sjukdomsinskt samt inte hade förståelse för behovet av tvångsvård.</p><p>Vidare forskning med kvalitativa intervjuer om patienters upplevelser av tvångsvård föreslås för att ge utökad förståelse och kunskap.</p>

<p>Elderly patients experiences of palliative care – a rewire</p><p>The purpose of this paper was to study elderly patient’s experience of palliative care with present knowledge as starting point. The questions were; what criteria do the elderly, dying person think is most important to fulfill in palliative care? and how satisfied is the elderly, dying person with the palliative care that are giving to him/her? The information were collected by a data based search trough science magazines and technical literature. Four relevant studies were found; Costello (2001), Heyland (2005), Wilson (1999) and Formiga (2004). Results in this studies show that the communication between patients, physicians and nurses need to improve. The elderly patients demands better, straighter and clearer information from the nurses and physicians, especially about their condition. The elderly demands more emotional and spiritual support from the health care and people with chronic diseases like COPD and CHF seems to bee less satisfied with palliative care then those with cancer. The reason for this can bee that, this group of patients is less likely to not being offered palliative care at all, much because it is harder for the physicians to set a proper medical prognosis.</p><p>Keywords: palliative care, elderly, patient- satisfaction</p>

<p><p>Syftet med denna studie var att beskriva hur patienterna upplevde Brännskadeteamets ettårsuppföljning. Studien har en deskriptiv design med såväl kvalitativa som kvantitativa data. Som underlag för studien har en utvärderingsenkät använts, svaren är insamlade under tidsperioden 2001- juni 2008. Svarsfrekvensen var hög (81,4%), 57 patienter av 70 hade besvarat enkäten.</p><p>Bemötandet skattades av samtliga patienter som mycket bra (77,2%) eller bra (22,8%). Samtliga patienter som hade ställt frågor ansåg att de hade fått svar på sina frågor (93%) medan en mindre grupp svarade att de ej hade ställt några frågor (7%). Informationen innan besöket ansågs som dålig eller mindre bra av 4 patienter (7,1%), bra/tillräcklig av 33 patienter (57,9%) och mycket bra av 19 patienter (33,3%). Informationen under besöket ansågs vara bra eller mycket bra av samtliga patienter utom en som klassade den som mindre bra. Fyra av de fem kommentarerna som skrivits till frågorna gällde brister i information och förberedelse. Majoriteten av patienterna (93%) ansåg att tiden för besöket var lagom.</p><p>Brännskadeteamets ettårsuppföljning är unik och den anpassas i möjligaste mån efter varje patients behov. Svaren på enkäten visar att detta lyckats ganska bra, men att informationen innan besöket behöver förbättras.</p></p> / <p><p>The purpose of this study was to describe the burn patients´ experience of the one-year follow-up, with a multidisciplinary team. The study has a descriptive design with both qualitative and quantitative data. An evaluation questionnaire was used to collect data. The answers are collected in the period from 2001 until June 2008. The response rate was high (81.4%), 57 patients out of 70 had responded to the survey.</p></p><p>The patients replied that they were treated very good (77.2%) or good (22.8%). All patients that had asked any questions felt that they had received answers to their questions (93%) a smaller group replied that they had not asked any questions (7%). The information before the visit was considered as poor or less good by 4 patients (7.1%), good/sufficient by 33 patients (57.9%) and very good by 19 patients (33.3%). Information during the visit was considered to be good or very good by all patients except one who rated it as less good. Four out of the five written comments was about issues related to gaps in information and preparation. The majority of all patients (93%) were satisfied with the length of time of the visit.</p><p>The multidisciplinary one-year follow-up, at the Burn Center, is unique and the aim is to adjust the follow-up visit after each patient's needs. The results show that it has succeeded quite well, but that the information given before the visit needs to be improved.</p>

<p>Syftet med denna studie var att hos patienter som varit på besök inom primärvårdenundersöka nöjdhet/tillfredställelse med besöket, hur delaktig patienten känt sig isjukskrivningsbeslut i förekommande fall samt eventuella skillnader avseende detta mellankvinnor och män, samt sjukskrivna och icke sjukskrivna.Enkäter som handlade om patientens tillfredsställelse med besöket delades ut till patientermellan 18 och 64 år som besökte läkare vid Tierps vårdcentral under nio vardagar i oktober2009. Totalt 129 patienter ingick i studien.Av dem som diskuterat sjukskrivning med läkaren kände sig nästan alla delaktiga i det beslutsom togs. Den stora majoriteten av besökarna var helt och hållet nöjda med sitt besök. Ettfåtal av besökarna var inte alls nöjda med sitt besök på Tierps vårdcentral. De mönster somkan ses i tillfredställelse med besöket är att kvinnor var mer nöjda än män samt att ickesjukskrivna var nöjdare än de sjukskrivna.De skillnader som påvisades mellan grupperna var inte signifikanta men hade kanske varittydligare om studien haft fler deltagare. De mått som användes visade ingen större variation,ett annat instrument hade kanske kunnat påvisa större skillnader.</p> / <p>The aim with this study was to investigate, among patients who have visited a physician in aprimary care setting, the satisfaction with the encounter, to what extent the patient felt thatthey participated in decisions regarding sick leave, and potential differences regarding thisbetween women and men and people on sick leave and people not on sick leave.A questionnaire concerning patient satisfaction with their visit to a physician was handed outto patients between the ages of 18 and 64 that visited a physician at a primary care centre inTierp during nine weekdays in October 2009. A total of 129 patients were included in thestudy.Almost all of those who discussed sick leave with their physician felt that they participated inthe decision that was made. The majority of the visitors were completely satisfied with theirvisit. A few of the visitors were not at all satisfied with their visit. Observed patterns were thatwomen were more satisfied than men and people not on sick leave were more satisfied thanpeople on sick leave.The observed differences between the groups were not statistically significant but perhapsthey would have been more apparent if the number of participants had been greater. Themeasures used did not show a lot of variation, a different instrument might have showngreater differences.</p>

<p>The aims of this thesis are threefold: (1) To investigate cancer patients’ satisfaction with and utilisation of an Individual Psychological Support (IPS) intervention. (2) To evaluate the effects of Individual Support (IS), comprising IPS combined with Intensified Primary Health Care and Nutritional Support, on psychological distress and quality of life during the first year after diagnosis. (3) To explore to what extent aspects of quality of life and emotional functioning one year after diagnosis can be predicted by medical, psychological and socio-demographic factors at diagnosis. The analyses are based on data from the Support-Care-Rehabilitation project, using a prospective randomised design to compare four conditions: (1) Individual Support (IS) starting at diagnosis, (2) Group Rehabilitation (GR) starting three months later, (3) a combination of IS and GR, and (4) Standard Care (SC). The study sample consisted of patients newly diagnosed with breast cancer, colorectal cancer, gastric cancer or prostate cancer. A total of 481 patients were randomised and followed for 24 months.</p><p>The IPS was an individually tailored, problem-focused intervention based on psychosocial oncology and cognitive behaviour therapy. Half of the patients receiving IPS had more than 2 sessions. Patients reporting that they had problems to address received more IPS sessions and reported more benefits of the intervention. Receiving an extensive medical treatment, young age, and not having someone besides the family to rely on in times of difficulties increased the odds of receiving tree or more sessions of IPS. The IS had limited impact on psychological distress and quality of life in intention-to-treat analyses. Additional analyses with stratification for baseline anxiety and/or depression levels suggested that for IS patients with higher levels of anxiety and/or depression, these problems continued to diminish below those of Control patients during the first year after diagnosis.</p><p>Linear regression models were used to explore, one year after diagnosis, quality of life aspects indicative of rehabilitation needs. High levels of baseline anxiety and / or depressive symptoms were associated with lower levels of Emotional Functioning, and high self-rated well-being was associated with higher levels of Emotional Functioning. Extensive medical treatment and presence of comorbid conditions during the year before diagnosis predicted a low Global Quality of Life, whereas self-rated wellbeing predicted a high Global Quality of Life. Advanced disease, one or more comorbid conditions and high age were found to be associated with lower levels of Physical Functioning. A high level of activities outside the home during the year before diagnosis and high self-rated wellbeing were predictive of a better Physical Functioning. </p><p>In conclusion, a large proportion of cancer patients offered IPS in conjunction with diagnosis and primary treatments seized this opportunity to discuss their situation, and perceived the experience as beneficial. Thus, offering newly diagnosed cancer patients these psychosocial support services may facilitate their situation.</p>

<p>The aims are to investigate cancer patients' perceived satisfaction with a Group Rehabilitation (GR) intervention, to evaluate its effects, and to explore the extent to which the patient's coping style (monitoring, blunting) modulates the effects of the GR. An additional aim is to investigate to what extent some aspects of health-related quality of life (HRQOL) [Physical Functioning (PF), Emotional Functioning (EF) and Global Quality of Life (QoL)] one year after diagnosis can be predicted on the basis of medical, socio-demographic and psychological data collected att diagnosis. Patients (n=481) newly diagnosed with breast, gastrointestinal or prostate cancer, were randomly assigned (Support-Care-Rehabilitation project) to one of four alternatives: 1. “Individual Support” (IS) starting at diagnosis; 2. “Group Rehabilitation” (GR) starting approximately four months later; 3. A combination of IS and GR; or 4. Standard Care (SC). All patients were monitored for two years. The GR comprised eight weekly sessions and one booster session after two months. The 2.5 hour meetings dealt with information about cancer, treatment, nutrition, cognitive behavioural therapy (CBT), light physical training and relaxation. Patients rated the physical and informative components as somewhat more beneficial than the CBT component. Meeting others was also rated as beneficial. However, there were limited effects on quality of life and anxiety. The monitoring concept was useful for distinguishing a subgroup of cancer patients (prostate cancer monitors) who benefited from the GR programme. Regression analyses demonstrated that the presence of advanced disease at diagnosis predicted a reduced physical function one year later. Having one or more comorbid conditions predicted lower PF and QoL, EF was predicted only by lower mental well-being and being classified as a case on the basis of the HADS. Indications for offering rehabilitative programs to cancer patients are critically discussed.</p>

A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn. The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire. Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity. Social desirability was lower among care utilisers and was associated with burn-related health aspects. The participants reported a low level of negative care experiences, the most common of which was Powerlessness. Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R2 was 0.25. In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R2 was 0.19. The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.