Abstract The background to this study was, firstly, the shortage of doctors in the remote areas in Finland and secondly, the possibilities to use new IT-technology to the organization of health care services. The aim was to find out whether it is possible to organize consultations between GPs and patients as remote work through the use of videoconferencing equipment. In literature the results of the studies on teleconsultations in remote areas have been positive in many specialties from the point of view of operating the system, patient satisfaction and costs. However few studies of teleconsultations are available in the area of general practice. The aims of this study were to identify the technical solutions what teleconsultation requires and to report on the implementation of the solutions and process of the teleconsultations. Two hypotheses were to be tested in the study: first that patients treated in the traditional way were more satisfied than teleconsultation patients: the second was that while a sizeable patient group could be treated remotely, teleconsultation would prove to be more expensive than the traditional consultation. The teleconsultation part of the study was organized so, that the patient and a trained nurse were in Puolanka Health Center and the GP in the city of Kajaani (100 kilometers away). The videoconferencing system worked on the LAN in the Kainuu area. The study group consisted of two random groups, 508 patient visits were treated as remote work and 490 visits were treated in the traditional way in Puolanka Health Center. In addition to the diary of technical problems and the patient satisfaction questionnaires the measures of the study were the analysis of success in the consultation and the account of the return consultations in the remote group. A part of consultations were videotaped and the success in transfer of information was analysed from those tapes. The cost of the consultation was calculated, and sensitivity analysis was used to examine the cost of teleconsultations for diabetic patients. The results indicated that with a local area network it is possible to build a well functioning, reasonably priced teleconsultation system. The patients were equally satisfied with the teleconsultation as with the traditional consultation. The transfer of information in teleconsultations was good enough to make reliable diagnoses. It is estimated that three out of four from a random population in general practice could be treated in teleconsultation. Although it is about 30% more expensive to treat patients by teleconsultation than by the traditional method, the advantages of the teleconsultation model are that it enables an efficient transfer of information and know-how regardless of distance, and that it enhances considerably the traditional scope of health care services. / Tiivistelmä Tutkimuksen lähtökohtana oli syrjäisten alueiden lääkäripula ja toisaalta telelääketieteen mukanaan tuomat mahdollisuudet järjestää palveluja uudella tavalla. Tarkoituksena oli selvittää, voidaanko lääkärin vastaanottopalveluita tuottaa etätyönä videoneuvottelujärjestelmää käyttäen. Kirjallisuuden mukaan tulokset monien erikoisalojen televideokonsultaatioista olivat myönteisiä toimivuuden, potilastyytyväisyyden ja kustannusten näkökulmista: mutta perusterveydenhuollon tutkimuksia etävastaanotosta ei löytynyt. Tutkimuksen tavoitteena oli selvittää millaisia teknisiä ratkaisuja etävastaanotto vaatii ja kuvata valitun järjestelmän toimivuus sekä etävastaanottotapahtuman kulku. Hypoteesissa oletettiin tavallisella vastaanotolla hoidettujen olevan hieman etä-vastaanotolla käyneitä tyytyväisempiä ja että merkittävä osa potilasjoukosta voidaan hoitaa etätyönä sekä että etävastaanottokäynti on kalliimpi kuin tavallinen vastaanottokäynti. Tutkimus toteutettiin siten, että etävastaanottotilanteessa potilas oli hoitajan kanssa Puolangan terveyskeskuksessa ja lääkäri Kajaanissa. Yhteys hoidettiin videoneuvottelujärjestelmällä, joka käytti Kainuun atk-alueverkkoa. Tutkimusjoukko koostui kahdesta satunnaistetusta ryhmästä, joista 508 vastaanottokäynnin ryhmä hoidettiin etätyönä ja toinen 490 käynnin ryhmä tavallisella vastaanotolla Puolangan terveyskeskuksessa. Mittareina käytettiin teknisten ongelmien päiväkirjaa ja potilastyytyväisyyskyselyä, vastaanoton onnistumisen arviointia ja etävastaanoton uusintakäyntien tarpeen selvitystä. Tiedon siirtymisen onnistumista tutkittiin siten, että analysoitiin joukko videonauhoitettuja vastaanottoja, laskettiin vastaanottokäyntien kustannukset ja tarkasteltiin herkkyysanalyysien avulla etävastaanottomallilla toteutetun diabetesetävastaanoton kustannuksia. Tuloksien mukaan on mahdollista rakentaa toimiva, kohtuuhintainen etävastaanottojärjestelmä, kun käytetään alueellista atk-verkkoa. Potilaat olivat vähintään yhtä tyytyväisiä etävastaanottoon kuin tavalliseen. Tiedon siirtyminen etävastaanotolla on riittävän hyvä luotettavien päätelmien tekemiseksi. Noin kolme neljäsosaa valikoimattomasta perusterveydenhuollon potilasjoukosta voitiin hoitaa etätyönä. Lääkärin oma arvio vastaanoton onnistumisesta oli kuitenkin parempi perinteisessä vastaanotossa ja etävastaanotolla jouduttiin määräämään hieman enemmän laboratoriokokeita. Kun etävastaanottomallia käytetään korvaamaan tavanomainen vastaanottotapa ilman toiminnallisia ja organisatorisia muutoksia, se on noin 30 % kalliimpi kuin tavanomainen. Etävastaanottomalli kuitenkin mahdollistaa tehokkaan tiedon ja osaamisen siirtymisen välimatkasta riippumatta ja luo edellytykset uudenlaisille tavoille organisoida terveydenhuollon palveluita.

Magister Public Health - MPH / The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of 'acceptable' waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests. / South Africa

Magister Public Health - MPH / Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of “acceptable” waiting time among the providers and clients.

Healthcare today has become a competitive industry, not only locally, but on a global level as well. In the South African economy the healthcare sector presently offers healthcare seekers two options to satisfy their healthcare needs – either through private business enterprises in the private sector or public enterprises in the public sector. Likewise, in the healthcare sector's hospital environment, patients can receive treatment from either private or public hospitals. As private business enterprises offering a relatively 'pure', but generally unsought-after service, private hospitals compete aggressively to attract patients. Patients are a hospital's lifeblood and they rightfully expect a high standard of customer service throughout the stay. With today's consumers being better informed, more sophisticated and more demanding than in the past, experts agree that the key to survival in the service industry today, almost without exception, is the quality of the service. The cornerstone of the service industry is without doubt the ability to deliver superior service quality that results in customer satisfaction. And the healthcare industry is no exception. Most consumers will experience a need for healthcare services at some time in their lives, but in South Africa, escalating medical costs in general and private hospitals in particular, have made private healthcare increasingly more expensive for the majority of the country's healthcare seekers. This situation raises the question of customer service in the private hospital industry and how patients' perceive service quality and evaluate customer satisfaction after a hospital stay. There is a growing body of empirical evidence from United States studies to show that service quality and customer (patient) satisfaction positively influence patients' behavioural intentions to reuse the hospital or recommend it to others (word-of-mouth endorsements). However, in South Africa, empirical studies to investigate these relationships have not been adequately addressed. This study was therefore an attempt to address the lack of scientific evidence and debate in the area of patient satisfaction. Against this background, the primary objective of this study was to measure patients' perceptions of service quality and customer satisfaction with a private hospital experience and to estimate the effect that each of these constructs will have on future behavioural intentions. More specifically, the present study was an attempt to assess empirically the most important dimensions of service quality and transaction-specific customer satisfaction dimensions that drive both patient loyalty and ‘overall’ or cumulative satisfaction in the South African private hospital industry. For the purpose of this study, buying intentions was used as a surrogate measure of loyalty as measured by willingness to reuse the hospital and/or willingness to recommend it to others (word-of-mouth endorsements). Initial exploratory research was conducted with the aim of assessing the views of three private hospital stakeholder groups, namely former patients, doctors and management about what the quality of service and customer satisfaction meant to each individual interviewed. A service enterprise that specialises in patient satisfaction surveys in the US provided particularly useful information during this phase of the study. Several case studies of patient satisfaction programmes, mostly at US hospitals, provided additional insights in this area. The study was conducted nationally at private hospitals owned by one of South Africa's three major hospital groups. Five private hospitals in four major centres were selected on a non-probability convenience basis to participate in the study. The hospital group's senior management and the management at each selected hospital gave their full commitment to ensure that the survey was successfully conducted in their hospital wards. Data were collected by means of a quantitative study using a selfadministered, structured questionnaire. Patients had to meet certain qualifying criteria which included being of adult age, in the hospital for an operation and at least one overnight stay. A total of 3 800 questionnaires was distributed to patients on a random basis in selected wards at the five hospitals by senior hospital staff designated for this task. From this distribution, 425 questionnaires were returned of which a final sample of 323 could be statistically analysed. To confirm the internal reliability of the measuring instrument, Cronbach alpha coefficients were calculated for each of the factors identified by the exploratory factor analysis. In order to assess the discriminant validity of the measuring instrument used to measure both service quality and customer satisfaction, the items were subjected to an exploratory factor analysis. The factors that emerged after the exploratory factor analysis were then used as independent variables in the four subsequent multiple regression analyses to assess the study's four hypothesised relationships. The findings revealed that the service quality dimensions that impact positively on both loyalty and cumulative satisfaction are Empathy of nursing staff and Assurance. The customer satisfaction dimensions to impact positively on both loyalty and cumulative satisfaction are Satisfaction with the nursing staff, Satisfaction with meals, and Satisfaction with fees charged.

Patient perceptions of health care quality are critical to a health care service provider's long-term success because of the significant influence perceptions have on customer satisfaction and consequently organization financial performance. Patient satisfaction affects not only the outcome of the health care process such as patient compliance with physician advice and treatment, but also patient retention and favorable word-of-mouth. Accordingly, it is a critical strategy for health care organizations to provide quality service and address patient satisfaction. The urgent care (UC) industry is an integral part of the health care system in the United States that has been experiencing a rapid growth. UC provides a wide range of medical services for a large group of patients and now serves an increasing population. UC is becoming popular because of the convenient locations, extended hours, walk-in policy, short waiting times, and accessibility. A closer examination of the current health care research, however, indicates that there is a paucity of research on urgent care providers. Confronted with the emergence of the urgent care industry and the increasing demand for urgent care, it is necessary to understand how patients perceive urgent care providers and what influences patient satisfaction and retention. This dissertation addresses four areas relevant to the above mentioned issues: (1) development of an instrument to measure perceived service quality in the urgent care industry; (2) identification of the determinants of patient satisfaction and behavioral intentions; (3) empirical examination of the relationships among perceived service quality, patient satisfaction and behavioral intentions; and (4) comparison of the perceived service quality across several primary urgent care providers, such as urgent care centers, hospital emergency departments, and primary care physicians' offices. To validate this new instrument and examine the hypothesized relationships proposed in this study, an electronic web based survey was designed and administered to college students. Both exploratory and confirmatory factor analysis were employed to assess the reliability and validity of the developed instrument. The contextualized relationships were evaluated using structural equation modeling. The results of this research could potentially contribute to urgent care management and quality improvement.

No description available.

KRY hjälper människor som behöver vård genom digitala möten. Efter vårdmötet kan patienter ge omedelbar feedback. Det fanns inget system för uppföljning när patienter hade lämnat ett enstjärnigt lågt betyg efter ett möte - en så kallad “bad review”.  Övergripande syftet med förbättringsarbetet var att utveckla en bättre service och erbjuda bättre vårdmöten i framtiden. Syftet med studien var att undersöka medarbetares upplevelser av ett system för uppföljning av missnöjda patienter som använt digital vård. Förbättringsarbetet genomfördes enligt Nolans förbättringsmodell. Studien var en kvalitativ intervjustudie med induktiv ansats.  Orsak till klagomål inom digital vård har inte skiljt sig nämnvärt i jämförelse med klagomål inom fysisk vård. Medarbetare upplever att arbetet med att ringa bad reviews gav nöjda patienter och en känsla av att göra ett gott arbete samt att det fanns vinster med arbetssättet både för patienter samt för företaget.  Studien har visat att uppföljning av patienter som lämnat bad reviews uppfattas som något positivt för både patienter och de som ska utföra uppföljningarna. Rapportering av förslag från patienter för förbättringar av tjänsten/produkten har skett och fått resultat. / KRY helps people who need healthcare through digital meetings. After the appointment patients can give instant feedback about their experience. There was no system to do follow-ups when patients have left a bad review after a meeting. The overall aim of the improvement work was to develop a better service and to offer better meetings in the future. The purpose of the study was to investigate employees' experiences of a system for monitoring dissatisfied patients who have used digital care.   The improvement work was carried out according to Nolan's improvement model. The study was a qualitative interview study with an inductive approach.  Reasons for complaints in digital care have not differed significantly in comparison with physical care. Employees feel that the work of calling bad reviews gave satisfied patients and a feeling of doing a good job. There was an experience of gains both for the patients as well as for the company.  This study has shown that follow-up of patients who left a bad review is perceived as something positive for both patients and those who will perform the follow-ups. Reports of suggestions from patients for improvement of the service/product has been done and got results.

Bakgrund: Personcentrerad vård är aktuellt i svensk sjukvård. Patientlag 2014:821 stärker kravet på information, delaktighet och samtycke från patienten. Personcentrerad vård leder till ökad patienttillfredsställelse och delaktighet. Sjukvården effektiviseras och vårdkvalitén ökar. Det kan finnas utmaningar i att arbeta personcentrerat på akutvårdsavdelning då dessa patienter kan uppleva hjälplöshet och sårbarhet vid akut sjukdom.   Syfte: Syftet med studien var att kartlägga upplevelsen av personcentrerat vårdklimat hos sjuksköterskor och patienter på akutvårdsavdelning.   Design: Prospektiv tvärsnittsstudie   Metod: Kvantitativ ansats med enkätstudie. Sjuksköterskor och patienter på akutvårdsavdelning tilldelades mätinstrumenten Person-centred Climate Questionnaire staff och patient version.   Resultat: I studien inkluderades 59 sjuksköterskor samt 121 patienter. På den sexgradiga skalan värderar sjuksköterskor personcentrerat vårdklimat lägre (4,16) och patienter högre (4,99) (p<0,001). Manliga patienter värderar personcentrerat vårdklimat högre än kvinnliga patienter (p=0,001). Sjuksköterskor som arbetat länge på avdelningen värderar personcentrerat vårdklimat lägre (rs= -0,26; p=0,05). Sjuksköterskor med högre utbildningsnivå värderar subkategorin säkerhet lägre (rs= -0,27; p=0,04). Vid en längre patientvårdtid värderas personcentrerat vårdklimat lägre (rs= -0,24; p=0,01).   Konklusion: Den viktigaste slutsatsen är generellt positiva resultat gällande personcentrerat vårdklimat på akutvårdsavdelning. Studiens resultat understryker att vården kan utvecklas för att förbättra det personcentrerade vårdklimatet för patienter på akutvårdsavdelning, med särskilt fokus på kvinnliga patienter. / Background: Person-centred care is of current interest in Swedish health care. The Patient Act (2014:821) strengthens the requirement for information, participation and consent of the patient. Person-centred care increases patient satisfaction and participation. It also leads to increased quality of care and is more efficient. Patients on acute care wards may experience helplessness and vulnerability during acute illness and it could be challenging to achieve person-centred care.   Aim: The aim of the study was to survey person-centred climate by nurses’ and patients’ on acute care ward.   Design: Prospective cross-sectional study   Method: Quantitative approach with survey. Nurses and patients was given the instruments Person-centred Climate Questionaire staff and patient version.   Results: The study included 59 nurses and 121 patients. On the six-graded scale nurses value person-centred climate lower (4,16) and patients higher (4,99) (p<0,001). Male patients value person-centred climate higher than female patients (p=0,001). Nurses that worked long time on the ward value person-centred climate lower (rs=-0,26; p=0,05). Nurses with higher education value the subscale Security lower (rs=-0,27; p=0,04). Patients with longer hospital stay value the person-centred climate lower (rs=-0,24; p=0,01).   Conclusion: The main conclusion is generally positive results in terms of person-centred climate on acute care ward. The study’s results underline that there is room for improving healthcare on acute care wards, with particular focus on female patients.

Objetivo: Asociar la calidad de servicio brindada al paciente con la calidad de sueño de los estudiantes de pregrado de odontología en un centro de salud de una universidad privada de Lima, Perú. Materiales y métodos: El diseño del estudio fue observacional, analítico y transversal. Se evaluaron a 82 estudiantes y 244 pacientes de los mismos de un centro universitario de salud de Lima. Para la evaluación de la calidad de servicio se empleó el cuestionario SERVQUAL, el cual evalúa expectativas y percepciones. Asimismo, para la calidad de sueño se aplicó el Índice de calidad de sueño de Pittsburgh. Para la asociación de las variables cualitativas y el cálculo de las razones de prevalencia crudas y ajustadas, se empleó la regresión de Poisson con varianza robusta. Se trabajó con un nivel de significancia estadística de p<0.05 y un intervalo de confianza del 95%. Resultados: Se obtuvo que el 59.84% de los pacientes estuvieron satisfechos con la calidad de servicio brindada, y el 58.54% de los estudiantes tuvieron una moderada dificultad para dormir. Asimismo, no se encontró asociación estadísticamente significativa entre ambas variables principales obteniéndose una RP 1.033, IC 95% 0.417 - 2.559. Conclusiones: En el presente estudio se encontró que, la calidad de servicio no se encuentra asociada con la calidad de sueño. Además, los valores en la percepción en todas las dimensiones de la calidad de servicio superaron a las expectativas. / Objectives: Making an association between the service quality provided to the patients and the odontology student’s sleep quality from a health center on a private university in Lima, Peru. Materials and Methods: This study was designed observational, analytical and transversally. 82 students and their 244 patients from a health university center in Lima, Peru were evaluated. To study the service quality, the SERVQUAL questionnaire was used, which evaluates expectations and perceptions. Likewise, for the sleep quality, the Pittsburgh Sleep Quality Index was applied. For the variables association and for the calculations of the crude and adjusted prevalence ratios, the Poisson regression with robust variance was used. The work was made with a statistical significance level of p<0.05 and a confidence interval of 95%. Results: The obtained results indicate that 59.84% from the patients were satisfied and the 58.54% of the students had a moderate difficulty to sleep. Moreover, a significant statistical association wasn’t found between the service quality and sleep quality; getting a PR 1.033, CI95% 0.417-2.559. Conclusions: In this study, it was found that the service quality is not related to the sleep quality. Additionally, the values and perceptions in all the service quality dimensions surpassed the expectative. / Tesis

Objetivo: Comparar el nivel de satisfacción en pacientes mayores de edad que acudieron a un servicio odontológico en una clínica privada con un hospital público. Materiales y métodos: La muestra estuvo constituida por 100 pacientes mayores de 18 años en cada establecimiento (público y privado). Ellos fueron encuestados bajo determinados criterios después de su consulta odontológica. Se empleó como instrumento de investigación un cuestionario con 15 preguntas distribuidas en 7 dimensiones tales como: trato personal; eficacia en la atención; información recibida; accesibilidad y oportunidad; seguridad y privacidad; instalaciones, equipos y materiales; atención general. El análisis univariado se obtuvo mediante estadística descriptiva, frecuencia absoluta y relativa. Por otro lado, para el análisis bivariado se empleó la prueba de Chi-cuadrado y prueba exacta de Fisher. Resultados: Se encontró una satisfacción del 97% de pacientes en la clínica privado y un 85% en el hospital público. Además, se encontraron diferencias estadísticamente significativas en el nivel de satisfacción con cada centro (p=0.003) y con las diferentes dimensiones del instrumento empleado. Por otro lado, se observó asociación de la edad y experiencia de dolor con la percepción de satisfacción de pacientes del sector privado. Mientras que en el ámbito público no se encontró asociación alguna. Conclusiones: Se encontró un alto nivel de satisfacción en ambos centros, 97% en el ámbito privado y un 85% en el público. Además, se evidenciaron diferencias estadísticamente significativas al compararlos. / Objective: To compare the level of satisfaction in patients of legal age who attended a dental service in a private clinic with a public hospital. Materials and methods: The sample consisted of 100 patients over 18 years of age in each establishment (public and private). They were surveyed under certain criteria after their dental consultation. A questionnaire with 15 questions distributed in 7 dimensions such as personal treatment was used as a research tool; effectiveness in care; information received; accessibility and opportunity; security and privacy; facilities, equipment and materials; general attention. The univariate analysis was obtained through descriptive statistics, absolute and relative frequency. On the other hand, the Chi-square test and Fisher's exact test were used for the bivariate analysis. Results: A satisfaction of 97% of patients was found in the private center and 85% in the public. In addition, statistically significant differences were found in the level of satisfaction with each center (p = 0.003) and with the different dimensions of the instrument used. On the other hand, there was an association between age and experience of pain with the perception of satisfaction of patients in the private sector. While in the public sphere no association was found. Conclusions: A high level of satisfaction was found in both centers, 97% in the private sector and 85% in the public. In addition, statistically significant differences were evidenced when compared. / Tesis