Provider Workload Research Articles

Participative customers as partial employees and service provider workload

For service providers, whether customers can act the role of partial employees when participating in the service production and delivery process is a subject that has been receiving conflicting explanations and has not been analysed empirically. The purpose of this study is to examine the relationship between customer participation and service providers' perceived workload. Empirical results of survey data collected from 293 customer‐contact employees at 64 restaurants in Taiwan indicate that customer participation is positively related to service providers' perceived workload, which implies that it is inappropriate to decrease the number of service employees based on service designs that include customer participation. Implications of these findings for managing customer participation, as well as future research directions, are subsequently discussed.

Heading the table: parenting and the junior consumer

From the 1970s onwards, studies of the dynamics involved in family food provisioning in Britain and the USA have provided consistent evidence of the centrality of husbands and male breadwinners to food decisions. Recent studies are beginning to show the significance of children or the “junior consumer” to household food decisions. This paper reports on focus groups conducted in Australia in the mid‐1990s that support the argument that children exert considerable influence over family diets. One obvious reason for this trend lies in the activities of food retailers and advertisers/marketers, who target their goods, services and messages to children. These marketplace actors are encouraging children to identify as consumers. A less obvious explanation, and the one explored in this paper, concerns changing parenting practices. Despite the double workload of many family food providers, children's demands are being responded to in unprecedented ways. Metaphorically, children are displacing male adults at the head of the table. The paper comments on the consequences of children's dominance over dietary practices.

Impact of NHS walk-in centres on the workload of other local healthcare providers: time series analysis

Objectives: To assess the impact of NHS walk-in centres on the workload of local accident and emergency departments, general practices, and out of hours services.Design: Time series analysis in walk-in...

Mass gathering events: retrospective analysis of patient presentations over seven years.

St John Ambulance Operations Branch Volunteers have been providing first-aid services at the Royal Adelaide Show for 90 years. The project arose from a need to more accurately predict the workload for first-aid providers at mass gathering events. A formal analysis of workload patterns and the determinants of workload had not been performed. Casualty presentation workload would be predicted by factors including day of the week, weather, and crowd size. Collated and analyzed casualty reports over a seven-year period representing >7,000 patients who presented for first-aid assistance for that period (63 show days) were reviewed retrospectively. Casualty presentations correlated significantly with crowd size, maximum daily temperature, humidity, and day of the week. Patient presentation rate had heterogeneous determinants. The most frequent presentation was minor medical problems with Wednesdays attracting higher casualty presentations and more major medical categories. Individual event analysis is a useful mechanism to assist in determining resource allocation at mass gathering events providing an evidence base upon which to make decisions about future needs. Subsequent analysis of other events will assist in supporting accurate predictor models.

An observational study comparing quality of care in walk-in centres with general practice and NHS Direct using standardised patients

Objectives: To compare the quality of clinical care in walk-in centres with that provided in general practice and by NHS Direct.Design: Observational study involving assessment of clinicians by standardised patients.Setting:...

The role of patients and providers in the timing of follow-up visits. Telephone Care Study Group.

Although the decision about how frequently to see outpatients has a direct impact on a provider's workload and may impact health care costs, revisit intervals have rarely been a topic of investigation. To begin to understand what factors are correlated with this decision, we examined baseline data from a Department of Veterans Affairs (VA) Cooperative Study designed to evaluate telephone care. Observational study based on extensive patient data collected during enrollment into the randomized trial. Providers were required to recommend a revisit interval (e.g., "return visit in 3 months") for each patient before randomization, under the assumption that the patient would be receiving clinic visits as usual. POPULATION/SETTING: Five hundred seventy-one patients over age 55 cared for by one of the 30 providers working in three VA general medical clinics. Patients for whom immediate follow-up (</=2 weeks) was recommended were excluded. Mean revisit interval was adjusted for patient factors using a regression model that accounted for patients being nested within providers and providers being nested within sites. Four patient-level variable blocks (illness burden-patient, travel time, illness burden-physician, and prior utilization) were sequentially entered into a linear model to determine their role in explaining the variance in revisit intervals. Physician identity was also entered after four blocks. Recommended revisit intervals ranged from 1 month to over 1 year with the most common recommended intervals being 2, 3, or 6 months. About 10% of the variance in revisit interval was explained by illness measures independent of provider (e.g., general health perception) and travel time. Adding other illness measures (e.g., diagnoses, medications) and prior utilization (e.g., clinic visits) doubled the variance explained (R2 =.21). Finally, the identification of individual provider doubled the explained variance again (R2 =.45). After adjusting for patient factors, the average revisit interval for individual providers ranged from 8 to 26 weeks (8 to 19 weeks when restricted to the 16 staff physicians). There were also substantial differences across the three sites (adjusted means: 14, 17, and 11 weeks). Even after adjusting for a detailed array of patient-level data, primary care providers have different practice styles regarding the timing of return visits. These may, in turn, reflect the local "culture" in which they practice. How many patients providers are able to care for may be determined by the providers' inclinations toward the timing of follow-up visits.

A Descriptive, Correlational Study of Patient Satisfaction, Provider Satisfaction, and Provider Workload at an Army Medical Center

Strong national interest in health care delivery systems and a highly competitive marketplace have mandated that military hospital commanders be increasingly aware of organizational performance. Historically, one variable that has been used to assess such performance is patient satisfaction with the care received. The purpose of this study was to measure patient satisfaction at a major military medical center and to assess how patient satisfaction correlated with the variables of provider satisfaction and nurse/patient ratio. One hundred eighty-eight patients completed the LaMonica-Oberst Patient Satisfaction Scale. Data analysis revealed that, although overall patient satisfaction was high, it was significantly higher on the intensive care units and in other areas where the nurse/patient ratio was high. Interestingly, there was no correlation between the staff's perceptions of their work environment and patient satisfaction. Findings from this study serve to highlight the continued need for a low nurse/patient ratio and are suggestive of the need for refinement of patient satisfaction survey tools available at present.

Computer-Assisted Quality Improvement in an Ambulatory Care Setting: A Follow-up Report

The Quality Care Program (QCP), introduced into the Swedish Family Medicine Clinic in 1992, is a comprehensive computer-assisted program of quality improvement for the medical office. Its goal is to improve specific aspects of ambulatory patient care: disease prevention, cancer detection, immunization compliance, risk management, outcomes monitoring, and patient education. The QCP uses a computer-generated worksheet that is attached to the medical record at each patient visit. It is a multipurpose worksheet that displays important clinical information and functions as part of an overall strategy to manage key aspects of the patient's care. The system enhances patient and physician performance of health maintenance and continuity of care, and it allows for the quantification and display of performance indicators without exclusive reliance on chart review. Physician reliability in recommending health maintenance interventions has improved to nearly 100%, and patient compliance with these recommendations has significantly increased. The test results tracking system has found test data that would have otherwise been lost, and the outcomes monitoring has resulted in measurable system improvements. There has been a modest increase in provider workload to meet these aggressive QCP goals, but measures of provider satisfaction have increased nonetheless. Ambulatory care, increasingly the focus of attention in the United States, can be difficult to perform well. The QCP, part of an overall quality improvement initiative, gathers and displays clinical information, reminds patients and physicians to do health maintenance, and refuses to let physicians and patients forget about specific aspects of patient care.