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Sample Essay On Healthcare

1. Analyze three (3) quality initiatives for your organization

Quality assurance is very vital in the healthcare sector more so in one of the largest healthcare organizations as most of the country’s population depends on it to deliver when need arises. It is expected to have top class services in order to meet the population needs, and in order to meet a top-class rating, the following quality initiatives comes highly recommended.

These include:

The first one is an implementation of technological systems in the patient care support. Staffing the organization need to be furnished with the necessary equipment to ease the daily workload that is mostly caused by documentation, which brings about traffic in hospitals where patients stay in long queues waiting for their records to be retrieved. This may take ages given that the manual documentation system is in place, and in order to bring sanity in the healthcare system, the system has to be put in place.

The other most important quality initiative that needs to be adapted is the improvement of communication which affects both the staff and the patients. Communication inefficiency is a vice that is common not only in the organization, but affects the entire healthcare sector. In order to curb this vice, proper measures have to be put in place to improve communication, as most of the time is spent searching for necessary medical supplies for patients.

An equipment tracking system is efficient enough to improve communication, as it reconciles data from the laboratory with that in the clinical department making it totally effective to initialize good communication.

The Introduction of a Bar Code Medication Administration (BCMA). This has been widely proven to bring about improvement in the administration of the medication process. This system ensures that the prescribed drug is the correct one and is administered at the correct time to the right patient. Each patient is provided with a wrist band that has a bar code scanning to provide the patient’s details and the medication administered. This will drastically reduce the errors experienced in the organization. (Weston Marla, 2013)

2. Determine the supporting factors that would aid in the reduction of healthcare cost in your organization without reducing quality of care for the patients.

It has reached a point where the cost of operation is way greater than the initial investment in a given year. The organization spends a lot in maintenance and wages thus making its healthcare services slightly costly to the average population requiring its services. These are the areas that need to be addressed to realize cost reduction in the organization.

The doctors and nurses wages are high in the organization, as they are paid based on how much they do, rather on how well they render their services. This encourages the practitioners to over treat their patients with a mission to earn more. To improve this and cut cost on their wages, an integrated medical system that generates medical records electronically to streamline the wages.

Technology will also play a major part in cutting cost of healthcare in the organization, as manual labor increases cost and also inefficiency in the organization. For example, buying of new equipment needed to offer services to the patients may just take a one-time huge investment, but it will end up cutting cost and improving service delivery in the organization, in the long run. In implementing the highlighted cost cutting ways will bring along efficiency, and cheaper ways of service delivery in the healthcare sector of the organization, which will bring merit to both the organization’s management and the patients seeking our services.

3. Differentiate between quality in a free market healthcare system and a single payer government system with three (3) examples in each.

A single payer government system in the healthcare refers to a system where the organization sums up the bill and send it to the relevant entity for the services rendered. At the end of the month, quarter of a year, half a year or even annually depending on how the organization has agreed with the given entity will receive a lump-sum payment from them to cover the medical expense, which in this case it is the government.An example of countries embracing the single payer government system includes Germany, Denmark and the United States of America. All the developed countries have adopted this type of healthcare system by ensuring their citizens have free access to healthcare.(Kwon, 2003)

One the other hand, a free market healthcare system is where price is set by agreement between the healthcare providers, in this case, our organization, and the patient. In this system of healthcare system, patients are allowed to either pay for services themselves or choose a convenient medical insurance cover provider all by themselves. This is common in the developing countries as governments in such countries do not have the ability to provide medical cover for all their citizens, thus leaving the average and high income earners with the advantage of getting an insurance cover as it is not affordable to every citizen. Examples, in this case, include Uganda, India, and Brazil.

4. Specify three (3) common law quality initiatives that are still found in 21st century healthcare organizations.

Healthcare being a broad and vital sector of any given economy, and it being the main focus of our organization, quality initiatives prior to services offered are to be given close consideration and attention and the common law quality initiatives followed to the latter. The laws governing quality initiatives have undergone major reforms in recent years as technology continues to grow significantly, and thus it is embraced widely in the sector.

There are common laws quality initiatives that remain unaltered in all the years of technological advancements and reforms in the healthcare sector. One of them being: “Use of unnecessary or inappropriate care”. This tends to expound on the unnecessary or excessive of diagnosis tests by use of x-ray machines, over-prescription and under prescription of antibiotics and other drugs that may have a negative side effects on a patient. The organization on following this law can put the money and resources wasted into other meaningful and productive use.

The other common law is: “Underuse of needed, effective and appropriate care”. This law on quality initiatives on the other hand revolves around discrimination of patients based on their financial background and insurance health insurance cover. Most healthcare organizations focus on the patients who have been insured and become hesitant to properly diagnose, offer preventive or therapeutic services. This law also highlights those faced by geographical, communication, cultural and organizational barriers among other barriers but still have insurance covers. The organization can give proper staff training to raise awareness in order avoid discrimination of the patients who seek their services.

The next most important law in the healthcare sector is:“Shortcomings in technical and interpersonal aspects of care”.Here, the law elaborates on inferior care being given to patients due to negligence from the organization’s medical practitioners as a result of inadequate or lack of proper mastery in their field of career practice. Poor communication is experienced when the organization’s medical practitioners cannot adequately explain effectively the necessary information to their patients, where they prescribe the wrong dosage or carry out an unnecessary surgery, or for instance in other cases, wrongly analyzing laboratory results. This can is a very serious vice that can be eliminated or curbed in the organization by carrying out vigorous examinations and reviews of the organization’s medical practitioner’s education levels and qualifications, and also carry out ethics training on them.

5. Defend your position on the importance of healthcare quality for your organization. Provide support with at least three (3) examples that illustrate your position

Healthcare quality provides a check and balance in an organization, which consists of vigorous and systematic changes to bring about measurable and realistic improvements in an organization. Quality is automatically associated with the efficiency of an organization’s level of handling patients and the patient’s level of satisfaction; this is the main importance of healthcare quality review in an organization.

For example, in Chicago, America’s leading healthcare experts recommend several strategies to curb various treatments and surgeries that are often prescribed but are not necessary.(American Medical Association, 2012)

In Canada, Health experts advise on proper reviews of the quality initiatives in healthcare after at least five years to bring about sanity in the healthcare sector.
Another example is the United States of America; hospitals are ranked not of how many doctors they have or how big the hospital is but on the quality of the organization. This should paint a picture in our organization that quality matters a lot.

6. Assemble a plan to protect patient information that complies with all the legal requirements.

It is highly recommended that all patient records to be kept electronically to meet all the necessary merits of cost savings, speed, accuracy and safety. It is the organization’s mandate to keep the records of the patient’s safe and in which, they can be saved in many forms that include: computer flash disks, disks and tapes, prescription forms, patient forms, emails, lab reports, collection documents, conversations between patient and doctor, insurance statements, faxes, collection documents among other forms. This will help in not only keeping the records safe but to also enable fast access to patient’s information and records, and also helps the medical practitioner follow up on a patient’s progress.

In order for the necessary measures to be implemented, the organization should make sure that there are staff specifically assigned to deal with patient’s records and be held accountable for all records, the organization should also ensure that the records follow a specific Protected Health Information Safety procedure for security and privacy. An office for policy and quality assurance should be set up to give the organization a reality check and to inform the patients of their rights and to also limit access to patient information by unnecessary bodies.

References

American Medical Association. (2012). Proceedings from the National Summit on Overuse. National Summit on Overuse, 2-4.
Kwon, S. (2003). Health Policy . Baltimore: Elsevier Science Ireland Ltd.
Weston Marla, R. D. (2013). The Influence of Quality Improvements Efforts on Patient Outcomes and Nursing Work. The Online Journal of Issues in Nursing , 3.

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Change resistance in Health Care Organization

Among the key concerns of the healthcare environment and management is change management. In the healthcare setting, professionals have an obligation of maintaining and as well, acquiring expertise needed while undertaking their professional tasks. In addition, in a healthcare profession, professionals face another obligation of only taking those tasks that are within their competence skills (Swansburg, 1996). Similar with other professions, in a healthcare profession environment faces need for change. Change in any organization faces different responses from workers and as well different individuals. There are individuals who want to support the change, some appear indifferent, while others appear passive or participate in the change. Resistance to change is among the common response workers have to change within their organization. The paper is a discussion of resistance to change in health care organization.

Change management in health care organization is an important aspect of management. It deals with the complexity of the change process (transformation process). This process involves evaluation, planning and implementing strategies with the aim of making the change worthwhile and relevant in the health care organization (Borkowski, 2011). This process is complex, dynamic and sometimes incorporates challenging processes depending on the response of the workers to the anticipated change in the organization. Unlike other decisions made in health care organization, change decisions are never a choice between technological approach and people-oriented strategies but highly relies on the combination of the two aspects (Swansburg, 1996).

Effective change within the health care organization unfreezes old behaviors within the organization and introduces new behaviors. As a dynamic process, it involves unfreezing of existing behaviors and introducing new ones. There are different types of change. The most common change in health care organization refers to a predictable change. Under this change, workers have the opportunity and tome for preparation before its implementation. On the other hand, unpredictable change poses challenges during its implementation. In this change, workers do not have time for preparation and, therefore, this change faces much resistance from the change as they face some challenges while coping with changes introduced in the organization. In health care organization, unpredictable change is common since changes in these organizations occur so rapidly (Borkowski, 2011).

Change promotion is demanding. It requires managers to challenge their workers. More so, due to different responses faced after introduction of change in an organization, the manager has a crucial role of persevering against these responses. Change implementation takes time. Therefore, as a manager implementing change in health care organization, there is a need for commitment of time. Apparently, the manager needs to understand the values and the change. Focusing on the precedent during change management is an important aspect as it prevents managers from reacting at every requirement of change. Therefore, despite different responses experienced from workers, managers have to develop their strategies of coping with the responses (Borkowski, 2011).

Despite resistance originating being a common response of workers to change, it is, on the other hand, a subjective matter where managers have the role of observing the behaviors of their workers that resist the change. Change that does not face resistance is not change. This is because it does not affect workers. Similarly, managers should not assume that resistance does not have merit. In health care organization, resistance to change is a healthy response to long-term decision made by the management. It gives the management an opportunity of learning their worker’s points of views regarding decisions made (Swansburg, 1996).

Resistance to change in health care organization originates from different aspects. Some of the sources of resistance to change in health care organization include; insufficient ownership of decision making process, inadequate compensation of workers in the health care organization, norm’s conflicts between the management and workers, lack of management commitment to issues facing workers and lack of consultation before landing on decisions of implementing the change (Melnyk, 2011). On the other hand, in health care organization, resistance to change may arise when the change threatens to modify the existing patterns of working conditions and relationships between workers. Apparently, many workers resist changing when communication about the change under implementation had its time insufficient and they did not have time for preparing for the change (Swansburg, 1996).

Resistance to change has both negative and as well, some positive influences the management. Resistance to change leads to loss of time while the management is compromising with its worker’s behaviors. This may lead the organization to lose focus making the organization fall behind its goals. Despite the disadvantage of resistance in health care organization, it also plays an important role in the evaluation of the change under implementation where the management gets the opportunity of learning the worker’s ideas regarding other possible change approaches (Melnyk, 2011).

In conclusion, due to the global changes taking place, health care organizations face an obligation of changing aiming at proceeding ahead. In change management, establishment of a clear vision on the direction of change process is an important aspect of determining and assuring successful change implementation. Furthermore, monitoring the outcomes of the change process is essential in recognizing whether the change process fulfills the anticipated intentions. Lastly, since change is a dynamic and continuous process in any organization, it is important for the management and workers to record and focus on the emerging issues regarding the change. This aids the management in avoiding future problems while implementing the change and in a suitable manner.

References

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Borkowski, N. (2011). Organizational behavior in health care. Sudbury, Mass: Jones and Bartlett Publishers.
Swansburg, R. C. (1996). Management and leadership for nurse managers. Sudbury, Mass: Jones and Bartlett Publishers.

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Nationwide Health Workforce Shortages Sample Essay & Outline

The healthcare sector is one of the most vital sectors in any economy. In most countries, healthcare services provision is supervised and sponsored by the government to promote the well-being of the country’s citizens. Moreover, the healthcare workforce should be able to produce sufficient workforce and skills in order to produce efficient healthcare services.

The thesis of this essay is to evaluate the level of healthcare task force shortages in U.S.A. Thus, this essay focuses on the areas of shortages in the U.S.A’s healthcare sector. Moreover, this essay seeks at establishing the causes of these shortages and the remedies to the causes.

Current State of the Public Health Sector

The National Center for Healthcare Workforce in the U.S addresses the issues affecting the supply and demand of healthcare workers in the country. According to the National Center for Healthcare workers in the U.S, the country has recorded a decrease in their public workers compared to the country’s health sector workers 20 years ago (Human Resource and Services Administration, 2012). The government’s public health department are currently facing workforce shortages, with the situation speculated to worsen through this year’s retirements and economic recession experienced by the country.

An estimated 20% of the country’s average healthcare workforce per state is eligible to retirement within the next three years. According to reports by the Trust for America’s Health, 2012 was expected to lose almost 50% of some state’s health agency workforce (Human Resource and Services Administration, 2012). The rate of retirement by the healthcare workers and the rate of hiring new healthcare personnel in not equal. Therefore, this simulates a prolonged shortage of healthcare taskforce in the future.

The total health sector workforce represents about 10% of the total workforce of the country’s public workers (Human Resource and Services Administration, 2012). The health sector workforce can be grouped into many professions depending on the level of skills employed by workforce. For instance, there are physicians, nurses and laboratory personnel among others. Health settings in the U.S entail clinics, hospitals, nursing homes and physician offices.

Moreover, the health sector workforce comprises of other professions that are not health related but their services are highly essential to the sector. These professions include food service workers and accountants among others. While discussing the shortages experienced by U.S in its healthcare workforce, it is primal to include health workers who work outside the health sector. These areas may include schools, insurance companies and local governments.

Data obtained from the U.S Department of Education and the U.S Census Bureau from 2008-2010 represents the distribution of physicians by their work setting. According to the data chart representation, hospitals account for the largest healthcare settings followed by physician offices. Hospitals account for 41.9% of the physicians and physician offices account for 39.5% of the physicians in the country. On the other hand, outpatient care centers represent 5.8% of the physicians’ workforce, whereas other health care services present in the country represent 5.1% of the country’s physicians (Human Resource and Services Administration, 2012).

A 66.5% male population and a female population of 33.5% represent the U.S healthcare physicians’ workforce. Analyzing the distribution by age, the highest population of physicians in the healthcare sector is aged between 35-55 years. Further, the population of physicians aged less than 35 years is slightly higher than the population of physicians’ aged more than 55 years. This simulates a shortage of new healthcare physicians to replace the almost retiring physicians (Human Resource and Services Administration, 2012).

Consequently, nurses also play a major role in the provision of health services. According to data reports extracted from the Department of education and the U.S Census Bureau, nursing care services in healthcare settings is paramount. Reflecting the graphical indications provided by data sources, hospital settings account for nearly 63.2% nurses’ population, nurse care facilities account for 7.4% and outpatient care centers account for 4.6% of the nurses’ population. Nurses population in the U.S is represented by a larger female population of 90.9% and a male population of 9.1%. Further, nurses aged between 35-55 years represent the highest population of nurses, by age. On the other hand, population of new nurses aged less than 35 years is slightly more than the population of nurses aged more than 55 years.

44 out of 50 states in the U.S reported task forces studies to evaluate the level of their workforce shortages. The task force studies ranged from long-term workforce shortage, shortage of nurses and the general health workforce shortages. Other health occupations such as pharmacy and dentistry were also included in the studies. According to the study’s results, the nursing profession reported the highest levels of task force shortage. 90% of the states reported a shortage in their nurses’ workforce. Consequently, 70% of the states reported pharmacist shortage. Other key professional shortage areas reported were radio-logic technicians and dentists (Human Resource and Services Administration, 2012).

Efforts by the Government to improve the Healthcare Task force

According to the state’s healthcare task force reports, the most commonly used strategies by the states to improve the level of their healthcare workforce, entails loan repayment programs and scholarships for the health professionals. Twenty-four states reported they had started programs to improve the total number of new registered nurses. On the other hand, 28 states reported they had started programs to improve a wide number of health professions such as dentists and pharmacists (Holtz, 2008).

Ten states reported that they had started long-term initiatives to help market health careers. These states have initiated Area Health Education Centers targeted to the youth, to improve the number of health education scholars among the youth. Apparently, twenty-eight of the total states that engaged in the study reported that they had started developing or had already developed an efficient career ladder program for various health professions (Holtz, 2008).

According to the recent studies conducted by the Department of Education, states have increased their involvement in addressing healthcare taskforce shortages. These states have come together to address the major concerns experienced by the states’ health care sectors. These concerns majorly include access to healthcare and the quality of healthcare services. Health and education sectors have implemented measures to improve shortage of the healthcare taskforce. However, their efforts have not been fully successful in reversing or preventing the taskforce shortages. Therefore, this calls for more state actions to improve the current healthcare taskforce shortage in the country (Williams, Satiani & Ellison, 2009).

Issues Affecting State Implementation of Healthcare Policies

American states have not been fully efficient in enacting efficient remedies to curb the shortage situation. Responses by states are generally designed to improve production of new workers rather than the quality of the healthcare services in the long run. States have failed to address the problems of retaining a sustainable healthcare taskforce or trying to improve the level of healthcare services productivity. Therefore, this reflects the government’s failure to oversee effective internal health facility operations. Moreover, most states do not offer new scope of practice regulations, which is a sensitive aspect to the healthcare profession (Williams, Satiani, & Ellison, 2009).

Individual state response to the healthcare taskforce shortage can lead to inevitable redundancy and duplication of new policies. Nevertheless, there are major benefits achieved by single state policy responses to address the healthcare taskforce shortage. For instance, when states work independently to create new healthcare policies, development of solutions and programs is consistent in each state. In addition, if states act independently, there is a positive improvement in the development of solutions and programs between state’s health and education sector to improve the shortage situation. Consequently, development of single state healthcare policies improves creativity and innovation (Holtz, 2008).

However, the early stage of development calls for continued attention to health workers by the states (Westphal, 2008). Further, there is a significant benefit for the government if states share collaboration and information. A quality evaluation investment should be implemented by states to assess the effectiveness of alternative policies and whether the most productive policy takes course.

Ways Recommended to Improve the Public Health Workforce

Enhancing data collection is an efficient and reliable way to improve the public health workforce shortage. Data is used to detect where the problem lies and to evaluate whether the impact of new policies created. In addition, enhanced data enables the government to understand the changing needs of the healthcare sector. These changing needs include the skills or scope of work in the healthcare sector. Therefore, the government should implement data collection to provide an enumeration survey for the public health workforce. The survey should be carried out on a certain period, maybe annually or biannually. This survey should address the current distribution of health sector jobs including the new trend lines, training, wages and benefits. The survey should be collaboratively carried out with the healthcare sector and the department of labor (Holtz, 2008).

The government should also enhance coordination through creating a reliable advisory panel. The advisory panel is necessary to advice the government on the right measures to undertake in the healthcare services provision. Further, the advisory panel should evaluate whether policies implemented are accurate. For instance, the department of labor authorities the government spending on various grants and loan programs to boost the healthcare taskforce shortage. On the other hand, the department of labor and the department of education work collaboratively to enact various healthcare related training programs. The involvement of a government agency to overlook the implementation of healthcare policies by individual states is necessary to create efficiency (Williams, Satiani & Ellison, 2009).

Consequently, development of retention, recruitment and re-training incentives for the public healthcare workers is necessary. For instance, states can institute loan repayment programs or grants to students who commit to entering community public health for a specified number of years. These students can be given a certain academic criteria that they should meet the standards. Moreover, the government can match funds allocated to the local and state governments to invest in retention, recruitment and retraining of public health workers. The government can also provide investment through health workforce grants to states to improve the supply and distribution of the healthcare workforce. The funding should be used to support health workforce education and training capacity.

The government can also improve the healthcare task force shortage by creating referral centers for health workforce education and jobs. This would help improve the size of the healthcare task force by linking medical scholars directly to the government’s health care jobs.

The provision of public healthcare services should be effective and diverse to achieve to goals of the public health system. Further, the department of labor plays a vital role in addressing the issues affecting the inadequacy of healthcare task force. The department of labor can enhance provision of grants to states to improve the remuneration standards for healthcare personnel in order to improve their work motivation. This is fundamental in improving the public health service delivery in the country.

The future of the healthcare sector is speculated to improve following the entry of new service regulation agencies. For instance, the American Nurses Association addresses the issues faced by nurses in performing their duties. Further, the agencies have improved the provision of services to the public by addressing different work issues facing the healthcare practitioners and the public. For instance, the American Nurses Association affected the ethical guideline for nurse practitioners (Westphal, 2008). Therefore, these professional agencies can work collaboratively with the state governments to tackle the emerging issues and address the relevance of enacting various healthcare policies.

The entry of new technology in the healthcare sector simulates a future improvement in the provision of healthcare services. Moreover, new technology reduces the level of human labor required in provision of certain healthcare services. Therefore, new technology innovations can help improve the healthcare taskforce shortage problem in the long term.

Reference

Human Resource and Services Administration (2012). Highlights from the 2012 National Sample Survey of Nurse Practitioners. U.S Department of Health and Human Services.
Holtz, C. (2008). Global health care: Issues and policies. Sudbury, Mass: Jones and Bartlett Publishers.
Westphal, J. A. (2008). The effect of workforce shortages on nurse leader turnover and succession in United States hospitals.
Williams, T. E., Satiani, B., & Ellison, E. C. (2009). The coming shortage of surgeons: Why they are disappearing and what that means for our health. Santa Barbara, Calif: Praeger/ABC-CLIO.

Patient Satisfaction in Health Care Essay & Outline

Abstract

The findings of the present study have showed that healthier, older patients, the males, with a lower level of education, those who see the system performance to be high as well as those with the lower levels of the system use have more satisfaction derived but them from their healthcare plan as well as their healthcare when compared with their counterparts. In regard to the response of incremental effect sot the variable, the findings which are so far most striking are the strong, pivotal roles of the physicians in the influence of the patient satisfaction with the healthcare. In the case of health plan, the levels of the problems which the member's have had in respect to their health plans have so far the greatest influence in statistics on their satisfaction with the plan that has been proposed for them. Some other effects of the variables which include the three demographic variables , self-stated health status, the number of visits to a doctors clinic , as well as issues which relate to access . Although these issues are very significant, they show relatively smaller statistical influences on the overall satisfaction of the patients in respect to healthcare as well as health plan.

Introduction

The service sector in the U.S is of undisputed importance. In fact, it accounts for more than 76 percent of the gross domestic product as well as an estimated 79 percent of the whole employment. Among some of the fastest growing industries, particularly in terms of service delivery is the healthcare sector. In 1999, the total healthcare expenditure totaled more than $671 billion and by 2000 had risen to $ 1.4 billion HALL. This increase seems to be very impressive, the expenditures of the healthcare when expressed in terms of GDP have been fairly stable going at about 13 percent from 1992 all through to 2000 (HALL, 2006). The coming decades have however been predicted to have faster growth in the healthcare industry. The expenditure of the healthcare industry has actually been projected to reach a total of $ 1.5 trillion by the year 2002, and by 2010 increased to $ 2.6 which is equivalent to more than 17% of the total G.D.P . The trend has been triggered by the fact that the customers have more appetite for improved healthcare services as well as lessened forms of managed care. In order to gain a competitive edge and thus increase the amount of profitability, providers of healthcare should consider finding out the factors which motivate the consumer of healthcare services to pursue better services (ZIMMERMAN, 1996). The providers are also expected to find out what a consumer considers to be better healthcare and therefore work on something that would enabled the consumer to find that value in the services that the providers provide (O'MALLEY, 1997). This would require a keen investigation into the customers preferences as well as behaviors and from this, factors which could be easily marketed are easily obtained a worked on to provide the needed level of consumer satisfaction. In addition, when putting into considerations the tremendous growth as well as the importance of the healthcare industry in the economy, the questions as well as the relationships that would surface would be of great value to the marketing scholars especially those interested in the behaviors of the consumers (MACSTRAVIC, 1991).

Literature Review

From this, it is clear that the main purpose of this particular study is therefore to investigate the construct patient satisfaction in a well organized and deeply researched manner (THOMPSON-BANKO, 2009). In addition, the predictor variables of researches which have been done previously identified by a number of various researchers as well as the present study which is more comprehensive as compared to the previous researches (MESSNER, 1996) . This is due to the fact that the current research includes more independent variables more than another preceding single study. The same variable will receive similar considerations, given the recent findings on the perceived effects of self-determined status of health on satisfaction on care as well as plan (MACSTRAVIC, 1991). In order to shed more light into the variables which have been postulated, the effects of specific socio-demographic variables such as age, educational level, and gender as well as a number of variables which are related to system performance as well as usage of the system shall be examined. At this point, it would be important to differentiate the variable which a provider has control of and those which the provider has no control over. That means that, if it is found that the incremental effects of the former variables are larger as compared to those of the latter ones, then it means that the understanding of these relationships will be able to provide care as well as plans to develop strategies which lead to more effective programs and therefore allocate resources in a better and more efficient manner (MESSNER, 1996). The issue however becomes problematic when it is established that the incremental effects of variables that are not under control of the provider are larger. That leads to a need to question whether indeed marketers as well as managers of the healthcare are able to step into the situation and bring any effective modification.

Patients satisfaction; definitions, measurement and predictor.

Providers have traditionally given the quality of healthcare from their point of view because they believe that patients do not have the necessary knowledge required in the evaluation of care intelligently. However, this has changed to the perception of care delivery. This move has been termed as significant especially since the level of competition has evolved. The healthcare providers are also dealing with more sophisticated patients who desire to have increased control and are therefore demanding greater focus on their needs and wants. Therefore, patients are treated as consumers and therefore an effective patient's relation has been highlighted to be important in the survival of today's turbulent market of healthcare (HALL, 2006). Therefore, according to the point of view of the customers, patient's satisfaction is derived from the scale of customer's point of view. It is difficult to define exactly what patient satisfaction is since each and every patient may have their own way of expressing what satisfaction id to them. The patient's expectations of care, attitudes as well as how they are handled by the providers contribute greatly to how the rate the provider in terms of satisfaction (HALL, 2006). Other factors which also contribute to the scores of the patient's satisfaction include psychosocial, aim and depression. In the past, surgeons have based their assessment of satisfaction on the surgical techniques used as well as the objective of the outcomes of measures of the patient's satisfaction (MACSTRAVIC, 1991). Patients place great value on the surgeon -patient interaction in rating the level of patient satisfaction. Another alterative in determining how the level of satisfaction is measured lies on the provider's terms. Well established predictors of the patients include the patient socio-demographic characteristics which include age, education and gender, as well as a variety of other external factors (O'MALLEY, 1997). The latter include system usage as well as the perceived system performance. Research has also established a relationship between health status and the level of satisfaction. It has been urged that the healthier patients are more satisfied with the quality of healthcare service which they receive that those who are unhealthy.

As a result of movement to the management care as well as the accompanying discussions of the negative effects is has, on the choice of the consumers as well as the quality of care, the managed care organization has become increasingly interested in the aspect of customer satisfaction, namely the satisfaction with health plan. There are many factors which have been shown to have great effects on the level of customer satisfaction with their health plans, which include the performance of the system as well as the usages. It has also been suggested that the health status of the patients has effects on the satisfaction as well as the health plan, with the healthier patients recording higher scores on the satisfaction charts.

The relationship between healthcare and satisfaction with healthcare.

The has been many studies which have investigated the relationship between the status of health and the satisfaction with healthcare, Generally there is a consistent high score on the satisfaction chart for the healthier patients as compared t the less health patients. Although some people have urged that satisfaction leads to better health, some have urge that better health services lead to higher satisfaction (SHORE, 2007). The satisfied patient's have an easy time remembering the advice given to them by their physicians, follow medical regimens more strictly and keep the same doctor for as long as possible in order to increase their rapport. Patients who are more satisfied are likely to participate more actively and effectively in such a way that that their behavior promotes better health. Such patients are at ease when dealing with the providers of healthcare and can therefore pose any question which they may need clarification on(O'MALLEY, 1997). Satisfaction has also been urging to consist of a more global dimension, in addition to the domain-specific dimensions. There has been a positive correlation between higher satisfaction with healthcare as well as a variety of dimensions of satisfaction in life. This includes aspects such as leisure, marriage, money as well as consumer issues.

The point of view that poor health generally results in dissatisfaction has been tested on the other hand. The technique of simultaneous equation was used to in the detection of the direction of causation. The findings of this study suggest strongly that health status is likely to affect satisfaction determines later health status. The results have been supported by many subsequent studies which have found out that patients health status is likely to affect satisfaction with healthcare over time, in spite of the fact that there exist no data to back this claim. Physicians seem to have a liking for those patients who have better health as opposed to those who are less healthy. In addition, those patients who have a feeling that the physicians have a liking for them report higher scores of satisfaction with care. The other factor which supports the claim that poor health leads to dissatisfaction is that physicians have been found to be less satisfied after visiting sicker patients. The same patients are likely to register lower score on the satisfaction chart if they happen to be less mentally or physically healthy. This effect is further consolidated by the fact that patients who are sicker normally display more negative cues of communications at the time of visits by the physicians. The third factor which seems to validate the previous findings is that poor health is known to produce dissatisfaction either directly or indirectly.

The relationship between health status and satisfaction with health plan.

Recent studied shave investigated the relationship which exists between satisfaction and health status with health plan. Although some have found that patients tend to have more satisfaction with their health plan as compared to those who are less healthy. There are some researchers who have however found this relationship to be mediated by the type of health plan that has been used. Comparing the satisfaction ratings between the healthy as well as the less healthy, the former has been found to be more satisfied than the latter by 4-5 percent. Similarly it has been shown through research that 8.5 percent to 22 percent of the healthy patients tend to be dissatisfied with their plan, while 11.8 percent to 23.5 percent of the functionally impaired patients continue to report dissatisfaction. The studies support the idea put forward previously that healthier patients are more satisfied with their own plans as compared to those patients who are less healthy.

The effects of age, gender, systems characteristics, level of education on satisfaction with healthcare and health plan.
Effects of age on satisfaction with healthcare and health plan

Older patients tend to be more satisfied with the kind of care which they receive as compared to their younger counter-parts. This occurrence has been suggested to be as a result of many factors. These include;

Older patients have memories of how poor healthcare services used to be over the past years and therefore end up lowering the expectations of the current systems and are therefore more satisfied.

The older people are treated with much more respect when compared to their younger counter-parts and end up getting more satisfied than the younger patients.

The older people are reluctant in complaining as compared to the younger patients.

Furthermore, it has been found that younger patients are less satisfied with the health plans which they have. The younger patients are also more likely to discontinue from their health plans as compared to the older people. This suggests that old people are more satisfied with the health plans which they have as compared to the younger people. From this, it is easy to postulate the following hypothesis.

H3. Older patients, when compared to the younger patients are generally more satisfied with the type of healthcare which they receive.
H4. Older patients when compared with younger patients are more likely to get more satisfaction with their health plans

The effects of gender on satisfaction with healthcare and health plan.

Some studied has concluded that there are no distinct differences in the rating s of the satisfaction between the females and the male patients; recent research has shown that the male are more satisfied with their care when tested against their female counter-parts. This is consolidated by the fact that most physicians tend to like their male patients as compared to their female patients. Since this correlates with how many the patients liked their physicians in order to determine their rating on the satisfaction charts, the study makes the findings to be much more intuitive. The same case applies to the health plans. Females are less satisfied with their health plan more as compared to their male counter-parts. It might be due to the fact that female patients might perceive their contacts with health plan representatives as being quite unsatisfying and negative, and therefore end up rating the health plans lower than their male counterparts.

The following hypothesis would be very applicable;

H5. Male patients when contrasted against the female patients are more satisfied with the kind of healthcare which they receive.

H6. Male patients when compared with the female patients are more satisfied with their own health as compare to their female counter-parts.

The effect of educational level on satisfaction with healthcare and health plan.

There is a negative correlation between education and the level of satisfaction with care. Parents who have lower levels of education tend to have more satisfaction with the care which they receive as compared to those who have higher levels of education. Patients who are educated end up being less satisfied because the set their expectations very high and thus end up being frustrated and disappointed (HALL, 2006). This makes them to have less satisfaction. The reverse is true. That is, patients who are less educated have more satisfaction when compared to their educated counter-parts. These findings lead to the next set of hypothesis;

H7. Patients who have a lower educational attainment, as compared to those having a higher educational attainment are much more satisfied.

H8. Patients with lower levels of education achievement, when compared with those having higher levels of educational achievement, are much more satisfied with their health plans.

The effects of system performance an system usage on the satisfaction with healthcare and health care plan.
The system performance has shown a strong link between system performance and satisfaction with care and plan. Patients who have a perception that the system performance is poor are more likely to abandon their health plans. This provides for the development of the next set of hypothesis;

H9. Patients who perceive system performance as being high, when compared to those who view system performance as being low, are more satisfied with their healthcare services.

H10. Patients who perceive system performance to be high, when compared to those who perceive the system as being low, are much more satisfied with their health plan.
System usage; Patients who have much more contact with their healthcare provider demonstrates a lower level of satisfaction with both as compared to those with a lower usage.

Methodology

The used in the research come from an alliance of various health plans having 76 participating plans running across the country. Each health plan produced individual samples that were drawn to support their internal proprietary member satisfaction research. Completed interviews were obtained from an averaged 531 members. Mail-telephone technique was used in this case with the following steps

A questionnaire was sent by mailing. The initial mailing was composed of a questionnaire, a cover letter which was keen in explaining the purpose of the survey, the significance of responding and the fact that data for each individual was to be kept confidential.

Reminder post card. Ten days after the initial mailing, a post card was sent to non-respondents.

A questionnaire was sent the second time.

A second questionnaire was sent, cover letter as well as the return mail were sent to non-respondents 20 days after the first questionnaire was sent.

There was a telephone follow-up. The mail -non respondents were given a follow-up using telephone 21 days after the initial questionnaire mailing.

Data Analysis and results.

item measure

The system performance was assessed using a number of questions that related to different dimensions of the same construct. The dimensions were analyzed by asking a series of questions which measured whether respondents had experienced problems:

Getting some doctor who they were comfortable working with.

Getting referrals to a specialist who they needed to see.

Getting the care which their doctor believed would serve as important

Delays in health care while waiting for the approval

Understanding information in written materials.

Analysis and discussions

Discussions and the implications of the findings to the managers.

In regard to the satisfaction which associated with healthcare, the findings support the fact that patients who are healthier, older, males, those having lower levels of education, those who have lower levels of system usage and those who perceive system performance to be high experienced more satisfaction as compared to the opposite counter-parts. The multivariate analysis provides more insight into those who are interested in patient satisfaction with their own healthcare (FOTTLER, 2002). One of the most striking finding is the pivotal role which is played by physicians as they try to influence the level of patient's satisfaction with their healthcare. The magnitude of the relationship of the influence that physicians have on level of satisfaction rating by patients was beyond the expected outcome. The relationship is stronger than could have been anticipated. The effects of the other independent variables including the three demographic variables, number of visits to doctors, self-stated health status, whether they had previous issues relating to access, though very important, have little statistical influence on the level of satisfaction with the healthcare received.

According to the research, improving the patient satisfaction would require improvement in terms of quality of the interactions with as well as the services provided by the physicians and their office staff (FOTTLER, 2002). The issue with the policy makers in agencies of the government , organizations as well as health plans which provide healthcare services is that they face limitation in terms direct control as well as the influence over how the doctors and other professionals in the hospitals deliver the services which they have been tasked with. In spite of the fact that most of these entities evaluate the credentials of the physicians, the focus of the entities is technical in nature- board certifications and other qualifications materials and documents (SHORE, 2007). These requirements barely contain any type of patient satisfaction input (STRASSER, 1991). The only method for improving the level of patient satisfaction is for the interested organizations to make avenues and create awareness to the physicians. When the physicians are informed of their importance in the matters concerning the level of patient satisfaction, they are capable of delivering duties with knowing that the way they handled patients is of outmost importance to the scores on the satisfaction chart. The doctors as well as the medical personnel need to be well educated so as to have a positive impact on the score of satisfaction charts by the patients.

The graph above shows the patients satsfaction results before Civista Medical Center implemented its hospital Consumer Improvement of Healthcare Providers and after the implementation( October 11- Jan 11). After the analysis of the data, it shows improved patients satsfaction scores across all the categories in the hospital when the program was implemented

Satisfaction with the health plan

The health plans are more than interested in improving the member satisfaction with the services which they provide (STRASSER, 1991). Just like satisfaction with the healthcare, the research demonstrated that with more healthy members, members who are older, members having a lower level of education, members who have a perception that system performance is high and members with low usage of services experience more satisfaction with their health plans when compared to their opposite counterparts.

The multivariate analyses demonstrates that the extent to which the problems which members have had their plans of health as having by far the largest statistical influence especially on their satisfaction with that plan. The doctor's related variables which showed ultimate importance especially in influencing the level of satisfaction with healthcare (STRASSER, 1991). The items are, in their order of estimated impact on statistics from the highest to the lowest, rating of doctors who are personal, rating of the quality of specialist as well as services received from the doctors as well as his office (MACSTRAVIC, 1999). The health plans have faced criticism over the fact that they are too complicated, doing a poor job in the communication of those rules to the members as well as to their own employees, as well as being erratic in administering their rules. The following improvement would help improve the validity of the providers to their patients.
o Provide patients with contact personnel who have been trained in answering patients' questions in a manner that is polite and comprehensive.

o Examine patients' expectations as well as whether the expectations are realistic.

o Place a greater emphasis into teaching patients about various aspects of their health plans and how to navigate through the said plans.

o Find out the type of information that the patients may need and then find a way of supplying that information in some form of newsletters.

o Influence physician's interactions with and services to the patients.

Recommendations and conclusions

The findings of the present study are very significant to providers of both the healthcare as well as health plans. It is important to point out that the variables which have the greatest effect on satisfaction with the healthcare as well as health plan come under the direct control of the physicians and focus on the efforts of communication with the patients as well as the patients. In order to increase the level of satisfaction with the healthcare, it is paramount for the doctors as well as their staff to work on their manners so as to have the right image on the patients. Most of the variables have showed that they affect the satisfaction with healthcare and can thus be positively influenced by the doctor as well as the nurses who treat the patients in a way that there is courtesy as well as respect, listening. Spending time with their patients and explaining in a manner that shows understanding. This improvement is likely to help even the less healthy, female, younger or the more educated subgroups of patients to have more satisfaction from the services which they receive.

Another improvement which is likely to improve the level of satisfaction is that of ensuring that the health plans are worked out in a manner which reduces the problems which their members are experiencing. Renewed focus on improving the customer satisfaction through health plans is necessary if improvements are to be made. In the era when physicians will be increasingly measured by the amount of outcome which they give to those that they treat, it is very important that the orthopedic surgeons better have a more precise understanding of patient satisfaction. The results of this research would mean a lot to both the manger as well as the marketers, but their approach to their clinical application is tenuous. The basic fundamental question aims at establishing whether information on the perception of values is likely to stimulate any genuine gains in patient-centered gains. There is also need t keep researching in this particular field so as to improve on the level of consumer satisfaction.

References
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SHORE, D. A. (2007). The trust crisis in healthcare: causes, consequences, and cures. Oxford, Oxford University Press.
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