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Background and purpose
Providers are under continuous pressure to provide high patient satisfaction while maintaining greater levels of productivity. It was important to understand whether these goals are antagonistic and if so, optimal trade-off point. The Army measures patient satisfaction through its Army Provider Level Satisfaction Survey (APLSS). Similar to the Civilian Sector’s Value Based Purchasing, the Army rewards satisfaction through its Integrated Resourcing and Incentive System. To determine the relationship between satisfaction and productivity (RVUs per provider per day), repeated measures analysis was conducted. Each provider was measured 12 different times (equal intervals). The results from JMP are used to show hospital senior leadership the relationship between the two variables and that one can simultaneously maintain both high satisfaction and productivity. .
MIXED MODELS
Data Sources and Processing
Patient Satisfaction data are from the Army Provider Level Satisfaction Survey (APLSS). Providers measurements are taken from Question 4 of the survey: “Overall, how satisfied do you feel about your visit with Provider X (Name inserted)?”
Patients were considered “satisfied” if they indicated “4” or “5” on a 5-point scale. The Provider scores are represented as “percent satisfied.”
Productivity ratings are taken from the Practice Management Revenue Model and are displayed as Provider Aggregate RVUs/per Full Time Equivalent hours (FTEs)
Full Time Equivalent hours include those hours spent working in a clinic related environment (does not include those activities done outside of the clinic, such as education and training).
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2. Examples of two different Providers over Time
Analysis
Repeated measures was performed three ways: In research, repeated measures designs are often a challenge and there are multiple ways to perform the analysis. In the first, mixed models was used, with subject as the random factor. The model shows no relationship between Satisfaction and Productivity.
In the second model, MANOVA with repeated measures was performed. Similar to mixed models, there is no relationship between satisfaction and productivity
Finally, a simple correlation was performed to examine the relationship between the two. The average satisfaction and average productivity for each provider were used.
Examples of two different Providers over Time
Impact of Results
Unlike previous research, these analyses suggest that Providers can have both high productivity and high patient satisfaction scores. As value based purchasing in the civilian sector is moving to a provider adjustment for patient satisfaction, the push to create a positive patient experience (while maintaining high productivity) is more and more critical.
Conclusions / Next Steps
This study only looked at the relationship between satisfaction and productivity. The next steps will be to add other factors to the model. It may be that provider type, provider position, and hospital type (i.e., large medical center vs. small medical clinic) all have an impact.
References:
Wood,GC, Spahr, R and Gerdes, J et al (2009) Patient Satisfaction and physician productivity: complementary or mutually exclusive? American Journal of Medical Quality, Nov-Dec: .
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