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American Association of Plastic Surgeons
36. Factors Affecting Efficiency and Patient Satisfaction in Hand Surgery Clinics
Frederick G. Weniger, MD, MBA1, Nikola Zivaljevic, MD, MBA, MHA2, Jason R. Dudas, BA1, Andrew Lee, MD1, Joseph E. Imbriglia, MD1.
1University of Pittsburgh, Pittsburgh, PA, USA, 2Hand and Upper Extremity Center, Pittsburgh, PA, USA.

PURPOSE: Excessive costs and lack of access have been cited by health-care economists as the primary reasons that Americans lack better health care, despite the highest per capita spending in this sector among industrialized nations. By maximizing efficiency, the issues of cost and access are both addressed. In any attempt to improve the efficiency of health-care delivery, it is essential to preserve patient satisfaction. Indeed, physicians depend on patients’ satisfaction, and their subsequent referral of others, in order to maintain sufficient patient volumes. The purposes of this study were to determine which aspects of hand clinics were predictors of efficiency, and how efficiency affects patient satisfaction.

METHODS: Two data sets were collected: 1) physician efficiency; 2) patient satisfaction. To assess physician efficiency, efficiency indices (clinic features) were evaluated and scored by an observer. Patient flow (patients/hour) was also calculated. Linear regression was performed between each physician’s score for a given index and patient flow. To assess patient satisfaction, patients completed questionnaires regarding their visit, including likelihood to refer others to the physician. The score for each questionnaire item was regressed with the likelihood to refer, in order to determine which items were most influential to referrals. Finally, the patient flow was regressed with “likelihood to refer” to elucidate any correlation between increased efficiency and patient satisfaction.

RESULTS: For physician efficiency, there was a statistically significant relationship between time spent on administrative tasks and patient flow (R2=0.73; p=0.031), as well as between clinic preparedness and patient flow (R2=0.87; p=0.006). Administrative tasks included charting, dictating, and completion of forms. Clinic preparedness was estimated by the degree to which hydrocortisone injections were ready for patient treatment. For patient satisfaction, only overall satisfaction with the physician himself was statistically significantly related to likelihood to refer (R2=0.94; p=0.001). Finally, patient flow and likelihood to refer also exhibited a statistically significant relationship (R2=0.87; p=0.021).

CONCLUSION: We have identified aspects of hand surgery clinics that are predictive of their efficiency, the latter approximated by patient flow. The statistically significant independent predictors are a) time spent on administrative tasks and b) clinic preparedness. Other aspects found not to be significant may be explained by the fact that the six clinics did not differ largely in their scores for those items. We have also determined that the physician is most responsible for his recommendation by patients to others. Even when time spent with the patient is relatively brief, as is often necessitated, a physician can still provide an encounter of high quality with which the patient will be satisfied. In fact, our data indicate that patients not only tolerate, but prefer, an efficient clinic experience. It is possible that these findings are unique to a specialty clinic such as hand surgery. Nonetheless, efficiency and satisfaction are applicable to all areas of medicine.

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