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      Patient satisfaction and GP trustworthiness, practice orientation and performance : Implications for selection, training and revalidation

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          – The purpose of this paper is to examine the doctor-patient relationship from the patients’ perspective. It tests a number of hypothesized relationships with respect to the interaction inside the doctor-patient relationship including the continuity of care, doctors’ practice orientation and performance, which help enhance the understanding of patient trust and satisfaction.

          Design/methodology/approach

          – A quantitative survey using a closed-ended questionnaire provided a useable sample of 372 respondents.

          Findings

          – There was an overall high level of patient trust in and satisfaction with GPs as well as good patient rapport with their GPs. Patients who were most satisfied with their doctor perceived them to be more trustworthy, were more satisfied with their performance and perceived them to have greater preference for a sharing orientation than those patients who were least satisfied.

          Practical implications

          – The research findings suggest ways of maintaining and enhancing trust through training, continuing professional development, appraisals and assessments and revalidation of doctors. The skill sets and competencies related to trust and practice are presented in light of current practice trends and changing health care agendas, including the recent Department of Health White Paper, “Liberating the NHS” (2010). Since the questionnaire was able to discriminate between those patients who were most and least satisfied with their doctors, it identified what patients appreciate and are concerned about with respect to GPs and their practice.

          Originality/value

          – The research provides new insights and understanding of how patient satisfaction in the GP-patient relationship is influenced by GPs’ trustworthiness, practice orientation and performance, for academic and practitioner communities.

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          Most cited references19

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          Patient-centredness: a conceptual framework and review of the empirical literature.

          A 'patient-centred' approach is increasingly regarded as crucial for the delivery of high quality care by doctors. However, there is considerable ambiguity concerning the exact meaning of the term and the optimum method of measuring the process and outcomes of patient-centred care. This paper reviews the conceptual and empirical literature in order to develop a model of the various aspects of the doctor-patient relationship encompassed by the concept of 'patient-centredness' and to assess the advantages and disadvantages of alternative methods of measurement. Five conceptual dimensions are identified: biopsychosocial perspective; 'patient-as-person'; sharing power and responsibility; therapeutic alliance; and 'doctor-as-person'. Two main approaches to measurement are evaluated: self-report instruments and external observation methods. A number of recommendations concerning the measurement of patient-centredness are made.
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            Measuring patients' trust in their primary care providers.

            Existing scales to measure trust in physicians have differing content and limited testing. To improve on these measures, a detailed conceptual model was constructed and a large item pool (n = 78) was generated following a detailed conceptual model and expert review. After pilot testing, the best-performing items were validated with a random national sample (n = 959) and a regional sample of HMO members (n =1,199). Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model. Compared with previous scales, the Wake Forest physician trust scale has a somewhat improved combination of internal consistency, variability, and discriminability. The scale is more strongly correlated with satisfaction, desire to remain with a physician, willingness to recommend to friends, and not seeking second opinions; it is less correlated with insurer trust, membership in managed care, and choice of physician. Correlations are equivalent with lack of disputes, length of relationship, and number of visits [corrected].
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              Concepts of trust among patients with serious illness.

              This paper examines conceptions of trust among three groups of respondents diagnosed with either breast cancer, Lyme disease or mental illness. Interviews were carried out using an open-ended interview guide to explore how patients made assessments of trust in their doctors and health care plans. The guide followed a conceptual approach that asked questions about competence, agency/fiduciary responsibility, control, disclosure and confidentiality. Respondents were given ample opportunity to raise other areas of concern. The data were organized using the NUDIST software package for the analysis of non-numerical and unstructured qualitative data. Patients viewed trust as an iterative process and commonly tested their physicians against their knowledge and expectations. Interpersonal competence, involving caring, concern and compassion, was the most common aspect of trust reported, with listening as a central focus. Most patient comments referred to learnable skills and not simply to personality characteristics. Technical competence also received high priority but was often assessed by reputation or interpersonal cues. Patients were much concerned that doctors be their agents and fight for their interests with health care plans. Disclosure and confidentiality were less common concerns; most patients anticipated that doctors would be honest with them and respect their confidences. Patients' responses also appeared to vary by their disease, their socio-demographic characteristics, their involvement with self-help groups, and how their illness conditions unfolded.
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                Author and article information

                Contributors
                Journal
                jhom
                10.1108/JHOM
                Journal of Health Organization and Management
                Emerald Publishing
                1477-7266
                18 August 2014
                18 August 2014
                : 28
                : 4
                : 532-547
                Affiliations
                Department : Leadership, Organisations and Behaviour, Henley Business School, Henley-on -Thames , UK
                Henley Business School, Oxfordshire, UK
                Article
                JHOM-12-2012-0238.pdf
                10.1108/JHOM-12-2012-0238
                25241598
                61acac97-5025-4310-a3f9-73afc0002af0
                © Emerald Group Publishing Limited
                History
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                Research paper
                Health & social care
                Healthcare management
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                Health & Social care
                Policy,Performance,Trust,Selection,Training
                Health & Social care
                Policy, Performance, Trust, Selection, Training

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