SummaryThis study among a sample of 207 general practitioners (GPs) uses a ®ve-year longitudinal design to test a process model of burnout. On the basis of social exchange and equity theory, it is hypothesized and found that demanding patient contacts produce a lack of reciprocity in the GP±patient relationship, which, in turn, depletes GPs' emotional resources and initiates the burnout syndrome. More speci®cally, structural equation analyses con®rmed thatÐboth at T1 and T2Ðlack of reciprocity mediates the impact of patient demands on emotional exhaustion. Emotional exhaustion, in turn, evokes negative attitudes toward patients (depersonalization), and toward oneself in relation to the job (reduced personal accomplishment). Moreover, this process model of burnout was con®rmed at T2, even after controlling for T1-scores on each of the model components. Finally, T1 depersonalization predicted the intensity and frequency of T2 patient demands, after controlling for T1 patient demands. This major ®nding suggests that GPs who attempt to gain emotional distance from their patients as a way of coping with their exhaustion, evoke demanding and threatening patient behaviors themselves. The theoretical and practical implications of these ®ndings are discussed.

Introduction Patient views on quality of care are of paramount importance with respect to the implementation of quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary. Objective To develop a conceptual framework for measuring quality of care seen through the patients' eyes, based on the existing literature on consumer satisfaction in health care and business research. Results Patient or consumer satisfaction is regarded as a multidimensional concept, based on a relationship between experiences and expectations. However, where most health care researchers tend to concentrate on the result, patient (dis)satisfaction, a more fruitful approach is to look at the basic components of the concept: expectations (or `needs') and experiences. A conceptual framework – based on the sequence performance, importance, impact – and quality judgements of different categories of patients derived from importance and performance scores of different health care aspects, is elaborated upon and illustrated with empirical evidence. Conclusions The new conceptual model, with quality of care indices derived from importance and performance scores, can serve as a framework for QA and QI programmes from the patients' perspective. For selecting quality of care aspects, a category‐specific approach is recommended including the use of focus group discussions.

Surveying the literature on the assessment of quality of care from the patient's perspective, the concept has often been operationalized as patient satisfaction. Patient satisfaction has been a widely investigated subject in health care research, and dozens of measuring instruments were developed during the past decade. Quality of care from the patient's perspective, however, has been investigated only very recently, and only a few measuring instruments have explicitly been developed for the assessment of quality of care from the patient's perspective. The authors consider patient satisfaction as an indicator of quality of care from the patient's perspective. This review is concerned with the question of whether any reliable and valid instruments have been developed to measure quality of care from the patient's perspective.

This study demonstrated the usefulness of multilevel analysis in studying patient satisfaction scores. Findings indicate that the effectiveness of strategies directed at health care providers or services and aiming to improve the quality of care through the patient's eyes can be questioned when these strategies are based on general satisfaction scores only. More attention should be paid to the interaction process between patient and GP.

This study used a representative sample of 507 general practitioners (GPs) to test the hypothesis that burnout is contagious. Following a two-dimensional conceptualization of burnout, it is assumed that burnout is comprised of emotional exhaustion and negative attitudes (i.e., depersonalization and reduced personal accomplishment). We hypothesized that perceived burnout complaints among colleagues and susceptibility to emotional contagion would make an independent contribution to explaining variance in negative attitudes through their influence on emotional exhaustion. The findings of a series of LISREL-analyses support this burnout contagion model. In addition, susceptibility to the emotions expressed by others had a moderating effect on the relationship between perceived burnout complaints among colleagues and individual GPs' emotional exhaustion: Burnout contagion was most pronounced among those GPs who were, in general, highly susceptible to emotional stimuli. These findings, as well as possible routes to burnout contagion are discussed in terms of recent theoretical work on emotional contagion."Miss Jones gradually became more discouraged, so that by the end of the first week she was sharing the feelings and attitudes of the other staff members and functioning in the same ineffective way"

The aim of the present study is (1) to investigate the impact of patient demands on primary care physicians’ burnout and (2) to examine the stability and change of burnout across time. Participants were drawn from the official Dutch registration system for primary health care, and longitudinal panel data (n= 165) from three waves with a 5‐year time interval were used. They filled in the Maslach Burnout Inventory (MBI) and a validated scale for the assessment of patient demands. The results of various stability and change models that were tested using structural equation modelling (SEM) indicated that demanding patient contacts lead to increased burnout among physicians. In addition, the findings suggested that about one quarter of the variance in physician's actual burnout levels across one decade is accounted for by a stable component, whereas about three quarters is accounted for by a change component. Hence, physician burnout seems to be a rather chronic condition that may be aggravated by exposure to demanding patients.

No abstract

No abstract