Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm. This article critically reviews the association between the decision to hospitalize and factors related to the residents' welfare and preferences, the providers' attitudes, and the financial implications of hospitalization. Regarding the resident's welfare, factors associated with hospitalization included sociodemographics, health characteristics, nurse staffing, the presence of ancillary services, and the use of hospices. Patient preferences (e.g., advance directives) and provider attitudes (e.g., overburdening of staff) were also associated with increased hospitalization. Finally, financial variables related to hospitalization included nursing home ownership status and state Medicaid policies, such as nursing home payment rates and bed-hold requirements. Most studies relied on potentially confounded research designs, which leave open the issue of selection bias. Nevertheless, the existing literature asserts that nursing home hospitalizations are frequent, often preventable, and related to facility practices and state Medicaid policies.
States that if the marketing community is to adopt the prescriptions of the relationship marketing school of thought, more knowledge and understanding of relationships is required. The base of knowledge is growing and there is now greater appreciation of the processes germane to healthy relationships, such as trust, satisfaction and commitment. Much less attention has been paid to the negative aspects such as relationship breakdown and ending. This paper addresses the neglected area of the ending of customer‐bank relationships or customer exit. Interviews were conducted with bank customers who had recently used the exit option. Content analysis of the customers’ stories was used to generate a model of the customer exit process. As reported here, the research took the perspective of the customer. This shows that customers end bank relationships after an involving process of problem(s), effort, emotion and evaluation. A discussion of the findings concludes that banks need to develop relationship management systems and skills.
Relationship marketing stresses that relationships, and not just transactions, should be the focus of marketing strategy. Part of the rationale for this lies in retention economics which are thought to be particularly powerful. Recent literature suggests that reduction of the defection rate can increase profits far more than growth in market share, better margins and other factors usually associated with competitive advantage. This paper reports the findings of a detailed analysis into the defection rate of university student accounts from financial service organizations throughout Ireland. University students’ accounts are a particularly illustrative case study since, a priori, their lifetime value, in terms of future revenue streams, have the potential of being greater than that of many other customer types. This paper then discusses defection issues and then presents evidence from the survey. Finally, the policy and strategic implications are examined.
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