Purpose: To identify the operational factors and quantify the effect those factors have on a patient's understanding of treatment
Method: 75 clinic encounter workflow observations were conducted at two primary care clinics in a single academic medical center in 2011. Observations were encoded using Observational Checklist of Patient Encounter (OCPE), a standardized worfklow observation tool documents time requirement and operation conditions occuring at the time of service. At conclusion of each observed clinic visit, patients were asked to select from a list of specific treatment recommendations. List items included "your doctor discussed laboratory results, ordered laboratory tests, reviewed medications, changed medications, made referral, etc. Patients' recollection was then compared against provider electronic medical record documentation within 24 hours and assessed for congruency.
Result: Patients' ability to remember hearing provider recommendation was strongly correlated with the amount of wait time before seeing provider. The "wait time" was strongly correlated with the amount of provider to staff ratio, and provider exam ratio. The less time patients spent waiting, the more likely they hear the provider recommendation.
| Heard more than 75% | Heard more than 50% | Heard less than 25% | |
| Provider -to- staff ratio* | 1.3 : 1 | 2 : 1 | 3 : 1 |
| Patient/provider face time -to- waiting time** ratio | 2 : 1 | 1 : 1 | 0.6 : 1 |
| Patient/provider face time -to- all other time in clinic ratio | 1 : 2 | 1 : 3 | 1 : 6 |
| *only staff directly involved in patient care, ie LVN, MA. **wait time before seeing provider |
Conclusion: It is important to recognize that patient's understanding of treatment plan is not solely dependant on the quality of physician-patient direct interaction. Excessive patient wait time could diminish patient's understanding of treatment plan. Operational factors, such as provider to staff ratio and patient wait time do affect patients' understanding of treatment. Provider needs adequate direct support staff and exam room to function efficiently and effectively. Operational factors can affect the quality of patient care.
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