Search Results (19)

Background: Digital transformation is reshaping healthcare operations, with loyalty programs increasingly used to strengthen patient engagement and streamline administrative workflows. However, fragmented information systems and manual verification routines continue to create bottlenecks, inconsistencies, and extended lead times. Methods: This study applies a mixed-methods approach within the Business Process Management (BPM) lifecycle to redesign the eligibility verification process for a loyalty program at Casa de Saúde São Mateus Hospital. Quantitative time measurements were collected during peak periods, while qualitative insights from staff observations and discussions supported process discovery and bottleneck identification. The proposed solution integrates a centralized SQL database, automated verification routines, and a dedicated administrative interface synchronized with the MedicineOne system. Results: The redesigned process reduced eligibility verification time by approximately 80% and improved Flow Efficiency by around 11.7%. Manual interventions, data fragmentation, and discount-application errors decreased substantially. The centralized database improved data reliability, while automated checks enhanced consistency and reduced staff workload. The system also enabled more accurate beneficiary management and improved coordination across administrative activities. Conclusions: Integrating Healthcare 4.0 principles with BPM enhances internal logistics, reduces lead times, and improves operational reliability. The proposed model offers a replicable framework for modernizing healthcare service delivery. Full article

Japanese narcissism refers to a culturally embedded form of narcissistic personality that emerges within collectivist societies, particularly in Japan, where self-worth is maintained through emotional over-adaptation, perfectionism, self-sacrifice, and conformity to internalized moral obligations. Within the framework of Schema Therapy, this construct is characterized by dominant coping modes, such as Armor mode and Demanding Community mode, that suppress vulnerable emotional states and promote socially sanctioned compliance. Although narcissistic personality disorder (NPD) has been extensively studied in individualistic Western cultures, its manifestation in collectivist cultures remains underexplored. Japanese narcissism offers a culturally contextualized model that integrates psychoanalytic and Schema Therapy perspectives to explain thin-skinned narcissistic vulnerability, disguised as adaptive functioning. Clinical observations and case analyses indicate that patients often develop Armor mode (fusing Detached Protector and Perfectionistic Over-controller functions) and Demanding Community mode (internalizing collective moral expectations). These adaptive-appearing modes mask core maladaptive schemas—Emotional Deprivation, Defectiveness/Shame, Enmeshment, and Self-Sacrifice—while being mistaken for mature or healthy functioning. Historically, such patterns have been reinforced by moral-collectivist ideals, exemplified by the Imperial Rescript on Education, which valorized loyalty, endurance, and self-denial. Japanese narcissism may therefore represent a culturally specific clinical configuration, suggesting the need for contextually adapted Schema Therapy interventions that recognize both the harmony-preserving and narcissism-reinforcing functions of adaptive behavior. This framework contributes to the cross-cultural extension of Schema Therapy by theorizing how narcissistic structures manifest in collectivist societies, and highlights the need for empirical validation of culturally sensitive treatment protocols. Full article

Background: Food-allergic reactions in restaurants often result from miscommunication between customers with allergies and staff, or from staff members’ insufficient knowledge of food allergies. This study examined the behaviors, attitudes, and risk perceptions of food-allergic consumers when dining out or ordering from foodservice establishments (FSEs) compared to consumers without food allergies. Methods: A representative pan-Canadian survey was conducted amongst three groups: one of individuals without food allergies (n = 500) and two of food-allergic individuals (allergic-convenience sample [n = 500] and allergic-general population [n = 500]). The convenience sample comprised members of Food Allergy Canada, a national patient advocacy organization. Some participants with food allergies had experienced reactions linked to an FSE (43% convenience, 27% general). Weighted responses from food-allergic groups were compared to those of non-allergic ones using chi-square (p < 0.05). Statistical comparison between allergic groups was not attempted due to inherent differences in their allergic condition. Results: In several questions, responses from the non-allergic group differed significantly from those of the allergic-convenience sample, but not from those of the allergic-general population. Food-allergic-convenience respondents were more likely to avoid ordering food or dining out than non-allergic ones, with the highest avoidance (66%) noted for third-party platforms. Cost was the main barrier for non-allergic and allergic-general populations, whereas the allergic-convenience sample prioritized allergy-related concerns. Although at a lower rate than for participants with food allergies, food allergies influenced restaurant selection for 44% of participants without food allergies when dining with individuals outside their household. Most allergic respondents perceived that FSEs underestimate the seriousness of food allergies (82% convenience, 71% general), yet they felt safe while dining out (60% convenience, 85% general), pointing at loyalty to specific FSEs as a risk mitigation strategy. Conclusions: This study highlights a potentially higher burden of disease (psychological and social strain, reduced quality of life) among a subgroup of the food-allergic population (convenience sample), as reflected in their behaviors, attitudes, and risk perceptions towards meals prepared in FSEs. Nevertheless, both allergic groups expressed shared concerns and needs related to safety (e.g., ingredient disclosure for all menu items, prevention of allergen cross-contact, ability of an FSE to offer a safe meal, establishing clear communication processes for allergy-related information), which FSEs and regulators should consider when designing risk management strategies. Full article

Background: Patient satisfaction and loyalty are essential indicators of healthcare quality, directly impacting patient outcomes and the long-term success of healthcare facilities. Despite the growing importance of patient-centered care in Saudi Arabia, there is limited research exploring the factors that influence patient satisfaction and loyalty, particularly in the Riyadh region. Aim: This study aims to identify the key factors influencing patient satisfaction and loyalty among Saudi patients attending public and private healthcare facilities in the Riyadh region. The study focuses on how healthcare service quality, communication, and demographic factors contribute to patient satisfaction and loyalty. Methods: A cross-sectional study was conducted with a sample of 350 Saudi patients from 10 healthcare facilities in Riyadh. Data were collected using the Patient Satisfaction Questionnaire (PSQ-18) and the Patient Loyalty Questionnaire (PLQ). Descriptive statistics, Pearson correlation, and multiple linear regression were employed to identify predictors of patient satisfaction and loyalty. Results: Significant predictors of patient satisfaction included general satisfaction (β = 0.48, p < 0.001), communication (β = 0.35, p < 0.001), and the frequency of healthcare visits (β = 0.13, p = 0.011). Private healthcare facilities had higher satisfaction (p < 0.001) and loyalty scores (p < 0.001) compared to public facilities. Patient loyalty was strongly predicted by general satisfaction (β = 0.55, p < 0.001) and communication (β = 0.42, p < 0.001). Conclusions: Communication quality and patient satisfaction are key drivers of patient loyalty in Saudi healthcare facilities. Private facilities outperform public ones in patient satisfaction and loyalty. These findings emphasize the need for healthcare providers to enhance communication and service quality to foster patient loyalty. Tailored approaches to meet the diverse needs of patients, particularly in terms of education and visit frequency, are crucial for improving healthcare outcomes in Saudi Arabia. Full article

China’s aging society has led to a major transformation of the healthcare model from traditional therapeutic medical care to life support healthcare. Med–small-sized hospitals (with 20–299 beds) are expected to play a major role in this transition compared to large hospitals. However, hospitals often take 3–5 years or more from design to construction. In order to guide architects in planning and designing for future needs, this study aims to identify the key points of planning and design that can enhance the value of med–small-sized hospitals in terms of functional configuration, spatial environment, etc. In this study, a questionnaire survey was conducted on the perceived value of 600 patients in Nanjing, China. The data were used to construct a structural equation model (SEM) of perceived value for med–small-sized hospitals in China. There are 24 observed variables in six dimensions, including cost value, functional value, social value, cognitive value, patient satisfaction, and patient loyalty. The final SEM indicates that optimizing functional configurations and spatial environment design can significantly increase the value of hospitals, while patients’ willingness to go to the inpatient department is quite low. Finally, based on the survey findings from Nanjing, we proposed four optimization strategies: (1) promoting diversified development and collaboration based on regional characteristics, (2) optimizing functional configurations, (3) maintaining an efficient and concise patient experience, and (4) optimizing the inpatient department. Full article

Background and Objective: Doctors should have full loyalty to their patients, while patients should be able to trust that physicians will act only in their best interests. However, doctors may be faced with situations where they must choose between the patient’s interests and those of a third party. This article presents the results of a study that aimed to identify situations of duality in the decision-making process of medical workers, which can compromise their ethical behavior. Materials and Methods: A cross-sectional study was carried out on a sample of 1070 participants, employed in 120 healthcare facilities in the Republic of Moldova. An online questionnaire was completed anonymously. Descriptive statistics for discrete data were performed by estimating absolute and relative frequencies. To perform the multivariate analysis, the logistic regression was applied. Results: A large number (74.4%) of respondents admitted that they had faced situations of conflicts of interest. Every third respondent (35.3%) had experienced ethical dilemmas when access to expensive treatments should be ensured. Every fourth respondent experienced a conflict between the patient’s interests and those of the institution (26.1%) or the insurance company (23.3%). As age increases, the probability of reporting the dilemma decreases. Physicians reported such dilemmas almost 3 times more often than nurses. A low rate of staff sought support when faced with dilemmas. Half of the respondents (50.6%) preferred to discuss the problem only with a colleague, and 40.1% preferred to find solutions without anyone’s help. There were significant gaps within organizations in terms of the ethical dimension of the decision-making process. Conclusions: Managers should adopt clear institutional policies and tools to identify and prevent situations of dual loyalty. Ethical support should be offered to employees facing such situations. The need to promote an institutional climate based on trust and openness becomes evident. Full article

Objective: This study aimed to identify the key aspects of patients’ dental care experience that influenced their self-perceived satisfaction and loyalty. Also examined was the agreement between patients and dentists regarding these factors. Methods: Questionnaires were administered to 1121 patients and 77 dentists, focusing on demographic information and 15 selected items related to the patients’ last dental visit. Descriptive and linear regression analyses were conducted. Results: The study included participants from 41 practices. Factors significantly influencing satisfaction and loyalty included location convenience, treatment quality, trust in dentists’ decisions, visit frequency satisfaction, clear treatment explanations, dentist’s interest in symptoms, patient-dental personnel attachment, and dentist’s knowledge of the patient and their medical records. While overall agreement between patients and dentists was high, some areas exhibited notable disagreement. Conclusions: The findings mostly align with existing literature, underscoring the importance of communication, trust, and a personal patient-dentist relationship in promoting satisfaction and loyalty. However, they also show that local, generally not reported factors might be at play, which necessitates dentists’ awareness and consideration of the local context for optimal outcomes. Full article

The increase in traditional and complementary medicine (TCM) methods has revealed the necessity of determining relevant behavioral tendencies among healthcare users. In our study, the evaluation of TCM approaches of healthcare users living in North Cyprus in terms of treatment effectiveness, patient trust and patient satisfaction, and the effects of these variables on patient loyalty, were investigated. Data were collected utilizing the scale approach as well as the survey technique in order to measure the variables in the study. A total of 452 participants completed the survey. TCM has a positive effect on treatment effectiveness, patient trust and patient satisfaction. Patient trust and patient satisfaction have a positive effect on patient loyalty, whereas treatment effectiveness did not have a significant effect on patient loyalty. There is a significant and positive mediating effect of patient trust and patient satisfaction between TCM and patient loyalty. However, the mediating effect of treatment effectiveness is not significant between TCM and patient loyalty. This study will help researchers and practitioners understand the importance of attitude, trust, effectiveness, satisfaction and loyalty in relation to TCM. It is suggested that studies that measure the behaviors of patients should increase in order to obtain better health outcomes. Full article

Background: Nowadays, health organizations seek to bring innovations to their services to stand out in competition with their rivals by improving service quality (SQ), encouraging patients to always make the same organizational choices, and enhance the behavior of patient citizenship. Objective: This study aims to determine the mediating role of patient satisfaction (PS), patient loyalty (PL), and employee responsiveness (ER) between the service quality and patient citizenship behaviors (PCB). Methods: In order to test the proposed hypotheses, quantitative research methods were utilized; cross-sectional data was collected using scales between December 2021 and March 2022. Results were obtained from 422 participants. The data were analyzed using descriptive statistics, correlation, confirmatory factor analysis, and structural equation modeling methods, using AMOS 21. Results: SQ was found to have a significant and positive effect on PL, PS, and ER. PL, PS, and ER were found to have a significant and positive effect on PCB. The indirect effect of SQ on PCB was found to be positive. Discussion: The findings demonstrate that SQ does not directly affect or create PCB, but it is affected by the mediators in order to create PCB via satisfaction, loyalty, and employee responsiveness. Full article

Digital marketing has given new life to healthcare services by enhancing their visibility in the online space. People choose online healthcare services because they can receive instant answers and communicate with specialists in their comfortable environment at the right time. The purpose of this study was to understand the impact of virtual communities on the intention to use telemedicine. The model is based on a combination of consumer desire (psychological objective) and loyalty through promotional formats (economic objective), as well as data collected from 442 respondents analyzed using structural equation modeling. The research results show that by analyzing target groups in social networks, content can be individualized, and an accurate measurement of e-patient satisfaction must be conducted in order to improve the experience of future consumers of telemedicine services. The results of this study explain what makes people want to use digital healthcare services and can serve as a guide for people who run virtual communities and help digital healthcare service providers figure out how to market their services. Full article

The purpose of this study was to analyze consumer or patient determinants of hospital brand equity (HBE) based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. A search of six databases: Scopus, Web of Sciences, PubMed, Google Scholar, Ebsco, and Elsevier was conducted. A search for studies published up to January 2022 was performed between 15 February and 5 March 2022. Article type, peer-reviewed papers, and studies based on empirical research were used as inclusion criteria. Non-English language papers, dissertations, short reports, works in progress, conference publications, and book chapters were excluded. As a result, a final set of 32 studies were selected for the analysis. Three research questions were formulated on the main determinants of HBE, brand-related factors, and specific medical-related factors. The studies included in the systematic literature review were analyzed in three areas: study description, key findings, and practical recommendations. Among the traditional HBE factors, brand loyalty has been analyzed most often, and the following have also been studied: perceived quality, brand associations, brand awareness, and brand image. Patient satisfaction, service quality, perception of the treatment process, and the work of medical staff were found to be specific medical-related factors. Other factors related to the management process, brand, and patients were also identified. It was noted that the number and variety of medical and other determinants of HBE have increased in recent years. The results of this systematic literature review are relevant to the analysis of consumer/patient behavior in choosing a hospital or other health care facility as they provide a deeper understanding of the increasingly differentiated needs of patients and the way in which the quality of health care services is evaluated. Full article

Body dysmorphic disorder (BDD) is an obsessive-compulsive disease, associated with increased addressability to plastic surgeons; however, as patients perceive body defects due to decreased insight, they are often unsatisfied with their appearance after cosmetic surgery. The purpose of this study is to evaluate the ethical reasoning that should be performed before accepting these patients as cosmetic surgery candidates. We will focus our analysis on three main areas of interest: autonomy, which in these patients is significantly decreased, beneficence as satisfaction, which in these particular patients does not justify performing the intervention, and loyalty, which should render cosmetic procedures immoral in patients with body dysmorphic disorder. Full article

The high demand for health information from pregnant women has encouraged the creation of an informative program through a weekly digital newsletter. The objective of this study is to evaluate its quality as a digital communication medium, in terms of satisfaction and loyalty to the pregnancy follow-up and delivery service. A cross-sectional, prospective study was carried out, surveying 179 patients by means of an online self-referral questionnaire including variables related to humanization, information needs, perceived accompaniment and satisfaction, as well as factors related to its influence on their decision to remain loyal to the center. A total of 81.2% of the participants showed high levels of satisfaction with the program. Satisfaction among nulliparous patients was significantly lower in several aspects. The resolution of doubts and the perception of peace of mind following the information received was positive for 54.8%. Of the patients in the program, 88.8% finally remained at the center, showing a strong influence of the program on their decision (mean value 75 on 1 to 100 scale). A weekly digital newsletter with specific information reduced the demand for information from pregnant women, generating high levels of satisfaction and positively influencing the decision to remain loyal to the Center. Full article

Incarceration, along with its most restrictive iteration, solitary confinement, is an increasingly common experience in America. More than two million Americans are currently incarcerated, and at least one-fifth of incarcerated people will experience solitary confinement. Understanding the barriers to care people experience in prison, and especially in solitary confinement, is key to improving their access to care during and after incarceration. Drawing on in-depth qualitative interviews with a random sample of 106 people living in solitary confinement and a convenience sample of 77 people working in solitary confinement in Washington State, we identify two key barriers to care that people in solitary confinement face: cultural barriers (assumptions that incarcerated people do not need or do not deserve care) and structural barriers (physical spaces and policies that make contacting a healthcare provider difficult). While scholarship has documented both the negative health consequences of solitary confinement and correctional healthcare providers’ challenges navigating between the “dual loyalty” of patient care and security missions, especially within solitary confinement, few have documented the specific mechanisms by which people in solitary confinement are repeatedly triaged out of healthcare access. Understanding these barriers to care is critical not only to improving correctional healthcare delivery but also to improving healthcare access for millions of formerly incarcerated people who have likely had negative experiences seeking healthcare in prison, especially if they were in solitary confinement. Full article

Background: The ‘Primary Care SHOPping Intervention for Cardiovascular Disease Prevention’ (PCSHOP) trial tested the effectiveness and feasibility of a behavioural intervention to reduce saturated fat in food purchases. The intervention offered feedback from data collected through a supermarket loyalty card to supplement brief advice from a nurse. This qualitative study aimed to describe participants’ experiences of receiving this intervention. Methods: We conducted semi-structured, one-to-one, telephone interviews with participants from the PCSHOP trial. Interviews were audio-recorded and transcribed verbatim. We employed the one sheet of paper technique and a thematic analysis to develop high-level themes in NVivo software. Results: Twenty-four participants were interviewed (mean age: 63 years (SD 12)). They reported that the brief advice did not provide any new information but they welcomed the sense of accountability the nurse provided. The personalised shopping feedback and healthier swap suggestions provided novel information that challenged previously held beliefs about the saturated fat content of food purchases and encouraged some positive dietary changes. However, the taste preferences of the participant or other household members were a barrier to changing food shopping behaviours. Conclusion: Harnessing loyalty card data is a novel and acceptable method to offering personalised dietary feedback. Yet, issues on the suitability of the healthier swap suggestions limited the extent of dietary change. Trial registration: ISRCTN14279335. Registered 1 September 2017. Full article