Strategies Clinic Managers Use to Reduce Missed Medical Appointments

141 Pages·2017·0.7 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2017
Strategies Clinic Managers Use to Reduce Missed
Medical Appointments
Sophea Ey Skym
Walden University
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Walden University

College of Management and Technology

This is to certify that the doctoral study by

Sophea Skym

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Patricia Fusch, Committee Chairperson, Doctor of Business Administration Faculty

Dr. Janet Booker, Committee Member, Doctor of Business Administration Faculty

Dr. Carol-Anne Faint, University Reviewer, Doctor of Business Administration Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2017
Abstract

Strategies Clinic Managers Use to Reduce Missed Medical Appointments
by
Sophea Ey Skym

MBA, University of Phoenix, 2011
MSN, University of Phoenix, 2011
BSN, Medical College of Virginia, 1998

Doctoral Study Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Business Administration

Walden University
July 2017
Abstract
Patients who miss their medical appointments increase health care costs for themselves
and for clinics. The purpose of this qualitative, single exploratory case study was to
explore strategies health care clinic managers use to reduce medical no-shows for patient-
scheduled appointments. Change management theory guided the scope and analysis. The
data collection included a single clinical operations manager who have strategies to
mitigate no-shows for patient-scheduled appointments participated in a semistructured
interview in southeastern Virginia, the direct observation of 2 office workers in their
natural setting of scheduling appointments, and for methodological triangulation, a
review of organizational archival documents about missed medical appointments.
Member checking was used to strengthen the credibility and trustworthiness of analyses,
which were carried out using Yin’s 5-step analysis process. Major themes were
forgetfulness and high deductible plan; minor themes were lead-time and inclement
weather that lead to no-shows. This study explored the strategies necessary to reduce
costs and increase revenues; it could free funds to provide services to patients, such as
education and counseling support. The findings from this study could contribute to social
change by adding new knowledge or informing the strategies to reduce medical no-
shows. These findings may also benefit organizational worth and increase community
health.
Strategies Clinic Managers Use to Reduce Missed Medical Appointments
by
Sophea Ey Skym

MBA, University of Phoenix, 2011
MSN, University of Phoenix, 2011
BSN, Medical College of Virginia, 1998

Doctoral Study Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Business Administration

Walden University
July 2017
Dedication
This is dedicated to Carl, my husband, who encouraged me to reach my terminal
goal and to my parents, Phally and Khosar, who instilled the love of education.
Acknowledgments
A hearty thank-you to “Abby” and all the amazing people at the research site
participated in the research study. Heartfelt thanks to all the faculty members: Dr. Gene
Fusch, Dr. Freda Turner, Dr. Janet Booker, Dr. Carol-Anne Faint, librarians, and peers
who have helped on this doctoral journey with kind words encouragement, and advices.
You all made it all possible! I am especially indebted to Dr. Patricia Fusch. You have
incorporated your knowledge, aptitudes, and support to me; for that, I am eternally
grateful!
Table of Contents
List of Tables ..................................................................................................................... iv
List of Figures ......................................................................................................................v
Section 1: Foundation of the Study ......................................................................................1
Problem Statement .........................................................................................................3
Research Question .........................................................................................................5
Interview Questions .......................................................................................................5
Operational Definitions ..................................................................................................8
Assumptions, Limitations, and Delimitations ................................................................9
Assumptions ............................................................................................................ 9
Limitations ............................................................................................................ 10
Delimitations ......................................................................................................... 10
Significance of the Study .............................................................................................11
Contribution to Business Practice ......................................................................... 11
Implications for Social Change ............................................................................. 12
A Review of the Professional and Academic Literature ..............................................12
The Importance of Change Management for Business ......................................... 14
Types of Change ................................................................................................... 15
History of Change Management Theory............................................................... 15
Contemporary Theory that Addresses Change ..................................................... 17
The Levels of Prevention ...................................................................................... 17
Health Seeking Behavior ...................................................................................... 19
i
Missed Medical Appointments ............................................................................. 22
Delay in Care ........................................................................................................ 30
Strategies to Reduce No-Shows ............................................................................ 32
Effect of Generational Differences and No-Shows .............................................. 45
Summary and Transition ..............................................................................................47
Section 2: The Project ........................................................................................................49
Purpose Statement ........................................................................................................49
Role of the Researcher .................................................................................................50
Participants ...................................................................................................................52
Research Method and Design ......................................................................................54
Research Method .................................................................................................. 54
Research Design.................................................................................................... 55
Population and Sampling .............................................................................................57
Ethical Research...........................................................................................................59
Data Collection ............................................................................................................60
Instruments ...................................................................................................................60
Data Collection Technique ..........................................................................................61
Data Organization Technique ......................................................................................64
Data Analysis ...............................................................................................................64
Reliability and Validity ................................................................................................66
Reliability .............................................................................................................. 67
Validity ................................................................................................................. 67
ii
Summary and Transition ..............................................................................................68
Section 3: Application to Professional Practice and Implications for Change ..................70
Introduction ..................................................................................................................70
Presentation of the Findings.........................................................................................71
Major Themes ..............................................................................................................75
Emergent Theme 1: Forgetfulness ........................................................................ 75
Emergent Theme 2: High Deductible Plan ........................................................... 81
Minor Themes ....................................................................................................... 82
Applications to Professional Practice ..........................................................................84
Implications for Social Change ....................................................................................85
Recommendations for Action ......................................................................................87
Recommendations for Further Research ......................................................................90
Reflections ...................................................................................................................91
Summary and Study Conclusions ................................................................................92
References ..........................................................................................................................94
Appendix A: Interview Questions ..................................................................................126
Appendix B: Interview Protocol .....................................................................................128
Appendix C: Observation Protocol .................................................................................129

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