title: ED services: the impact of caring behaviors on patient loyalty.
abstract: BACKGROUND
  This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city.
  
  
  METHODS
  Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information.
  
  
  RESULTS
  Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P < .05) at all sites.
  
  
  CONCLUSIONS
  The study results raised considerations for ED caregivers, particularly with regard to those caring behaviors that are most closely linked to patient loyalty but that occurred least frequently. The study showed through factor analysis that some caring behaviors tended to occur together, suggesting an underlying, unifying dimension to that factor.
authors.affiliation: Purdue University, West Lafayette, IN, USA.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Liu
authors.forename: David
authors.initials: D
authors.lastname: Franz
authors.forename: Monette
authors.initials: M
authors.lastname: Allen
authors.forename: En-Chung
authors.initials: EC
authors.lastname: Chang
authors.forename: Dana
authors.initials: D
authors.lastname: Janowiak
authors.forename: Patricia
authors.initials: P
authors.lastname: Mayne
authors.forename: Ruth
authors.initials: R
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D000407:Alabama; D004219:District of Columbia; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004645:Empathy; D005260:Female; D006764:Hospitals, Community; D006786:Hospitals, Urban; D006801:Humans; D007196:Indiana; D008297:Male; D008824:Michigan; D008875:Middle Aged; D019370:Observation; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires