Abstract
Purpose of the research. The dissertation is an evaluation of the effects of changing the methods of health care delivery in three satellite clinics of the Ventura County Medical Center from "public service" to "private practice" models. Prior to the change, the satellite clinics were both inefficient and ineffective. Not only were they far more costly than comparable private practice care, but few services were being provided, even though the clinics were located in areas that had demonstrably greater needs. Methodology. The effects of implementing the franchise model were evaluated with measures of clinics' provision of services, financial performance, physicians' productivity, patients' satisfaction, and staff morale. Given the nonrandom assignment of both outpatient clinics to implement the franchise practice model and patients to receive services at the five clinics, the effects will be evaluated with a quasi-experimental, time series research design. Analysis. The analysis found that the financial performance improved for the three franchise clinics to the extent that their income exceeded their expenses. In comparison, the two nonfranchise clinics maintained their poor financial performance with income continuing to lag behind expenses. Like the financial data, the three franchise clinics clearly improved their productivity, while one of the two nonfranchise clinics continued at the same level of service for both 1987 and 1992. One nonfranchise clinic increased its services because of an increase in staff and not an increase in productivity. Conclusion. Prior to implementing the franchise model, the citizens of Ventura County had only limited access to costly public clinic medical care. The clinic physicians did not know their patients, and patients received their primary care in the emergency room. After implementing the model, patients now have access to a continuity of care that is both efficient and effective. Staff have a renewed sense of ownership and accountability, and patients are respected and treated with a sense of humanity, not like a herd that may be seen between 8:00 a.m. and 5:00 p.m. Patients now enjoy a personal relationship with their physicians that previously existed only in a private practice office. Patients are treated with dignity and valued for what we all are, human beings, regardless of our social status or financial resources. This is true capitalism with compassion, one well-positioned to actively spearhead new methods of delivering care in these turbulent, reform-minded times.