2007 student administration the university of auckland, new zealand key changes for student health...

20072007Student AdministrationStudent AdministrationThe University of Auckland, New ZealandThe University of Auckland, New Zealand

Key changes for student health to facilitate transition and retention in the student

population

Dr. Vivienne Peterson Director of University Health Services

Cherie Buchanan Manager of University Health Services

ANZSSADecember 2007

Strategic Health Management


• Strategic Imperatives

• Core Business Transition

• Current Business Model

• PHO Issues

• Student Health Awareness

• Where to from here?

OVERVIEW


Alignment with University of Auckland Strategic Plan 2005 - 2012

• Objective 14: Enhance and promote a student environment that is welcoming, enjoyable and stimulating, encouraging students to reach their full potential within a climate of academic excellence [Keep them mentally, physically, spiritually well for their studies and exams]

STRATEGIC IMPERATIVES


Objective 19: Promote governance and management practices consistent with the mission and values of The University of Auckland.

• Create opportunities for significant strategic change as well as incremental change

• Ensure that all parts of the University actively meet the needs of those to whom they provide services, and that service delivery is client-focused, responsive, constructive and helpful



Guide to Financial Management – VC Memo November 2005 regarding trading activity

• Break even or make a margin

• Service divisions should at all times manage their expenditure within budget and any shortfall in revenue should be wholly off set by cost savings



Kuh (1991;1993;1995)A unique combination of external and internal factors work

together to crystallize and support an institution-wide focus on student success.

Noel and Levitz (1999)Institutions have to think in terms of forces of attrition that

precipitate drop-out.

Pascarella and Terenzini (1980; 1983)“Determinants of persistence are not solely embodied in the

kinds of students enrolled, but are subject to the institutional policies, programs or conditions that

affect students after their arrival on campus”

SELECTED THEORETICAL VIEWS REGARDING RETENTION


Adapted from Tinto, V. (1975) “Dropout from Higher Education: A Theoretical Synthesis of Recent Research” Review of Educational Research vol.45, pp.89-125.

“Whether a student departs from an institution is largely a result of the extent to which the student becomes academically and socially connected with the institution.” (Tinto, 1975;1987;1993)

TINTO’S MODEL OF RETENTION


• In its published literature University Health Services states:

“Students, International Students and Staff are eligible to use the service for general

problems as well as emergencies or accidental injury”

• In a review of the Health Services patient population in July 2007

14,570 total appointments from Jan – June 2007 from 6797 people– 69% domestic student– 11% international student– 14% “patient” – 5% staff– 1% other

CORE BUSINESS TRANSITION


• “Patient” group identified largely as persons who used to be students or staff and who continue to come to the practice as casual or enrolled patients.

• Decision made that the Health Service no longer provide a service to this group and focus all efforts on providing a better service to the core business of current students and staff effective 1 January 2008.



• After consultation with the PHO (and according to MOH guidelines for dis-enrolment), a letter was sent to 4700 people informing them they had 3 months to change their health provider. A list of Auckland health providers was included.

• Response from mail out highlighted the following issues:– A need to identify specific patients that should stay on

the register and a process required to handle these – Register updates; Large numbers of COA and

correcting wrongly coded accounts



• University Health Service is General Practice based with allocated clinical time:– 80% booked appointments – with double bookings for

urgent cases– 20% walk-in Duty Doctor Clinics

• Depending on demand there can be a wait from 3-7 days for an appointment during semester

• Urgent cases are seen but semi urgent and non urgent cases presenting on the day are often turned away

CURRENT BUSINESS MODEL


• Age group/gender variances are based on % of student population seen in Health Services

0

10

20

30

40

50

15-24 25-44 45-64

Female

Male



• Strengths– Location on campus for easy access– Captive audience, age group orientated service– Academic staff – easy access for advice re students and also

the assessment services for special conditions, exams and tests– High quality medical services GP & A&M

• Weaknesses– Long appointment waits– Difficulty providing a quick service and capacity for demand– Student awareness– Limited physical space for expansion



• Opportunities– Access to captive audience for marketing campaigns– Aligning with other campus service providers and the AUSA– Use of campus online ability for PHO enrolments– Streamlining clinics overall, more nurse led clinics

• Threats– Inability to maintain PHO enrolments from natural attrition– Losing business by not being proactive to student needs– Competition with Auckland students using their family GP



• University Health Services joined the PHO in April 2006 with an initial funded register of 12,454

• PHO funding has been beneficial and significantly reduced contribution from Student Services Levy

• Funding for the 25-44 age group (from July 2007) is the main reason for the decreased 2008 forecast contribution required

0

500000

1000000

2005 2006 2007 2008

2005

2006

2007

2008

PHO FUNDING


• Clawbacks– Consistently 3-4% of income which is considerably less than the

average practice 8%

• After hours service– Currently use a phone nurse triage service

• Initial funding – loss after 3 years– Auckland City DHB is one of the few DHBs that may insist on “dis-

enrolment” of the initial registered patient group after 3 years if no signed enrolment form

• Extra administration– Enrolment process and medical record transfers

PHO ISSUES


• Sustainability of enrolled population– Keeping pace with the natural attrition rate– The requirement for getting a physical form signed– Realistic population figures for potential enrolees

Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Total

Funded population 12454 11790 10347 10049 10430 10646 10455

Patients enrolled 263 1185 985 1224 2160 1222 7039

Turnover -927 -2628 -1283 -843 -1944 -1413 -9038

PHO ISSUES


“Student loyalty is positively related to student satisfaction and the performance of an educational institution.”

(Kotler and Fox, 1995;Zeithaml, 2000;Helgesen, 2006)

“Satisfaction with an entity is based on experience.” (Oliver, 1997; Elliot and Healy, 2001).

• A survey was conducted to assess how students perceive student health services and their access to them. There were 256 respondents.

STUDENT HEALTH AWARENESS


• Survey Demographics– Gender: 64% female, 42% male– Year in University: 19% year1, 23% year2, 22%

year3, 13% year4, 7% year5, 3% mature student, 3% doctoral

– Ethnicity: 53% NZ/European, 28% Asian, 4% Maori, 5% PI, 10% Other

– Residence: 39% family home, 47% in apartment, 12% Halls of Residence, 2% other

– Permanent Residence: 80% Auckland, 8% outside Auckland, 12% International



• 83% of the students responded they had used Student Health Service with 42% between 2-4 visits

• Top three methods for gaining information were via a friend, website and orientation week. The least 2 important methods were via phone, parents and residential assistants

Q2. How many times have you been to Student Health Services to see a healthcare provider since the beginning of Semester 1 2006?

0

10

20

30

40

50

60

70

80

90

100

1 visit 2-4 visits 5-7 visits 8-10 visits 11-13 visits 14+ visits not stated

Q3. How did you learn about the services offered to students at Student Health?

0

10

20

30

40

50

60

70

80



• When asked how students rate the current Health Service (% response)

Friendliness and helpfulness

Ex

53

Go

41

Av

Medical knowledge of staff 50 42

Time medical personnel spent 42 38 16

Communication skills of staff 41 49

Amt of time in waiting area 40 35

Ease of making/securing appt 32 36 23

Overall experience 41 50 9



• When asked what qualities in health care were important

Q6. What qualities are most important to you in utilising a healthcare facility on Campus

0

20

40

6080

100

120

140

160

convenie

nt

location

pro

fessio

nalis

m

& k

now

edge

abili

ty t

o g

et

an

appts

convenie

nt

hours

confidentialit

y

help

fuln

ess o

f

sta

ff oth

er

Quality

Nu

mb

er



• Services important to students in order of preference– 19% treatment for acute illness/injury– 10% sexual health– 9% counselling– 9% aegrotats/compassionates– 7% immunisations– 6% psychological conditions– 5% specialist referrals– 5% std checks– 5% medical certificates– 5% test considerations– 4% chronic health problems– 3% medicals for work or leisure– 2% and less: weight management, travel medicine, immigration

medicals, mole checks, skin lesion removal, smoking cessation



• Do students need health care?

• Majority of students think their health is very good 38% or good 32%, with 51% of students having between 3-6 health needs in the last 2 years

Q8a. Thinking back over your time at The University of Auckland approximately how many health needs have you had?

12+ health needs11%

7-11 health needs11%

0-2 health needs27%

3-6 health needs51%

Q8b. Overall what is the current status of your health?

excellent10%

very good38%

good32%

average18%

poor2%



• How important is the cost of treatment?

• There is awareness of PHO enrolment and subsidy by the Student Services Levy

• 46% students would consider a charge of $5 - $10 fair

Q9a. How important is cost of treatment to you?

0

20

40

60

80

100

120

aware of PHO aware that Student ServiceLevy subsidises

enrolled in university PHO

Q9b. If I had to pay an amount for healthcare at Student Health I would consider the following charges fair

0

20

40

60

80

100

120

140

nothing $5-$10 $10-$20 $20-$30 current marketrates



• Customer based service– Increase walk in capacity. Looking to trial a 50/50 booked appointment and Duty Doctor

Clinic– Separate clinics for nurse vaccination, travel consults, cervical smears

• Marketing initiatives for increased awareness of the health centre– Improved website visibility– General all over campus promotion with posters/brochures– Develop relationships – outreach into faculties and other service groups– Text and email campaigns to student groups

• Focus enrolments with specific groups of students– Halls of Residence– Medical School – Epsom campus

• Personnel – Increase Nursing FTE

• Financial – Charge students a fee for medical consultation

WHERE TO FROM HERE


Thank you for your time.

Any Questions?


Elliot, K.M. and Healy, M.A. (2001). “Key factors influencing student satisfaction related to recruitment and retention”, Journal of Higher Marketing for Higher Education, Vol.10 No.4, pp. 1-11.Helgelsen, O. (2006), “Are loyal customers profitable? Customer satisfaction, customer (action) loyalty and customer profitability at the individual level”, Journal of Marketing Management, Vol. 22, pp. 245-66.Kotler, P. and Fox, K.F.A. (1995), Strategic Marketing for Educational Institutions, Prentice Hall, Upper Saddle River, NJ.Kuh, G. D. (1993). In their own words: What students learn outside the classroom. American Educational Research Journal, 30,277–304.Kuh, G. D. (1995). The other curriculum: Out-of-class experiences associated with student learning and personal development. Journal of Higher Education, 66, 123–155.Kuh, G. D., Schuh, J. H., Whitt, E. J. & Associates. (1991). Involving Colleges. San Francisco:

Jossey-Bass.Levitz, R., Noel, L., Richter, B. (1999). Strategic Moves for Retention Success. New Directions for Higher Education, 108, 31-49.Oliver, R.L. (1997). Satisfaction: A Behavioral Perspective on the Consumer, McGraw-Hill, New York.Pascarella, E.T., & Terenzini, P.T. (1980). Predicting Freshman Persistence and Voluntary Dropout Decisions from a Theoretical Model. Journal of Higher Education, 51, 60-75.

REFERENCES


Zeithaml, V.A. (2000), “Service quality, profitability, and the economic worth of customers: what we know and what we need to learn”, Journal of the Academy of Marketing Science, Vol. 28 No.1, pp.67-85.

Pascarella, E.T., & Terenzini, P.T. (1983). Predicting Voluntary Freshman Year Persistence/Withdrawal Behavior in a Residential University: A Path Analytic Validation of Tinto’s Model. Journal of Educational Psychology, 75, 215-226.Pascarella, E. T., & Terenzini, P. T. (1991). How college affects students. San Francisco: Jossey-Bass.Tinto, V. (1975), “Dropout from higher education: a theoretical synthesis of recent research”, Review of Educational Research, 45, pp. 89-125.Tinto, V. (1987), Leaving College: Rethinking the causes and cures of student attrition (Chicago, University of Chicago Press).Tinto, V. (1993). Leaving College: Rethinking the causes and cures of student attrition, 2nd edn (Chicago, Universityof Chicago Press).

REFERENCES – CONT’D

2007 student administration the university of auckland, new zealand key changes for student health...

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