The allocation of healthcare professionals’ time in hospitals has become a central concern in modern medicine. While direct patient care is considered the core of hospital practice, studies consistently show that it accounts for only a minority of working hours, with administrative and clerical tasks occupying an increasing share. This imbalance risks undermining patients’ understanding of their care, the quality of bedside interactions, and ultimately patient outcomes. At the same time, demographic shifts, workforce shortages, and rising burnout threaten the sustainability of high-quality hospital care.
This thesis examines whether, and how, programs designed to increase the quantity and quality of clinical encounters – the moments of direct interaction between patients and healthcare professionals – can improve patient-centred care.
First, a systematic review and meta-analysis synthesized 117 studies including nearly 300,000 patients worldwide. Interventions aimed at protecting or enhancing patient-dedicated time were associated with higher patient satisfaction (+8%, 95%CI [+4.7%: +11.4%]), shorter hospital stays (-1.07 day, 95%CI [-1.62: -0.52]), and increased likelihood of home discharge (+2.6%, 95%CI [+0.3%: +5.0%]).
Second, the thesis translated, adapted, and validated the Picker Patient Experience 15 (PPE-15) satisfaction scale into French for adults, adolescents, and children, using item response theory (IRT). Across more than 27,000 respondents, the adapted scales demonstrated robust psychometric properties, enabling reliable monitoring of patient satisfaction across age groups at Geneva University Hospitals and beyond.
Third, with support from the Swiss Federal Office of Public Health, a Delphi process involving 18 national experts and patient partner identified 11 hospital-based equity of care indicators and five vulnerability criteria. Tested on routine data from three hospitals covering over 700,000 patients, the project demonstrated variable feasibility but highlighted several indicators – such as interpreter availability – that could be readily implemented.
Finally, the thesis presents the first formal evaluation of the More Time at Patients’ Side (MTP) program at Geneva University Hospitals. Using a difference-indifferences design with 80,000 patient stays across 76 hospital units, the study showed that units implementing MTP achieved sustained improvements in timely painkiller administration and pain documentation, compared with matched controls. Satisfaction with pain management, however, showed no significant change – likely reflecting ceiling effects of current instruments and the complexity of patient-reported experiences.
Taken together, these four studies provide a coherent body of evidence supporting practical implementation programs and the strategic value of clinical encounter– focused interventions. They demonstrate that such programs can improve meaningful patient outcomes, and they contribute validated tools and indicators for evaluating both patient-centeredness and equity. At the same time, they underline the methodological challenges of studying complex, context-dependent interventions, where heterogeneity, publication bias, and ceiling effects are recurrent obstacles.
