Organisational change and quality of health care: an evolving international agenda

McKee, Martin; Aiken, Linda H.; Rafferty, Anne-Marie; Sochalski, Julie

doi:10.1136/qshc.7.1.37

Cited by 70 publications

(19 citation statements)

References 26 publications

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“…27 While a number of worrying trends have emerged from intercountry analysis of nurses' job satisfaction, intention to leave, and high levels of burnout, not all aspects of work were regarded as unsatisfactory. Indeed, 75% of nurses across all countries reported that they work with physicians who provide high quality care and 85% said they work with nurses who are clinically competent.…”

Section: The International Hospital Outcomes Studymentioning

confidence: 99%

Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

Rafferty

Ball²,

Aiken

2001

Quality and Safety in Health Care

116

152

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A postal questionnaire survey of 10 022 staff nurses in 32 hospitals in England was undertaken to explore the relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care. The key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision making were found to correlate with one another as well as having a relationship with nurse assessed quality of care and nurse satisfaction. Nursing autonomy was positively correlated with better perceptions of the quality of care delivered and higher levels of job satisfaction. Analysis of team working by job characteristics showed a small but significant difference in the level of teamwork between full time and part time nurses. No significant differences were found by type of contract (permanent v short term), speciality of ward/unit, shift length, or job title. Nurses with higher teamwork scores were significantly more likely to be satisfied with their jobs, planned to stay in them, and had lower burnout scores. Higher teamwork scores were associated with higher levels of nurse assessed quality of care, perceived quality improvement over the last year, and confidence that patients could manage their care when discharged. Nurses with higher teamwork scores also exhibited higher levels of autonomy and were more involved in decision making. A strong association was found between teamwork and autonomy; this interaction suggests synergy rather than conflict. Organisations should therefore be encouraged to promote nurse autonomy without fearing that it might undermine teamwork.

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Section: The International Hospital Outcomes Studymentioning

confidence: 99%

Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

Rafferty

Ball²,

Aiken

2001

Quality and Safety in Health Care

116

152

View full text Add to dashboard Cite

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“…While many concerns about the quality of hospital care are shared internationally (McKee et al, 1997;McKee et al, 1998), decision-makers in other countries have not always considered these US findings to be applicable to their particular national contexts. This paper reports on analyses of data on NHS hospitals in England from the International Hospital Outcomes Study and provides evidence of the kind sought by the Audit Commission on the relationship between nurse staffing levels and patient outcomes in England.…”

Section: Outcomes Of Variation In Hospital Nurse Staffing In English mentioning

confidence: 99%

Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Rafferty

Clarke

Coles

et al. 2007

International Journal of Nursing Studies

440

330

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Context-Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.Objectives-To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.Design and setting-Cross-sectional analysis combining nurse survey data with discharge abstracts.Participants-Nurses (N = 3984) and general, orthopaedic, and vascular surgery patients (N = 118 752) in 30 English acute trusts.Results-Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.Conclusions-Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA. Outcomes of variation in hospital nurse staffing in English hospitalsThe impact of nurse staffing on patient outcomes has been controversial in the US and as contentious in the UK. A 2001 Audit Commission report on ward staffing in National Health Service (NHS) hospitals noted considerable variation across trusts in expenditures on nurse staffing but was not able to determine whether those differences were associated with variation in patient outcomes (Audit Commission, 2001). The Commission concluded, "Unless and until trusts that spend more [on staffing] can demonstrate a clear link with the quality of care that is delivered, movement towards a more even allocation of resources seems reasonable both for patients and staff." (1, p. 15). The Healthcare Commission released a report in June 2005 suggesting that patients were more satisfied in hospitals with more qualified nurses but emphasized again the lack of evidence linking staffing to patient outcomes and the need for research to guide decision-making in this area (Healthcare Commission, 2005).The Audit Commission's report coincided with the publication of the first results from the five-country International Hospital Outcomes Study. The International Hospital Outcomes Study, involving seven interdisciplinary research teams in five countries (US, Canada, England, Scotland and Germany), examined the extent to which the relationships between nurse staffing, the quality of the nurse work environment, and patient and nurse outcomes are similar across countries with well-resourced health care systems (Aiken et al., 2002a, b). It was seen that...

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“…They also provide evidence of the detrimental eVect that non-supportive and inflexible organisations have on nurse job satisfaction. 9 The reader would be forgiven for concluding from this editorial that managers who call for skill substitutions were interested in cost and not quality and nurses were interested in quality and not cost. This conclusion is too simplistic in an area where quality is diYcult to measure and most of the important eVects of qualified nurses are invisible to the naked eye.…”

Section: Nursing: Quality In Numbersmentioning

confidence: 99%

Quality improvement in primary health care: a European perspective

Baker¹

1998

Quality and Safety in Health Care

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Organisational change and quality of health care: an evolving international agenda

Cited by 70 publications

References 26 publications

Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Quality improvement in primary health care: a European perspective

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