Hospital caregivers' perceptions of factors influencing the quality of care at the unit level

2.50
Hdl Handle:
http://hdl.handle.net/10755/163620
Category:
Abstract
Type:
Presentation
Title:
Hospital caregivers' perceptions of factors influencing the quality of care at the unit level
Author(s):
Field, Lucy; Fay, Mary S.
Author Details:
Lucy Field, West Roxbury, Massachusetts, USA, email: field@bc.edu; Mary S. Fay
Abstract:
Purpose: The purpose of this study was to identify and describe the variables, as perceived by direct caregivers representing multiple disciplines, that were influencing the quality of care on inpatient units of a large academic medical center. This work was part of a larger study to measure the impact of work redesign to improve the efficiency and quality of care delivery during a time of increasing economic constraints. Research Question: What factors do direct care providers describe as having the most influence on their ability to provide high quality care? Methods: Data were collected on a rolling basis among 34 patient care units between January, 1998 and November, 2000 on two occasions -- shortly before and again one year after the implementation of unit-specific administrative changes. All unit-based staff members and their nurse leaders, as well as purposive samples of attending physicians, house staff, nurse consultants, and other health care professionals who regularly provided care or consultation for patients and families on individual units, were invited to respond. Participation was anonymous and voluntary. For this study, data were written responses to an open-ended question, included with a survey questionnaire, in which staff were invited to share individual comments regarding factors influencing the quality of care on their respective units. Of the combined 3293 surveys returned, 20% provided such data. All data were transcribed verbatim, and content analysis was done independently by two investigators using HyperRESEARCH software. Categories were generated directly from the data. Differences regarding data classification were resolved through mutual discussion. Verification of the findings was consistently obtained via presentations to staff at all organizational levels. Results/Conclusions: Respondents identified four categories of antecedent conditions that influenced the quality of care: workload (comprising staffing and patient acuity), staff clinical competence, accountability for professional standards, and resources (material and personnel). Two usual patterns of response to problems in these areas -- chronic crisis management and chronic triaging -- were uniformly judged as ineffective. Contextual conditions included both environmental factors (noise, clutter, & traffic) and philosophical conflicts arising from the clash of business and professional values. The degree of staff teamwork, the level of professional commitment of individual staff members, and the amount of respect and recognition accorded to staff for their efforts to maintain quality were important intervening conditions. The interaction of these factors on each unit determined both perceived quality of care and staff morale. Implications: Findings from this study provide a useful framework for understanding and exploring differences in perceived quality of care, both within and across tertiary care settings. To do their best work despite limited resources, direct care staff need leaders who will: help them to maintain clinical competence and be accountable for their practices, foster group cohesion, value their individual efforts, minimize environmental stressors, and ensure that they have the necessary resources to provide optimal care.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleHospital caregivers' perceptions of factors influencing the quality of care at the unit levelen_GB
dc.contributor.authorField, Lucyen_US
dc.contributor.authorFay, Mary S.en_US
dc.author.detailsLucy Field, West Roxbury, Massachusetts, USA, email: field@bc.edu; Mary S. Fayen_US
dc.identifier.urihttp://hdl.handle.net/10755/163620-
dc.description.abstractPurpose: The purpose of this study was to identify and describe the variables, as perceived by direct caregivers representing multiple disciplines, that were influencing the quality of care on inpatient units of a large academic medical center. This work was part of a larger study to measure the impact of work redesign to improve the efficiency and quality of care delivery during a time of increasing economic constraints. Research Question: What factors do direct care providers describe as having the most influence on their ability to provide high quality care? Methods: Data were collected on a rolling basis among 34 patient care units between January, 1998 and November, 2000 on two occasions -- shortly before and again one year after the implementation of unit-specific administrative changes. All unit-based staff members and their nurse leaders, as well as purposive samples of attending physicians, house staff, nurse consultants, and other health care professionals who regularly provided care or consultation for patients and families on individual units, were invited to respond. Participation was anonymous and voluntary. For this study, data were written responses to an open-ended question, included with a survey questionnaire, in which staff were invited to share individual comments regarding factors influencing the quality of care on their respective units. Of the combined 3293 surveys returned, 20% provided such data. All data were transcribed verbatim, and content analysis was done independently by two investigators using HyperRESEARCH software. Categories were generated directly from the data. Differences regarding data classification were resolved through mutual discussion. Verification of the findings was consistently obtained via presentations to staff at all organizational levels. Results/Conclusions: Respondents identified four categories of antecedent conditions that influenced the quality of care: workload (comprising staffing and patient acuity), staff clinical competence, accountability for professional standards, and resources (material and personnel). Two usual patterns of response to problems in these areas -- chronic crisis management and chronic triaging -- were uniformly judged as ineffective. Contextual conditions included both environmental factors (noise, clutter, & traffic) and philosophical conflicts arising from the clash of business and professional values. The degree of staff teamwork, the level of professional commitment of individual staff members, and the amount of respect and recognition accorded to staff for their efforts to maintain quality were important intervening conditions. The interaction of these factors on each unit determined both perceived quality of care and staff morale. Implications: Findings from this study provide a useful framework for understanding and exploring differences in perceived quality of care, both within and across tertiary care settings. To do their best work despite limited resources, direct care staff need leaders who will: help them to maintain clinical competence and be accountable for their practices, foster group cohesion, value their individual efforts, minimize environmental stressors, and ensure that they have the necessary resources to provide optimal care.en_GB
dc.date.available2011-10-27T11:10:47Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:10:47Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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