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14 - Rini Rachmawaty - Jurnalmankep - Shannon-2002
14 - Rini Rachmawaty - Jurnalmankep - Shannon-2002
Purpose: To compare patient, nurse, and physician assessments of quality of care and
patient satisfaction in selected critical care units.
Design: As part of a study of patient outcomes from critical care, data were collected
between December 1991 and March 1993 from 489 patients, 518 nurses, and 515
physicians in 25 critical care units located in 14 hospitals in the U.S. Pacific Northwest.
Methods: Views of patient satisfaction and quality of care were measured using
standardized instruments. All data were aggregated to the unit level (N=25) and were
normalized to a common scale for analysis.
Findings: Physicians rated quality of care higher than did either patients or nurses within
the same critical care unit, and nurses had the lowest perceptions of quality. Nurses
and patients had similar views of patient satisfaction, but physicians tended to
overestimate patients’ satisfaction. However, physicians’, nurses’, and patients’ scores
varied considerably within and between units. Physicians’ and nurses’ views of quality
and patient satisfaction were strongly related to processes such as MD-RN
collaboration and outcomes such as nurses’ job satisfaction.
Conclusions: Patients, nurses, and physicians viewed quality of care and patient
satisfaction differently. Nurses’ and physicians’ perspectives were more related to their
views of the work environment than to organizational factors, patient characteristics, or
commonly used outcome measures.
JOURNAL OF NURSING SCHOLARSHIP, 2002; 34:2, 173-179. ©2002 SIGMA THETA TAU INTERNATIONAL.
***
cost (Becker, 1998). The secondary analysis reported in
this paper was done to compare patients’, nurses’, and
Background
payers and providers in evaluating quality of health care,
Obtaining patients’ viewpoints may be difficult,
to market-driven purveyors of care in attracting and
particularly in settings such as critical care where the
keeping customers, and to patients as they weigh
effects of illness or treatment may interfere with patients’
alternatives in seeking elective care (Christensen &
cognition or consciousness. In such situations,
Inguanzo, 1989; Oswald, Turner, Snipes, & Butler, 1998;
substituting provider ratings for patient ratings (Shortell et
Rosenthal & Shannon, 1997). Although patients were
al., 1994) is tempting. Based
once thought ill-prepared to render appropriate judgment
regarding the technical components of quality of care
(Cleary & McNeil, 1988), they are increasingly
recognized as key informants about all aspects of quality
including technical and interpersonal (Rubin et al., 1993). Sarah E. Shannon, RN, PhD, Psi-at-large, Associate Professor,
Pamela H. Mitchell, RN, PhD, FAAN, Psi-at-large, Professor &
Their viewpoints have become particularly important in Associate Dean, Kevin C. Cain, PhD, Associate Professor, all at
the current economic climate, when providers of care University of Washington School of Nursing, Seattle. The authors
compete more on quality than on uniformly discounted acknowledge Dr. Sue Hegyvary, Dr. Karen Seachrist, and the
graduate student research assistants from the CCNS Study. Funding
in part from NIH, NINR RO1 NR02343. Correspondence to Dr. Seattle, WA 98195- 7266. E-mail: sshannon@u.washington.edu
Shannon, Box 357266, University of Washington, School of Nursing, Accepted for publication October 24, 2000.
hospital.
C
50
f
o
Correlational analyses were done to
y further explore the relationship among
physicians’, nurses’, and patients’ views
t
i
l
Patients' View RNs' View
40
a of quality of care and patient satisfaction
and other key variables in the original
u
Q
MDs' View
30
variables and greater than 10-point study (Mitchell et al., 1996). Table 2
difference for patient satisfaction). All of shows the correlation matrix of these
20
these units were specialized critical care variables. Nurses’
10
satisfaction were moderately correlated. However, care
All scores have been normalized to a 0-100 scale. Physician data not available for unit 9.
providers’ opinions did not correlate with patients’ views
of quality of care (r= -.146 with nurses and r=.103 with
physicians) or patients’ reports of satisfaction with care
Figure 2. Patients’, nurses’, and physicians’ ratings (r=- .212 with nurses, r=
.165 with physicians).
of patient satisfaction (N=25 units). If nurses and physicians did not accurately estimate
patient satisfaction, what did their scores indicate?
100 Similarly, if nurses and physicians had different views of
90 quality than did patients, what influenced their
80
perspectives? To answer this question, we examined
relationships among patients’, nurses’, and physicians’
70
ratings of quality of care and patient satisfaction with
other measures of unit processes and
n
c
1 3 5 7 9 11 13 15 17 19 21 23 25 Unit ID
t
a a
f
50 30
P
s
i
t
S 20
t
10
between nurses’ or physicians’ views of (d) quality of care as measured by the
unit quality or patient satisfaction and MEDICUS instrument (Mitchell et al.,
(a) average severity of illness for 1996).
patients in the critical care unit as However, physicians’ and nurses’
Patients' View RNs' View
measured by the APACHE III ratings of unit quality and satisfaction
MDs' View
instrument, (b) average ICU or hospital were strongly related to unit processes
effectiveness. No correlation was found length of stay, (c) mean patient age, or such
All scores have been normalized to a 0-100 scale. Physician data not available for unit 9.
of MD-RN
as MD-RN collaboration and unit outcomes such as
nurse job satisfaction (see Table 2). Physicians’ ratings
Table 2. Correlation Matrix of Views of Quality and Patient Satisfaction Among Patients, Nurses, and Physicians
1 2 3 45 6 7 8 9
1. Patients’ view of quality 1.000
2. RNs’ view of unit quality -.146 1.000
3. MDs’ view of unit quality .103 .489* 1.000
4. Patients’ satisfaction .986** -.121 .150 1.000
5. RNs’ view of patient satisfaction -.220 .608** .320 -.212 1.000
6. MDs’ view of patient satisfaction .134 .362 .847** .165 .513* 1.000
7. RNs’ view of RN-MD collaboration -.023 .798** .315 .002 .506** .284 1.000 8. MDs’ view of RN-MD collaboration .066 .476* .964** .124 .321 .845**
.310 1.000 9. RNs’ job satisfaction .019 .851** .438* .050 .418* .280 .726** .424* 1.000
* p<.05 (2-tailed)
** p<.01 (2-tailed)
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