Research-health services deliveryHospital staffing, organization, and quality of care: Cross-national findings*,**,*
Section snippets
Study background
The International Hospital Outcomes Study Consortium consists of seven interdisciplinary research teams headed by the University of Pennsylvania's Center for Health Outcomes and Policy Research. The study includes over 700 hospitals located in the United States (Pennsylvania), three provinces in Canada (Ontario, Alberta, British Columbia), England, Scotland, and Germany. The conceptual framework and design of the study derive from more than a decade of research on U.S. hospitals conducted by
Study design
The International Hospital Outcomes Study includes three primary linked and overlapping sources of data. These sources include surveys of nurses, patient discharge data, and secondary data on hospital characteristics. We sought to study hospitals in comparable countries but with differently organized and financed health care systems and selected the U.S. (Pennsylvania), Canada, the U.K. (England and Scotland), and Germany. Where feasible, our design called for the inclusion of all hospitals in
Results
We begin by describing some key variables in the sample of medical-surgical nurses we used in these exploratory analyses. Table 2 provides mean scores by jurisdiction for staffing, organizational support, and burnout.Staffing levels vary by country and site and may reflect differences in average length of stay and severity of illness between countries. The U.S. has the shortest average patient length of stay and Pennsylvania nurses also have the smallest numbers of assigned patients.
Discussion and conclusions
Consumers' and health professionals' concerns about adverse consequences of health system change on quality of hospital care are consistent with the findings of the International Hospital Outcomes Study. Deficiencies in hospital care were found in the five jurisdictions included in the present analysis representing the United States, Canada, and the United Kingdom. In addition to uneven quality of care, high levels of nurse job dissatisfaction and burnout signal the potential for a worsening
Acknowledgements
This research has been supported by: National Institute of Nursing Research, National Institutes of Health (NR04513); Commonwealth Fund of New York; Agency for Healthcare Quality and Research; Alberta Heritage Foundation for Medical Research; British Columbia Health Research Foundation; Federal Ministry of Education and Research (Germany); Nuffield Provincial Hospital Trust, London; and the Baxter Foundation. The authors represent the International Hospital Outcomes Research Consortium, which
References (46)
Healing medicare: managing health system change the Canadian way
(1994)- et al.
Downsizing, reengineering, and restructuring: long-term implications for healthcare organizations
Frontiers in Health Service Management
(1997) Restructuring hospital nursing: reversing the trend toward a professional work force
International Journal of Health Services
(1996)- et al.
Does reengineering really work? An examination of the context and outcomes of hospital reengineering initiatives
Health Services Research
(2000) - et al.
Hospital restructuring and downsizing in Canada: are less experienced nurses at risk?
Psychological Reports
(2000) - et al.
The cost of health system change: public discontent in five nations
Health Affairs
(1999) - et al.
The elderly in five nations: the importance of universal coverage
Health Affairs
(2000) - et al.
Physicians' views on quality of care: A five-country comparison
Health Affairs
(2001) - et al.
Hospital restructuring: does it adversely affect care and outcomes?
Journal of Nursing Administration
(2000) - et al.
The effects of health care reform on job satisfaction and voluntary turnover among hospital-based nurses
Medical Care
(1997)
Trouble in the nurse labor market? Recent trends and future outlook
Health Affairs
Nursing mistakes kill, injure thousands
The nurses: the front-line caregivers are burned out. Is it any wonder?
Macleans
One nurse in three ‘is ready to resign’
Daily Mail (London)
When the hospital staff isn't enough
Washington Post
Hospital restructuring in North America and Europe: patient outcomes and workforce implications. Medical Care
Accounting for variation in hospital outcomes: a cross-national study
Health Affairs
Studying outcomes of organizational change in health services
Medical Care
Magnet hospitals: attraction and retention of professional nurses
Magnet hospitals - Part I: institutions of excellence
Journal of Nursing Administration
Magnet hospitals - Part II: institutions of excellence
Journal of Nursing Administration
Lower medicare mortality among a set of hospitals known for good nursing care
Medical Care
Adverse outcomes and variations in organization of care delivery
Medical Care
Hospital characteristics and mortality rates
New England Journal of Medicine
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Reprinted from International Journal for Quality in Health Care; 14, Copyright 2002, Oxford Press. All rights reserved. For the International Hospital Outcomes Research Consortium.
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Forthcoming, International Journal for Quality in Health Care, 2002: 14(1) Do Not Reproduce or Cite Without Authors' Permission Based on Dr. Aiken's Plenary Address to the 17th International Conference of the International Society for Quality in Health Care, Dublin, Ireland, September 15, 2000.
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Reprint requests: Professor Linda Aiken, Center for Health Outcomes and Policy Research, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA, 19104-6096. Tel: (215) 898-9759, Fax: (215) 573-2062, E-mail: [email protected]