Recipients of AcademyHealth's Presidential Scholarship for New Health Services Researchers were invited to blog about select sessions during the 2012 Annual Research Meeting. The following session summary is written by Yea-Jen Hsu, Ph.D., M.H.A., Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University.
Health care leaders and researchers have identified organizational change as one of the most promising ways to improve patient safety and quality of care. The four panelists in this session presented recent studies in the association of organizational change and patient safety or care quality.
Dr. James Burgess presented his study observing the changes in quality of care before and after VA facilities removed goals in some of their quality indicators. Health care organizations set goals to provide clear direction and guide resource allocation to improve quality of care. Many of these goals are adjusted or removed as they are achieved to allow the organization to shift focus to other quality aspects. However, this may affect the sustainability of previous efforts. This presentation reported changes in seven quality indicators and performance in these indicators was generally sustained after goal removal, which suggests that behavioral changes made to achieve the goals had been embedded in the practice and therefore goal removal would not influence the performance. The findings can inform organizations’ and leaders’ decisions in shifting their focus over time. One thing worth noting here is that the quality indicators were still being measured, even after related goals were removed. The sustained performance might disappear if the indicators were not measured. Future research can further investigate this issue.
Dr. Carl-Ardy Dubois discussed important factors to redesign nursing care organization, then identified the main models of nursing care in acute care units in Quebec, and finally compared patient outcomes among different models using data from 22 medicine units. The study identified four factors to redesign nursing care organization -- staffing, scope of practice, capacity for innovation, and practice environment -- and analyzed them against, four models of nursing care organization (basic functional model, adaptive functional model, basic professional model, and innovative professional model). Dr. Dubois then discussed how different models may affect quality of care.
The objective of the study Dr. Joel Weissman presented is to assess the association between the occurrence of adverse events and patients’ rating of quality of care, and further identify hospital-related factors that may moderate the association. Using patient reports from 16 hospitals in Massachusetts, this study found that adverse events patients experienced were associated with lower patient satisfaction with their stay in the hospital. For patients who ever experienced any adverse events, higher involvement, good discharge timing, and appropriate disclosure of the event were related to greater patient satisfaction. This study suggests that patients are more comfortable with a transparent and collaborative environment. Moreover, when adverse events occur, hospitals can take actions to mitigate the consequences and to improve patients’ experiences.
Dr. Amy Witkoski Stimpfel presented some of her dissertation findings regarding the association between nurses’ shift length and patient and nurse outcomes. This study generated the most discussion in this session. Participants discussed the reasons why nurses might work long shifts and how contextual factors such as the working environment could contribute to the variations in shift length. The option of conducting analysis at the organization level, rather than individual nurse level was also suggested by one of the participants.
Reviewing these studies as a group, one finds that efforts to improve quality of care need to involve initiatives at all levels from leadership, organizational change, interdepartmental collaboration, and individual training. These four studies will help leaders and researchers understand the dynamics of organizational change and other factors in the organization, and offer managerial insights as organizations plan changes to support better quality of care.
As a health services researcher specializing in organizational behavior research, I am pleased that the AcademyHealth Annual Research Meeting provides me and other experts in this area a venue to make our voice heard and to communicate with researchers in other disciplines. This session and other sessions related to organizational research and quality of care were very well organized and involved great discussion.
[Editor's note: Dr. Dubois and Dr. Witkoski Stimpfel opted not to share presentation slides pending publication of their work.]