RESUMO
BACKGROUND: Organizational structure and process are thought to affect patient care outcomes beyond the effects of expert clinical care. OBJECTIVES: To test the hypothesis that a discretionary pattern of organizational structure and process factors is predictive of critical care unit performance, ie, desirable patient and organizational outcomes. METHODS: Quality-of-care patient and organizational outcomes were evaluated in 25 critical care units. A single value representing each critical care unit's euclidian distance from a theoretically ideal pattern of discretionary function was determined and correlated with unit-level measures of outcomes (standardized mortality ratio, severity-adjusted length of stay, patient satisfaction, quality of nursing care, and nursing retention). RESULTS: Distance from the ideal-type discretionary pattern predicted organizational but not clinical outcomes. Units closer to the ideal-type pattern had higher RN retention, and were viewed as better places to work, with higher-quality care by both nurses and physicians. Objectively measured quality of care, patient satisfaction, severity-adjusted mortality, and length of stay were not consistently related to better-structured units. CONCLUSIONS: With experienced critical care practitioners, unit-level structure and process factors were better predictors of organizational outcomes than of clinical outcomes.
Assuntos
Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva/organização & administração , Modelos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , APACHE , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Noroeste dos Estados Unidos , Satisfação do Paciente , Qualidade da Assistência à SaúdeAssuntos
Fadiga/enfermagem , Serviços de Enfermagem/normas , Avaliação de Resultados em Cuidados de Saúde , Dor/enfermagem , Coleta de Dados/métodos , Fadiga/etiologia , Fadiga/prevenção & controle , Fadiga/psicologia , Previsões , Humanos , Pesquisa em Avaliação de Enfermagem/métodos , Pesquisa em Avaliação de Enfermagem/tendências , Dor/etiologia , Dor/prevenção & controle , Dor/psicologia , Satisfação do PacienteAssuntos
Características Culturais , Educação em Enfermagem/normas , Preconceito , Socialização , HumanosRESUMO
As school of nursing deans are increasingly returning to a faculty position in the same school, the authors believe it important to reflect on the relationship between the previous and new deans and the effect of their relationship on the organization. From the authors' own experiences, recommendations for both are offered.