Development of a patient-orientated instrument to measure service quality in outpatient departments.

AIMS OF THE STUDY: To describe three stages in the development of an instrument to measure service quality from the patients' perspective in hospital outpatient departments. RATIONALE: A reliable and valid service quality instrument is a valuable tool for collecting feedback from patients when improving outpatient services. DESIGN: A multiphase process with several versions of the questionnaire testing its validity and reliability. The first version of the questionnaire was constructed from information collected in a previous interview study of patients' service experiences. Using this version (47 questions) information was collected in 15 outpatient departments (314 patients) and the second version of the questionnaire was developed. At this stage, a survey of employees (n=111) was included in the development process. This second version of the questionnaire (43 questions) was used to collect more data in three outpatient departments of a university hospital and in two outpatient departments of two regional hospitals on three different occasions (1416, 369 and 124 patients) within a period of 2 years. The reliability of the instrument was tested in terms of stability by using three repeated measurements, and using the Cronbach's alpha coefficient as an indicator of internal consistency. Content validity was assessed by means of percentage agreement between staff and patients. Logistic regression analysis was performed to assess construct validity. RESULTS: The final version of the questionnaire contained 12 items. Agreement between patient and staff ratings was found to be acceptable for most questions (content validity). Two measurements on different occasions yielded a similar structure (construct validity). Internal consistency was acceptable (Cronbach's alpha = 0.67-0.93 in the first and 0.71-0.94 in the second survey). The variance of the alpha coefficients was small in the retest (stability). CONCLUSIONS: The instrument developed is general to the extent that it is suitable for assessing service quality improvement needs in individual units and for making cross-departmental comparisons.

Validation of a new method for patient classification, the Oulu Patient Classification.

At Vasa Central Hospital in Western Finland a further development of the Oulu Patient Classification (OPC) has been made by the development of weight coefficients and by estimating the nursing care intensity per nurse. The daily level of nursing care intensity of a ward is expressed by the number of nursing care intensity points per nurse. This article presents results from a validity test of the OPC at Vasa Central Hospital. The test was carried out by comparing the daily patient classifications by means of the OPC against measurements made by means of a new measuring instrument, the 'Professional Assessment of Optimal Nursing Care Intensity Level' (PAONCIL) developed at the Vasa Central Hospital. The study was implemented in eight wards during a period of 3 months. The data material consisted of two parts, the daily patient classifications based on the OPC (n = 19 324) and the measurements by means of the PAONCIL forms (n = 8458). Simple and multiple linear regression analyses were used as statistical methods in quantifying the linear relationship between the two interval-scaled variables. In the test of concurrent validity the coefficient of determination was 0.366, i.e. the association between these two indicators is fairly strong (36.6%). The testing of construct validity showed that the construct validity of the indicator hardly deteriorates as a result of the patients being placed in separate nursing care intensity categories. There was a clear correlation between the scores allotted by the indicator to the six different sub-areas of nursing care. When examining the construct validity of the OPC, no factors with independent explanatory power in predicting PAONCIL values were discovered other than those of the OPC. The OPC proved on the basis of this research material and these statistical methods to possess fairly adequate validity, and thus there is a good basis for further research and a development of nursing care.

Professional assessment of optimal nursing care intensity level. A new method for resource allocation as an alternative to classical time studies.

In the article a new method is presented for allocation of staff resources, 'Professional Assessment of Optimal Nursing Care Intensity Level' (PAONCIL). This method is presented as an alternative to classical time study, which has traditionally been considered to belong to systems for patient classification. By means of this method the optimal nursing care intensity level for individual wards can be established. The study comprised 8 wards, and the nurses working in these wards provided a total of 8,458 professional assessments of optimal nursing care intensity levels. The material was analysed by means of simple linear regression analysis. The nursing care intensity scores per nurse in a single ward were used as independent variables and the average PAONCIL score for the same calendar day was used as a dependent variable. The average determination coefficient for different wards were 0.37; the PAONCIL instrument thus explained 37% of the nursing care intensity/nurse variation. This corresponded to a linear correlation of 0.60. In five out of six wards for adults the optimal nursing care intensity/nurse scores were close to each other, ranging from 3.0 to 3.6. The advantage of the PAONCIL method is that it can be easily implemented in a ward, can be used time and again, is advantageous and is based on quality aspects. The PAONCIL method has been developed on the basis of a caring science perspective and can be seen as an administrative method for the nurse manager, with whose help 'good care' can become possible.

[The social skills of long-term psychiatric patients--a challenge for nursing practice]. / Psykiatrisen pitkäaikaispotilaan sosiaaliset taidot--haaste hoitotyölle.

The social skills of long-term psychiatric patients were chosen as one of the subjects to be evaluated in a study of the results of a development programme carried out in the psychiatric hospitals of North Häme mental health care district in 1986-1988. Attention was paid to the patients' social skills, because earlier studies have shown that many long-term patients would be able to live outside institutions if they could manage their daily activities. Improving the patients' skills was regarded as a challenge for nursing practice. Their development was followed for a period of 18 months and the sample consisted of 121 patients and selected randomly from 12 wards. Every six months, the social skills of the patients were assessed separately by the nursing staff and the patients themselves. The patients' skills improved considerably in the course of the development programme, as intensive and systematic action was taken in the nursing unit to further their rehabilitation. However, the patients proved unable to maintain these newly acquired skills without constant support from the nursing staff or the community. The patients had a higher opinion of their skills than the nursing staff. In the development programme, this evaluation of social skills utilized to construct an individual rehabilitation plan for each patients.