Patient experiences with information in a hospital setting: a multilevel approach.

BACKGROUND: Patients tend to be critical of poor communication and the provision of information from health professionals. One explanation may be related to organizational aspects characterizing the hospital unit. Studies have indicated quality of contact with nursing staff to be a major determinant of patients' experiences with information. Yet many studies do not simultaneously analyze the effects of patient and unit characteristics.
OBJECTIVE: To explore the extent to which variation in patients' experiences with the provision of information from hospital staff are associated with differences between patients, and the extent to which they are associated with differences between hospital wards. RESEARCH
DESIGN: Cross-sectional study of patients nested within hospital wards including hospital administrative data and survey data on patients' experiences with hospital care and nurses' assessments of working conditions and job satisfaction.
RESULTS: Multilevel regression analysis indicated low intraward correlation and high within ward variability. In explaining variability in experiences with information, patients' sense of coherence was the most important patient-level characteristic. The percentage of nurses satisfied with their work contributed to an additional proportional reduction in variance between hospital wards.
CONCLUSIONS: This study has illustrated the use of multilevel methods in analyzing patient perceptions of hospital care. Ward-level factors are at most modestly related to patients' experiences with information. The effect of hospital, department, and ward characteristics is likely to be mediated through the existence of microunits within hospital wards. Quality of contact with nursing staff may be a characteristic of the microunit rather than an organizational characteristic related to hospital wards.