Michael Kleinknecht-Dolf1, Elisabeth Spichiger2, Irena Anna Frei3, Marianne Müller4, Jacqueline S Martin5, Rebecca Spirig6. 1. Zentrum Klinische Pflegewissenschaft, UniversitätsSpital Zürich und Departement für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke,Witten. 2. Institut für Pflegewissenschaft, Universität Basel und Bereich Fachentwicklung, Direktion Pflege/MTT, Inselspital Universitätsspital, Bern. 3. Abteilung Praxisentwicklung Pflege, Universitätsspital Basel. 4. Institut für Datenanalyse und Prozess Design, School of Engineering, Zürcher Hochschule für Angewandte Wissenschaften, Winterthur. 5. Ressort Pflege/MTT, Universitätsspital Basel. 6. Institut für Pflegewissenschaft, Universität Basel und Direktion Pflege & MTTB, UniversitätsSpital Zürich.
Abstract
BACKGROUND: The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be impacted. AIM: The Sinergia Project aims to develop a monitoring model and related instruments to continuously monitor the impact of DRG-based reimbursement on central nursing service context factors. METHOD: The descriptive, quantitative results were collected within the framework of a study with a mixed methods design by means of an online survey in which nurses from five hospitals participated. RESULTS: The results show that the nursing service context factors examined (nursing care complexity, quality of the work environment, management, moral distress and job satisfaction), have relevance in all practice areas as regards practice setting and nursing care delivery. Patterns can be recognized that are consistent with those found in the literature and which could be an indication of the relationships between the context factors above, as was hypothesized in the model. CONCLUSIONS: The study has provided the participating hospitals with useful data upon which to base discussions on ensuring quality of nursing care and practice development, in addition to information important to the further development of the model and the instruments employed.
BACKGROUND: The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be impacted. AIM: The Sinergia Project aims to develop a monitoring model and related instruments to continuously monitor the impact of DRG-based reimbursement on central nursing service context factors. METHOD: The descriptive, quantitative results were collected within the framework of a study with a mixed methods design by means of an online survey in which nurses from five hospitals participated. RESULTS: The results show that the nursing service context factors examined (nursing care complexity, quality of the work environment, management, moral distress and job satisfaction), have relevance in all practice areas as regards practice setting and nursing care delivery. Patterns can be recognized that are consistent with those found in the literature and which could be an indication of the relationships between the context factors above, as was hypothesized in the model. CONCLUSIONS: The study has provided the participating hospitals with useful data upon which to base discussions on ensuring quality of nursing care and practice development, in addition to information important to the further development of the model and the instruments employed.
Entities:
Keywords:
Akutspital; Diagnosis Related Groups; Mixed-Methods-Design; Monitoring; Pflege; acute-care hospital; diagnosis related groups; mixed methods design; nursing administration research; nursing service