Patients, Nurses, and Physicians Have Differing Views of Quality in the ICU

Abstract & Commentary

Synopsis: Physicians rated the quality of ICU care higher than nurses, and these health care providers’ opionions did not correlate with those of patients. Patients’ perceived satisfaction with their care waas rated higher by physicians than by either nurses or patients.

Source: Shannon SE, et al. J Nurs Scholarsh. 2002;34(2):173-179.

Through a secondary analysis from a multisite study of critical care unit outcomes and organizational features, Shannon and colleagues compared patient, nurse, and physician assessments of quality of care and patient satisfaction in selected ICUs. Data regarding patient satisfaction and quality of care were collected from 489 patients, 518 nurses, and 515 physicians in 25 ICUs from 14 hospitals in the Pacific Northwest. The majority of the ICUs were small, mixed, medical-surgical units (average 12 beds/unit), in a mix of tertiary-care and community hospitals (9 ICUs nonteaching and 16 teaching [9 members of the Council of Teaching Hospitals and 7 nonmembers]), with an average of 316 total beds. Patients’ perceptions of quality and satisfaction with care during a critical care stay were measured by 3 subscales from the Medicus Viewpoint Instrument, administered within 48 hours of ICU transfer. Nurses’ and physicians’ views of unit quality and patient satisfaction were obtained from portions of the Charns Organizational Diagnosis Survey. The unit of analysis was the critical care unit (n = 25). Data were normalized to a common scale (0-100) for analysis.

Physicians’ opinions about unit quality were higher (83.55) than patients’ views (81.69). Nurses’ ratings of unit quality were the lowest (73.86). Nurses and patients had similar views of patient satisfaction (81.43 and 81.28, respectively). Physicians’ opinions about perceived patient satisfaction were higher (86.24). Correlation analyses revealed that opinions of quality and patient satisfaction varied considerably within and between units. Care providers’ opinions did not correlate with patients’ views of quality of care (r = -0.146, nurses; r = 0.103, physicians). Physicians’ and nurses’ views of unit quality of care and patient satisfaction were moderately correlated. These ratings were strongly related to MD-RN collaboration and nurse job satisfaction.

Comment by Karen Johnson, PhD, RN

How many signs/posters are currently displayed in your ICUs that address patient satisfaction? If yours is like mine, probably quite a few! Patients’ viewpoints and satisfaction with care have become particularly important in the current economic climate of acute and critical care. Patient satisfaction is both a process of care and an outcome measure.

As an outcome measure, institutions use various methods to evaluate how well patients are satisfied with care received. This study demonstrates that we cannot use health care professionals’ perceptions of patient satisfaction and perceived quality of care as proxies for patients’ views. These results indicated that health care providers may evaluate patient satisfaction through rose-colored glasses. Organizational harmony may affect health care providers’ perceptions of patient satisfaction. If life in the unit is good (in particular good RN-MD collaboration), perceived patient satisfaction and quality of care are good; if life in the unit is bad, perceived patient satisfaction and quality of care are bad.

These findings may become increasingly important as institutions consider future organizational changes that affect staff attitudes and perceptions. These organizational changes and their linkages to patient outcomes and patient satisfaction are in desperate need of process and outcome evaluation strategies. We must remind ourselves that patient satisfaction and perceived quality of care as outcome measures are a reflection of our process of care that incorporates patient satisfaction and quality of care on a daily basis.

Dr. Johnson is Assistant Professor University of Maryland School of Nursing, Baltimore.