Mitchell P H, Shannon S E, Cain K C, Hegyvary S T
School of Nursing, University of Washington, Seattle, USA.
Am J Crit Care. 1996 Sep;5(5):353-63, quiz 364-5.
Organizational structure and process are thought to affect patient care outcomes beyond the effects of expert clinical care.
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.
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).
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.
With experienced critical care practitioners, unit-level structure and process factors were better predictors of organizational outcomes than of clinical outcomes.
人们认为组织结构和流程对患者护理结果的影响超出了专家临床护理的作用。
检验以下假设，即组织结构和流程因素的一种自主模式可预测重症监护病房的绩效，即理想的患者和组织结果。
对25个重症监护病房的护理质量患者和组织结果进行了评估。确定了一个单一值，该值代表每个重症监护病房与理论上理想的自主功能模式的欧几里得距离，并将其与结果的单位层面指标（标准化死亡率、病情严重程度调整后的住院时间、患者满意度、护理质量和护士留职率）相关联。
与理想类型自主模式的距离预测了组织结果而非临床结果。更接近理想类型模式的病房护士留职率更高，被视为更好的工作场所，护士和医生提供的护理质量更高。客观测量的护理质量、患者满意度、病情严重程度调整后的死亡率和住院时间与结构更好的病房并不始终相关。
对于经验丰富的重症监护从业者，单位层面的结构和流程因素对组织结果的预测比对临床结果的预测更好。
