Newswise — PHILADELPHIA, (July 8, 2015) – New research findings from the University of Pennsylvania School of Nursing show that patient and nurse outcomes in Kaiser Permanente hospitals were significantly better compared to other hospitals. Differences in nursing explained a significant proportion of the Kaiser Permanente outcomes advantage for patients.
“This has enormous implications in hospital settings, given nurses’ key role in the process of clinical surveillance,” said Matthew McHugh, PhD, JD, MPH, RN, professor at Penn Nursing and primary author of the study “Achieving Kaiser Permanente Quality,” to be published in an upcoming issue of the peer-reviewed journal Health Care Management Review, and available online now in advance of print.
McHugh explains that efforts to reproduce Kaiser Permanente’s success have focused on the way the organization operates as an integrated delivery system — yet most of these efforts have failed. One factor that has received little attention and which could explain Kaiser Permanente’s advantage is its commitment to investment in nursing as a driver of patient-centered care.
This is important because nurses are at the bedside 24 hours a day, they are responsible for early warning system monitoring, they have a direct knowledge of patient condition and changes in condition, and they initiate and coordinate the activities of others to prevent complications and save a patient’s life when complications occur.
The researchers found that Kaiser Permanente hospitals had significantly better nurse work environments, staffing levels, and more nurses with bachelor’s degrees. And Kaiser Permanente hospital outcomes were comparable to Magnet hospitals, where better outcomes have also been explained by differences in nursing.
“Our results suggest that a less expensive and less difficult strategy to achieve good outcomes like Kaiser Permanente may be for hospitals to consider Magnet designation, a proven and cost-effective strategy to improve process of care through investments in professional nurses,” said McHugh.
The team studied survey data which included almost 26,148 nurses from 564 general acute care hospitals in California, Florida, Pennsylvania and New Jersey in 2006-2007. The focus was on patients aged 21-85 who underwent general, orthopedic or vascular surgeries.
They examined whether patient outcomes (mortality and failure-to-rescue) and nurse outcomes (burnout, job satisfaction, and intent-to-leave) in Kaiser Permanente hospitals were better than in non-Kaiser Permanente hospitals. They assessed whether differences in nursing explained outcomes differences between Kaiser Permanente and other hospitals. And they examined whether Kaiser Permanente hospitals compared favorably with hospitals known for having excellent nurse work environments – Magnet hospitals.
Their focus was on three hospital-level nursing characteristics with a strong evidence-base suggesting a relationship with nurse and patient outcomes: Nurse work environment, nurse staffing, and proportion of nurses with a bachelor of science in nursing degree.
Co-authors of the paper are Linda H. Aiken, PhD, RN, FAAN, FRCN, Myra E. Eckenhoff, BA, Penn Nursing, and Lawton Robert Burns, PhD, the Wharton School at Penn.
Aiken, who is the director of the Center for Health Outcomes and Policy Research at Penn Nursing, explains that an important element in Kaiser Permanente's success is its investment in professional nursing, which may not be evident to systems seeking to achieve the nonprofit health plan’s advantage.
Principal funding for the research was from the National Institutes of Nursing Research (a branch of the National Institutes of Health) and the Robert Wood Johnson Foundation with some additional support from Kaiser Permanente. Funders had no role in analysis, data generation, or writing the paper.
The next step of this research is already underway with surveys to 250,000 nurses in the same four states as previously queried. The questions are related to nurse work environments, nurse staffing, nurse qualifications, and quality of care.
###
The University of Pennsylvania School of Nursing is one of the world’s leading schools of nursing and is ranked the #1 graduate nursing school in the United States by U.S. News & World Report. Penn Nursing is consistently among the nation’s top recipients of nursing research funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through research, education, and practice.