FOD MJP 7 mei 2014
Impact van beleidsbeslissingen op kwaliteit van zorg: resultaten van de RN4CAST-studie
Prof. Walter Sermeus KU Leuven
Inhoud • Situering van de rol van het management in het kwaliteitsbeleid • Casus RN4CAST studie o Design o Enkele beschrijvende gegevens o Effecten verpleegkundige bestaffing op: • • • • o
Mortaliteit verpleegkundige praktijk Patiëntentevredenheid jobtevredenheid
Kosten-effectiviteit van verpleegkundige bestaffing
Context
Maatregelen t.a.v. personeel
Zorgnet, 2014 – resultaten bevraging 35 algemene ziekenhuizen
Swiss cheese model - J. Reason We can’t change the human condition, but we can change the conditions under which humans work. Reason, 1990
Inhoud • Situering van de rol van het management in het kwaliteitsbeleid • Casus RN4CAST studie o Design o Enkele beschrijvende gegevens o Effecten verpleegkundige bestaffing op: • • • • o
Mortaliteit verpleegkundige praktijk Patiëntentevredenheid jobtevredenheid
Kosten-effectiviteit van verpleegkundige bestaffing
RN4CAST STUDY 7th Framework Programme for Research and Technological Development ‘RN4CAST: nurse forecasting in Europe’: €3 million funding for 2009-2011 Health theme 3: Optimising the delivery of health care 16 partners: 12 European countries, USA, China, South-Africa, Botswana Co-ordination: Leuven University (W. Sermeus), U. Pennsylvania (L. Aiken)
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RN4CAST DESIGN Multicountry, multilevel, cross-sectional design to obtain important
unmeasured factors in forecasting models, collected at the hospital, nursing unit and individual nurse and patient level:
Nurse survey: working environment, quality & safety, staffing Patient survey: patient experiences with nursing staff, hospital, information
Hospital survey: type of hospital, inflow & outflow
Hospital Discharge data: ICD9/10, length-of-stay, adverse events, mortality
Setting
At least 30 general acute hospitals in each European country.
At least 2 general surgical and internal medicine wards in each hospital. 8
SAMPLE EUROPE (2009-2010) - 12 countries Belgium, Finland, Germany, Greece, Ireland, Netherlands, Poland, Sweden, Norway, Spain, Switzerland, UK
486 hospitals 33541 nurses 11318 patients In 210 hospitals South-Africa (2009-2010) – 6 Provinces Gauteng, North-West, Free State, KwaZulu-Natal, Eastern Cape, Western Cape
62 hospitals 4657 nurses
CHINA (2008-2010) – 9 Sites
6 provinces, 2 municipalities, 1 autonomous region
181 hospitals 9698 nurses 6494 patients In 181 hospitals
USA (2006-2008) - 4 states
Pennsylvania, California, New Jersey, Florida
617 hospitals 27509 nurses Millions of patients In 430 hospitals
Sermeus et al., BMC Nursing 2011
Framework Framework: A nursing organization model
Dubois et al. 2012 BMC Health Services Research
Main RN4CAST publications
Sermeus et al. (2011). Nurse forecasting in Europe (RN4CAST): rationale, design and methodology. BMC Nursing, 10 (1):6
Aiken et al. (2012). Patient safety, satisfaction and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. British Medical Journal, Mar 20; 344:
IJNS special issue (2013): RN4CAST - Nursing workforce a global priority area for health policy and health services research
Ausserhofer D et al. (2014), Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry crosssectional RN4CAST study. BMJ Qual Saf. 2014 Feb;23(2):126-35.
Aiken et al. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, Feb 26 .
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Inhoud • Situering van de rol van het management in het kwaliteitsbeleid • Casus RN4CAST studie o Design o Enkele beschrijvende gegevens o Effecten verpleegkundige bestaffing op: • • • • o
Mortaliteit verpleegkundige praktijk Patiëntentevredenheid jobtevredenheid
Kosten-effectiviteit van verpleegkundige bestaffing
Nurse to Patient Ratios (3 shifts) Country Belgium
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Aiken et al., IJNS, 2013
Mean 25th Pctl 50th Pctl 75th Pctl 10.7 9.1 10.1 12.2
England
8.6
7.2
8.8
9.6
Finland
8.3
6.8
7.8
9.5
Germany
13.0
11.5
13.1
14.3
Greece
10.2
7.6
9.8
11.8
Ireland
6.9
6.2
6.8
7.7
Netherlands
7.0
6.4
7.2
7.7
Norway
5.4
4.8
5.2
6.0
Poland
10.5
9.1
10.6
11.5
Spain
12.5
11.5
12.6
13.5
Sweden
7.7
6.9
7.5
8.5
Switzerland
7.9
6.8
7.8
8.7
Percent Bachelor prepared Nurses 100 90 80 70 60 50 40 30 20 10 0
100
51
60
52
59 32
56
22
20
10 0
14
Aiken et al., IJNS, 2013
100
Nursing education in a selection of European countries First Cycle: entry to profession Country Iceland Ireland Malta Spain Italy Norway Sweden UK Greece Portugal Luxemburg Finland Denmark France Switzerland
Vocational training
Austria Netherlands Belgium Germany
Diploma - 3y Diploma - 4y Diploma - 3y Diploma - 3y
College/polytechnic
Bachelor – 4y Bachelor – 4y Bachelor – 4y Bachelor – 3,5y Bachelor – 3,5y Bachelor - 3 y Bachelor – 4y F: only BA – 4y Bachelor – 3y Bachelor – 4y Bachelor – 3y Bachelor – 3y
Diploma - 3y
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(Source: based on Spitzer and Perrenoud, J. Prof. Nursing, 2006 – update)
University Bachelor – 4y Bachelor – 4y Bachelor – 4y Bachelor – 4y Bachelor – 3y Bachelor – 3y Bachelor – 3y Bachelor – 3y Bachelor – 4y Bachelor – 4y
Nurses’ work environment Captures 5 dimensions: Staffing adequacy Nursing foundations for quality Nurse manager ability & leadership Nurse-physician relations Nurse involvement in hospital affairs Hospitals classified into quartiles by PES scores
Total England Sweden Poland Norway Netherlands Ireland Greece Finland Spain Germany Switzerland Belgium
poor
mixed better
0% 16
Aiken et al., IJNS, 2013
50%
100%
Inhoud • Situering van de rol van het management in het kwaliteitsbeleid • Casus RN4CAST studie o Design o Enkele beschrijvende gegevens o Effecten verpleegkundige bestaffing op: • • • • o
Mortaliteit verpleegkundige praktijk Patiëntentevredenheid jobtevredenheid
Kosten-effectiviteit van verpleegkundige bestaffing
Effect of nurse staffing on patient mortality
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Aiken et al., The Lancet, 2014
Significant effect
Aiken et al., The Lancet, 2014
Scope of practice: Nursing Care Left Undone because of Lack of Time
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Ausserhoger et al., BMJ Q&S 2014
Scope of practice: Nursing Care Left Undone because of Lack of Time
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Ausserhoger et al., BMJ Q&S 2014
Patient satisfaction rates (1-10)
Aiken et al., BMJ, 2012
Relationship of nurse staffing with patient satisfaction
Aiken et al., BMJ, 2012
Jobsatisfaction of nurses in Europe
Aiken et al., BMJ 2012
Hospitals with Better Work Environments: Lower Nurse Burnout, in every country
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Aiken et al., BMJ, 2012
Best
Effect of nurse staffing on nurse outcomes
Relationship of nurse satisfaction and patient satisfaction
Aiken et al., BMJ, 2012
Likelihood of Poor Patient Outcome
Nurse burnout and patient satisfaction
-- 24% Recommend Hospital
- 27%
Rate Hospital 9 or 10
5
25
Percent of Nurses with High Burnout 28
Aiken et al., BMJ 2012
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Inhoud • Situering van de rol van het management in het kwaliteitsbeleid • Casus RN4CAST studie o Design o Enkele beschrijvende gegevens o Effecten verpleegkundige bestaffing op: • • • • o
Mortaliteit verpleegkundige praktijk Patiëntentevredenheid jobtevredenheid
Kosten-effectiviteit van verpleegkundige bestaffing
Is there a business case for nursing?
Source: Rothberg, 2005
The Economic Value of Professional Nursing • One RN more will generate 72% of her salary in medical savings: less deaths, less complications, short length of stay, less medical costs,… • This is only a partial estimate of the economic value of nursing, omitting the intangible benefits such as: o o
o
of reduced pain and suffering by patients and family members; benefits to the hospital such as improved reputation, reduced malpractice claims and payouts, and reduced compliance-related costs; the benefits of increased staffing related to improved work environment (eg, reduced turnover);
(Dall et al., Medical Care, 2009)
Aanbevelingen • Investering in werkomgeving loont o o
Op patiëntenoutcomes (vnl. Patiëntentevredenheid) Op jobtevredenheid en retentie
• Investeren in verpleegkundige bestaffing o
o
Reductie in aantal en kwalificatie van verpleegkundigen heeft impact op patiëntenoutcomes / mortaliteit Verpleegkundige bestaffing is een kosten-effectieve interventie
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Dank voor uw aandacht
Meer info: www.rn4cast.eu
