A new study has found that nursing resources affect hospital scores on a key measure of patient-centred care.
As reported in the journal Medical Care, nursing resources such as the nursing work environment, nurse education, and staffing levels are independent factors affecting patient experience ratings.
“Our results provide evidence-based guidance about which modifiable aspects of hospital nursing are likely to improve patient experience ratings,” said Kathleen E Fitzpatrick Rosenbaum, PhD, RN, CCRN, of Yale University.
How do nursing resources affect HCAHPS scores?
The team analysed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for 540 hospitals in four states (California, Florida, New Jersey, and Pennsylvania) for the year 2016.
The HCAHPS survey, developed by the US Centres for Medicare and Medicaid Services, assesses patient experiences of hospital care. The survey aims to establish the extent of patient-centred care.
As patient experience ratings affect Medicare reimbursement levels, hospital executives must identify levers to improve HCAHPS scores.
However, the team states that there is little evidence about what organisational strategies hospitals can follow to improve these ratings.
The research revealed that nursing resources are associated with better patient outcomes.
HCAHPS relationships and four categories of hospital nursing resources
Using data on a wide range of hospital characteristics, the study focused on the relationships between HCAHPS ratings and four categories of hospital nursing resources:
- Education: Percentage of nurses with a bachelor’s degree or higher
- Skill mix: Proportion of registered nurses to total nursing staff
- Staffing: Patient-to-nurse ratio
- Work environment: Nurse ratings of the quality of their work environment
Insights into HCAHPS ratings and work environment’s impact
The median ‘top tier’ HCAHPS rating stood at 68%.
Across hospital categories, ratings varied, with the highest-scoring hospitals achieving around 76% and the lowest around 60%. Notably, large, non-teaching hospitals with advanced technology typically garnered the highest HCAHPS scores.
Upon accounting for hospital attributes, the work environment emerged as the most influential factor shaping HCAHPS ratings. For every standard deviation increase in work environment score, hospitals were over twice as likely, with an odds ratio of 2.42, to belong to a higher patient experience performance tier.
Improving nursing resources will improve HCAHPS ratings
Nurse education and staffing showed notable but comparatively weaker correlations with HCAHPS scores, whereas nursing skill mix didn’t emerge as a significant determinant.
Among the work environment facets, investments in staff development/continuing education and active engagement of nurses in hospital affairs appeared to exert the most substantial influence on HCAHPS ratings.
“Our findings enhance three decades of evidence generated by the Centre for Health Outcomes and Policy Research at the University of Pennsylvania, where the research was conducted, revealing the potential to improve patient outcomes by providing optimal settings for professional nurses,” said senior author Eileen Lake, PhD, RN.
Improving the nursing resources is a strategic organisational interventional likely to improve HCAHPS ratings, the researchers believe.
Although the work environment is the most important factor for improving ratings, the study has shown that taking steps to improve nurse staffing and the work environment together may achieve higher patient experience ratings.
Dr Rosenbaum concluded: “Our findings offer a signal to hospital executives that improving the work environment, staffing, and nurse education may be wise investments toward achieving ‘top-box’ patient experience levels.”
