CHOPR International Research in the UAE
Nursing & Quality of Hospital Care
A decade ago the Center for Health Outcomes and Policy Research under the direction of Dr. Linda Aiken launched the International Hospital Outcomes Study (IHOS) to determine how nurse workforce factors affected quality of hospital care in different countries. Findings of high nurse dissatisfaction and burnout linked to adverse patient outcomes in every country studied led to wide media coverage and had a significant impact on turning the attention of hospital managers and public policy makers to the need to reform hospital work environments to improve the retention of nurses.
The hospital sector in the United Arab Emirates (UAE) is experiencing substantial expansion and modernization. Baseline measures established now of quality of hospital care and nurse workforce adequacy will permit the outcomes of current investments to be documented. Thus, the primary purpose of this study is to establish a baseline of hospital quality of care and nursing workforce adequacy in hospitals in the UAE through systematic surveys of nurses and patients in every major inpatient facility.
1) To evaluate the qualifications of the hospital nurse workforce and their association with quality of care;
2) to measure indicators associated with nurse recruitment and retention including nurse job dissatisfaction, burnout, intent to leave and to determine organizational features that adversely affect retention;
3) to examine whether and how modifiable features of the hospital work environment affect quality of care and adverse patient outcomes; and
4) to provide baseline information on hospital workforce and quality of care that can be benchmarked against data from other countries and that will create the opportunity to evaluate change over time in UAE hospitals.
The methods and measures to be used in this study have been well tested in thousands of hospitals in over 15 countries in the IHOS. To enable hospitals in the UAE to be compared to hospitals internationally it is important to preserve the basic design and instruments used in studies in other countries. 1) Hospital selection: We invited all major and community hospitals to participate in the study with a target of 40 participating hospitals with over 100 beds; 2) Nurse survey: within each hospital we surveyed a minimum of 50 nurses yielding a national sample of at least 2000 nurses; and 3) Patient survey: Within each hospital, a minimum of 50 inpatients were surveyed using a patient satisfaction questionnaire common across all hospitals.
The Center for Health Outcomes and Policy Research of the University of Pennsylvania directs the study under the leadership of Dr. Linda Aiken. Dr. Aiken is among the most respected health services researchers in the world having won almost all of the research honors in her field. She designed and directs the IHOS which has carried out similar work in 16 countries to what is proposed here. She also co-directs RN4CAST, a European Union study of 15 countries using comparable design and measures to those proposed here.
Shown above: Surveys were distributed, collected, sorted and shipped by our research associates in Dubai.
Magnet Hospital Creation in Dubai
CHOPR continues to provide support to the creation of University Hospital Dubai, a R&D project with collaboration between Pennsylvania University Hospital, Massachusetts General Hospital, and the American Nurses Credentialing Center to create a magnet hospital in the United Arab Emirates (UAE) and conduct a national study replicating RN4CAST.
A Magnet Hospital in such a rapidly growing urban center is vital to provide quality medical care in the Middle East. As the UAE has a shortage of nurses (a third of America's nursing to population ratio), health care and education reform is necessary to increase the ratio of nurses and thus provide superior medical and nursing service. The current study established a baseline of care in UAE hospitals, which will be compared to the results of a restudy in 2012, after the University Hospital opens.
Photo: Dr. Aiken with Princess Muna Al-Hussein (right) and the research coordinator of the United Arab Emirate Hospital Survey effort, Dr. Lauren Arnold (left).
The HRH Princess Muna Al-Hussein Award from the American Nurses Credentialing Center is awarded for significant contributions to healthcare across borders and for a demonstrated dedication to nursing. Princess Muna is the mother of King Abdullah II of Jordan and a long-time patron of nursing. In 2011 Dr. Aiken became the first recipient of this prestigious award.
Time Line -- What’s New in 2011
In 2011 all completed nurse and patient survey, over 3,000 in total, were shipped from Dubai to the University of Pennsylvania, where data entry and analysis began. Analysis of these surveys began this past September, with a focus on hospital environment and nurse characteristics. Stay tuned for more updates on upcoming projects and research findings spurred from the data coming in the spring and summer.
Shown right: CHOPR received thousands of completed surveys this past summer. Someone had to take a photo of this historic event.