CHOPR Founder and Director, Dr. Linda H. Aiken established The Center for Health Outcomes and Policy Research in 1989 to explore organizational effectiveness in health care with the potential to affect patient outcomes.
One of the first large studies the Center undertook, in 1991, was a national study of dedicated AIDS units to examine the impact of hospital culture on nurses and patient care.
Aiken and her research team developed “a survey-based measure of the culture and context of care delivery” that was based on an earlier instrument called the Nursing Work Index (NWI). It was designed to measure nurses’ satisfaction with various aspects of their work. The CHOPR team modified the NWI to create a new research instrument called the Revised Nursing Work Index (NWI-R), which would make it possible to empirically measure and describe the quality of the nursing work environment itself.
We were able to “create a unique database on all 210 hospitals in Pennsylvania without having to recruit any hospitals directly.”
Over time, subscales of the NWI-R were refined and five of the subscales became known as the Practice Environment Scale, which the National Quality Forum endorsed as a nurse-sensitive measure of hospital quality. Thus, adding to the information nurses provided about these hospitals by linking their nurse survey data with patient discharge outcomes reported to a state agency. In the Center’s next big study, funded by the NIH Institute for Nursing Research and launched in 1996,
“We used the same survey instrument but instead of recruiting hospitals, we surveyed 50 percent of all nurses licensed to practice in Pennsylvania and asked them to provide the names of their employing hospitals.”
CHOPR Researchers have made rich use of this mother lode of data to pinpoint crucial interactions between nurses and their patients and other medical staff. They have been able to map out the consequences of understaffing, budget cutting, extended shifts and nurse burnout.
Study after study, says Aiken, “shows that the greatest single major change a hospital could make [to ensure quality care] would be to improve the nursing environment.”
Note: We would like to acknowledge the Robert Wood Johnson Foundation for highlighting the early beginnings of the Center in “Hospital Restructuring: Implications for Patient Outcomes and Workforce Policy”