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.
The Center has its origins in a research project created in 1991 to examine the impact of hospital culture on nurses and patient care in dedicated AIDS units.
The selection of AIDS patients for the study was associated with Aiken’s leadership role in the development and successful grant funding by NIH of Penn’s Center for AIDS Research (CFAR), in which she led the Behavioral and Social Science research program and core. She was interested in studying the AIDS epidemic as a natural experiment in which nurses were granted unusual autonomy to design and lead patient-focused dedicated AIDS units in hospitals in the AIDS epicenters.
It was an opportunity to determine the impact of nurse autonomy on patient outcomes by comparisons with standard medical units that had long suffered from nurse job dissatisfaction, burnout, and turnover.
Dr. Aiken recruited Eileen Lake as a Research Associate. Dr. Herb Smith from Sociology joined the collaboration, and together they submitted their first NIH grant application, “AIDS Care: Nurse Recruitment and Patient Satisfaction,” which involved primary data collection from 20 hospitals nationally. A year or so later, Dr. Douglas Sloane joined the CHOPR investigative team. The group surveyed 826 nurses and interviewed patients.
“Additionally we undertook abstracts of all the patients’ charts. The labor intensive nature of this large study motivated us to develop a different research design for future studies that did not require recruiting individual hospitals.”
In response to a call for proposals from NIH to study HIV prevention in developing countries, we were awarded a R01 to study the role of nurses in HIV prevention in Chile. Additionally we won an R01 on factors associated with needlestick injuries to nurses.
Dr. Aiken notes, “While we were not ‘AIDS researchers’ in a conventional sense, the AIDS epidemic offered a number of possibilities to test our basic hypotheses of how nursing was associated with clinical and workforce outcomes.”
These major research projects marked the early beginnings and foundation of CHOPR and established CHOPR’s trajectory of researching hospital organization through surveys of nurses, and showing that patient outcomes are better in nursing units with greater nurse autonomy.
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.”