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Multicountry Study of Hospital Restructuring launches with CHOPR-Led Meeting in November 1996

The early stages of the RN4CAST International study on how organizational features of hospital care impact on nurse recruitment and retention and patient outcomes started in 1996 with the CHOPR-led meeting at the Rockefeller Foundation’s Bellagio Study and Conference Center in Italy.

CHOPR Founder, Dr. Linda H. Aiken, and Penn Nursing Dean, Dr. Claire M. Fagin brought together experts in the hospital sector, public policy, health workforce, and health outcomes research from five countries—US, Canada, England, Scotland, and Germany. Attendees set out to determine the impact of hospital restructuring on patient and nurse outcomes across countries with differently organized and financed health care systems.

The study designed in Bellagio resulted in a Medical Care supplement in 1997 and to NINR funding to carry out the study.

“The research produced results that generated influential scientific papers published in leading international journals which impacted practice and policy changes in the US and abroad and eventually led to the replication of the research in 30 countries.” Linda H. Aiken, PhD, RN

One of the first publications, “Nurses’ reports on hospital care in five countries” appeared in Health Affairs in 2001, describing a survey of 43,000 nurses from more than 700 hospitals across the United States, Canada, England, Scotland, and Germany in 1998 and 1999. The study found that across the various countries, nurses experienced similar challenges associated with too few nurses and poor work environments that adversely affected quality of patient care and nurse retention. The paper was named one of the “29 Most Influential Papers Published in Health Affairs” in its first 25 years. Google Scholar reports 2082 citations to date. It was reprinted in “Debating Health Care: a Health Affairs Retrospective” (Igelhardt, 2007, and was Winner of American Academy of Nursing Media Award). In addition, the study was highlighted at the 15th Anniversary of the National Institute of Nursing Research.

CHOPR Expanded the research to additional countries over time including in Asia, South Africa, Australia, New Zealand. The research got a big boost by funding from the European Commission in 2009 to expand the research to 15 countries in Europe that would result in over 75 scientific papers including a highly cited paper in The Lancet in 2014. The latest replication of the study that began in Bellagio in 1996 is in Chile.

From the CHOPR Archives

  • Linda H. Aiken and Claire M. Fagin (eds.). 1997. Evaluating the consequences of hospital restructuring. Medical Care 35(10): OS1-OS4, Supplement. Download
  • Linda H. Aiken, Sean P. Clarke, Douglas M. Sloane, Julie A. Sochalski and others. 2001. Nurses’ Reports of Hospital Quality of Care and Working Conditions in Five Countries. Health Affairs 20(3): 43-53, May 2001. Download
  • Susan V. White and Colleen J. Hewes. 2003. Interview with a quality leader: Linda Aiken on the healthcare industry and workplace issues. Journal for Healthcare Quality 25(3), 21-23. Download
  • Linda H Aiken, Douglas M Sloane, Luk Bruyneel, Koen Van den Heede, Peter Griffiths, Reinhard Busse, Matthew D. McHugh, and others for the RN4CAST consortium. Nurse staffing and education and hospital mortality in nine European countries: a retrospectiveobservational study. 2014. The Lancet 383(9931): p1824-1830. Download