Health Policy and Systems

Patients, Nurses, and Physicians Have

Differing Views of Quality of Critical Care
Sarah E. Shannon, Pamela H. Mitchell, Kevin C. Cain

Purpose​: To compare patient, nurse, and physician assessments of quality of care and
patient satisfaction in selected critical care units.
Design​: As part of a study of patient outcomes from critical care, data were collected
between December 1991 and March 1993 from 489 patients, 518 nurses, and 515
physicians in 25 critical care units located in 14 hospitals in the U.S. Pacific Northwest.
Methods​: Views of patient satisfaction and quality of care were measured using
standardized instruments. All data were aggregated to the unit level (N=25) and were
normalized to a common scale for analysis.
Findings:​ Physicians rated quality of care higher than did either patients or nurses within
the same critical care unit, and nurses had the lowest perceptions of quality. Nurses
and patients had similar views of patient satisfaction, but physicians tended to
overestimate patients’ satisfaction. However, physicians’, nurses’, and patients’ scores
varied considerably within and between units. Physicians’ and nurses’ views of quality
and patient satisfaction were strongly related to processes such as MD-RN
collaboration and outcomes such as nurses’ job satisfaction.
Conclusions​: Patients, nurses, and physicians viewed quality of care and patient
satisfaction differently. Nurses’ and physicians’ perspectives were more related to their
views of the work environment than to organizational factors, patient characteristics, or
commonly used outcome measures.

J​OURNAL OF ​N​URSING ​S​CHOLARSHIP​, 2002; 34:2, 173-179. ©2002 S​IGMA ​T​HETA ​T​AU ​I​NTERNATIONAL​.

[Key words: care delivery system, continuous quality improvement, outcome

evaluation, patient outcomes, critical care, secondary analysis, correlational, systems]

***
cost (Becker, 1998). The secondary analysis reported in
this paper was done to compare patients’, nurses’, and

P​ atient satisfaction with care and patients’ views of

desired outcomes are increasingly important to

physicians’ views’ of quality of care and patient
satisfaction.

Background
payers and providers in evaluating quality of health care,
Obtaining patients’ viewpoints may be difficult,
to market-driven purveyors of care in attracting and
particularly in settings such as critical care where the
keeping customers, and to patients as they weigh
effects of illness or treatment may interfere with patients’
alternatives in seeking elective care (Christensen &
cognition or consciousness. In such situations,
Inguanzo, 1989; Oswald, Turner, Snipes, & Butler, 1998;
substituting provider ratings for patient ratings (Shortell et
Rosenthal & Shannon, 1997). Although patients were
al., 1994) is tempting. Based
once thought ill-prepared to render appropriate judgment
regarding the technical components of quality of care
(Cleary & McNeil, 1988), they are increasingly
recognized as key informants about all aspects of quality
including technical and interpersonal (Rubin et al., 1993). Sarah E. Shannon​, RN, PhD, Psi-at-large, Associate Professor,
Pamela H. Mitchell​, RN, PhD, FAAN, Psi-at-large, Professor &
Their viewpoints have become particularly important in Associate Dean, ​Kevin C. Cain​, PhD, Associate Professor, all at
the current economic climate, when providers of care University of Washington School of Nursing, Seattle. The authors
compete more on quality than on uniformly discounted acknowledge Dr. Sue Hegyvary, Dr. Karen Seachrist, and the
graduate student research assistants from the CCNS Study. Funding
 in part from NIH, NINR RO1 NR02343. Correspondence to Dr.
Shannon, Box 357266, University of Washington, School of Nursing,
Views of Quality
on several research studies, Nelson and colleagues said
that “Better quality in the eyes of patients will also be
regarded as better quality in the eyes of other critical
customer groups [physicians and nurses]” (Nelson et al.,
1992).
A test of this assumption of interchangeability was
found in only three studies. One study reported patients’
and clinical staffs’ ratings of “ward atmosphere” in three
Veterans Administration neuropsychiatric hospitals (Rice,
Berger, Klett, Sewall, & Lemkau, 1963). In that small
study, the rank order of satisfaction with ward
atmosphere was identical between patients and staff for
four wards in each of two of the hospitals. However, ward
atmosphere was a different construct from the elements
of quality typically included in measures of patient
satisfaction. Carson and colleagues (1996) alluded to
data regarding nurse, physician, and patient ratings of
aspects of quality care and satisfaction in a comparison
of open versus closed medical staffing of an intensive
care unit, but the results were not provided in the
published paper. Kurata and colleagues reported
physicians’ and patients’ views of satisfaction with
ambulatory care, and also found patients more satisfied
with most aspects of care than were providers (Kurata,
Nogawa, Phillips, Hoffman, & Werblun, 1992).
Multiple provider and patient assessments of quality
and satisfaction have rarely been gathered
simultaneously in acute care during the same time period
(Mitchell, 1991). A multiple site comparison of critical
care unit outcomes and organizational features showed
data that allowed us to examine patients’, physicians’,
and nurses’ views of quality of care and patient
satisfaction measured concurrently to test the
assumption of interchangeability. Current questions
about quality and satisfaction indicate the need to
examine available databases, such as this one, to
identify relationships among these process and outcome
variables.
Methods
Instruments and Procedure
This report is based on a secondary analysis from a
multisite study of critical care unit outcomes and
organizational features (Mitchell, Shannon, Cain, &
Hegyvary, 1996). Data about patients’ severity of illness
were collected over 1 year in a convenience sample of
25 critical care units, with survey and observational data
collected over 1 to 2 months during a unit’s study year.
Because of the large number of units, the entire
data-collection process occurred over 18 months, from
December 1991 through May 1993. Data regarding
satisfaction and quality of care were collected from 489
Seattle, WA 98195- 7266. E-mail: sshannon@u.washington.edu
Accepted for publication October 24, 2000.
Journal of Nursing Scholarship Second Quarter 2002 ​173  
patients (​M​=20 patients per unit; range=7-24), 518
nurses (​M​=21; range=6-41), and 515 physicians (​M= ​ 21;
range=4-40) in 25 critical care units and were aggregated
to the unit level for correlational analysis. The critical care
units were located in 14 hospitals in the greater Puget
Sound region of the Pacific Northwest. Four hospitals
were part of multiple hospital systems, and the critical
care units ranged from specialized units, such as
cardiovascular or burn, to mixed medical
surgical units. The majority were relatively small, mixed
medical-surgical units, averaging 12 beds per unit (range
4 to 22 beds). Sixteen of the 25 critical care units were in
teaching hospitals (nine members and seven
nonmembers of the Council of Teaching Hospitals
[COTH]). Five of the critical care units were in one
hospital; the others were the only unit or one of two units
in a given hospital. At the time of the study, all units had
all-registered-nurse (RN) staffing and none limited
admitting privileges to physician intensivists.
Description and psychometric properties of instruments
have been reported. All instruments retained acceptable
psychometric properties in the sample for this study,
when analyzed at both the individual and unit-aggregate
levels (Mitchell et al., 1996).
Patients’ perceptions of quality and satisfaction with
care during a critical care stay were measured by three
subscales from the Medicus “Viewpoint” instrument
selected for relevance to critical care patients’ experience
(Hegyvary, Packard, & Jelinek, 1988). A 9-item subscale
was focused on the overall care environment such as
“being cared for by friendly people” and “respect for my
personal preferences in my care and treatment.” A 5-item
subscale related to having assistance with comfort and
support such as “personal hygiene” and “coping with the
emotional stress and strain.” Finally, a 7- item subscale
was focused on being kept informed about the course of
treatment, such as “who my main doctor would be” and
“the medical purpose of the tests, treatments, surgery, or
other procedures.”
The instrument was administered to patients within 48
hours of transfer from intensive care to a general medical
or surgical unit. Patients were asked to rate the quality of
care in the critical care unit for a given item on a 4-point
scale (ranging from 1=poor quality to 4=outstanding
quality) and the importance of that item to them on a
similar scale (ranging from 1=not very important to
4=extremely important). Satisfaction was calculated as
the patient’s perception of quality weighted by the
importance of the item, resulting in a 16-point scale
ranging from -8 (low quality and very important) to +8
(high quality and very important). All scores were then
normalized to a 0- 100 scale to allow for comparisons
with other instruments.
Nurses’ and physicians’ views of unit quality and of
 patient satisfaction with care were obtained from portions
of the Charns Organizational Diagnosis Survey (CODS;
Charns, Stoelwinder, Millen, & Schaefer, 1980). The
CODS Physician Opinionnaire is a 24-item Likert-type
scale to rate aspects of unit function. The physicians’
view of overall unit quality is measured by eight items
such as “The medical needs of patients are met,” “There
is a high quality of care,” and “The overall error rate for
patient care is low.” Physicians’ perception of patient
satisfaction is measured by two items: “Patients are
174 ​Second Quarter 2002 Journal of Nursing Scholarship
to registered nurses. Nurse perception of unit quality was
measured by three items such as “Patients get better
care on my unit than on similar units in the city.” Nurse
perception of patient satisfaction was measured by two
items: “Patients on my unit are pleased with the care they
receive” and “Families of my patients are pleased with
the nursing care they receive.” RN-MD collaboration is
measured by four items and nurse job satisfaction by
seven items. Nine items were not included in this
analysis. Both physicians’ and nurses’ scores were
normalized to a 0-100 scale.
Selected descriptive and outcome variables measured
in the original study were included in this analysis
(Mitchell et al., 1996). Patients’ age, severity of illness,
ICU length of stay, and hospital length of stay were
measured using APACHE III methodology (Knaus et al.,
1991) from a random sample of approximately 340
patients’ medical records from each of the 25 critical care
units (​N=​ 8,502). The outcome variable of observed
quality of nursing care was measured using the Medicus
Quality First instrument (Hegyvary, Wood, & Jelinek,
1988) which allows rating seven components of critical
care nursing through researcher observations of care
delivery and documentation of care.
The study was approved for protection of human
subjects by institutional review boards of the university
and the 14 participating hospitals. Informed consent was
obtained from patients and staff who completed surveys.
All physicians and nurses practicing in the 25 critical care
units were invited by letter and during presentations at
staff meetings to participate in the study. Similarly,
patients who completed the satisfaction with quality of
care survey were a convenience sample of critical care
patients who agreed to participate and were available
during data-collection periods.
Data Aggregation and Analysis
The unit of analysis for this study was the critical care
unit, not individual clinicians or patients. Hence, data
were aggregated to the critical care unit level for all
analyses and met criteria for group referents, interitem,
and intraclass correlations (Rousseau, 1985; Verran,
Gerber, & Milton, 1995; Verran, Mark, & Lamb, 1992). All
data showed adequate instrument reliability at both
individual and group levels. Intraclass correlations,
eta-squared, and ANOVA indicated greater homogeneity
satisfied with the care they receive,” and “Families of my
patients are pleased with the nursing care they receive in
this unit.” The survey also indicates physicians’ views of
RN and MD quality (three items each) and RN-MD
collaboration (seven items). Four items were not included
in this analysis.
The CODS Job Inventory, a 25-item survey with
comparable items to the Physician Opinionnaire, was
given
within units than among units, indicating that unit level
data were conceptually valid rather than merely showing
the average of a group of unrelated individuals.
Results
Table 1 ​shows descriptive data about the key variables
and structural characteristics of the participating sites.
The hospitals were a mix of tertiary and community
hospitals, with an average of 316 beds. Critical care units
were a mixture of special and mixed medical-surgical
critical care units.
Overall, physicians’ opinions about unit quality and
perceptions of patient satisfaction were higher than were
Views of Quality
Table 1. Descriptors of Hospitals, Quality of
Care, and Patient Satisfaction Variables (N =
25 units)
Mean SD Range
Hospital bed size 316 beds 134 beds 27-630 beds Total ICU beds
in hospital 27 beds 12 beds 4-45 beds
Teaching type Nonteaching 9 units (36%) Teaching—non-COTH 7
units (28%)
Teaching—COTH 9 units (36%)
Percentage Medicare 35% 14 19%-63% Percentage Medicaid 22%
18 3%-48%
Patient view of quality​1 ​81.69 5.87 71.17-92.08 RN view of unit
quality​1 ​73.86 10.42 51.85-88.85 MD view of unit quality​1 ​83.55 5.73
67.40-94.79 Patient satisfaction​1 ​81.28 5.59 70.72-91.05 RN view of
​
patient satisfaction​1 81.43 5.07 71.43-90.15 MD view of patient
​
satisfaction​1 ​86.24 4.76 73.04-95.83 ​Note. 1​Original scale was
normalized to 0-100 points to allow for comparison.
patients’ or nurses’ perspectives. Nurses and patients
had similar views of patient satisfaction, but nurses’
ratings of unit quality were generally lower than were
patients’ ratings of the quality of care they received. For
both quality of care and patient satisfaction, the variability
of unit scores was relatively low (​SD ​ranged from
4.76-5.87) except for nurses’ views of unit quality
(​SD​=10.42), which varied considerably among units. The
 low variability on the other measures is similar to the
relatively low variability on satisfaction measures
reported in the literature (Rosenthal & Shannon, 1997).
Figure 1 ​shows the aggregated, normalized scores for
patients’, nurses’, and physicians’ opinions about quality
of care provided in each of the 25 critical care units in this
study. Physicians tended to rate the unit’s quality of care
higher than did either patients or nurses within the same
critical care unit. Conversely, nurses on 19 of the 25 units
had lower views of quality than did either physicians or
patients. Within units, the differences among nurses’,
physicians’, and patients’ views of quality of care ranged
from 2.06 to 37.05 points.
As shown in ​Figure 2​, physicians were likely to rate
patient satisfaction higher than were nurses or patients.
Patients were just as likely as nurses to have the lowest
rating of patient satisfaction within a unit. Overall,
physicians’, nurses’, and patients’ views of patient
satisfaction were more similar within units than were their
opinions about the quality of care provided on the unit.
The differences among patients, nurses’, and physicians’
views of patient satisfaction within a unit ranged from
0.98 to 16.26 points. Additional analyses provided insight
into this high variability.
Unit congruence of views of physicians, nurses, and
patients views was examined. Seven units had high
congruence for both quality of care and perceptions of
patient satisfaction (less than 10-point difference on both
measures). These units included five in nonteaching
community hospitals and two

Journal of Nursing Scholarship Second Quarter 2002 ​175  

Views of Quality care units were in the same hospital and the other five
were the only critical care units in the hospital. Three of
Figure 1. Patients’, nurses’, and physicians’ the units were specialized units and the other four were
ratings of quality care (N=25 units). mixed medical surgical units.
Four units had low congruence among patients’,
100
nurses’ and physicians’ views for both quality of care and
90 patient satisfaction (greater than 20-point difference for
80 quality
70

units in COTH tertiary care facilities. Two of the critical

60
e
0​
units. Three were in non-COTH
1 3 5 7 9 11 13 15 17 19 21 23 25 Unit ID
hospitals and one was in a COTH
r

hospital.
C

50
f

o
Correlational analyses were done to
y further explore the relationship among
physicians’, nurses’, and patients’ views
t
i
l
Patients' View RNs' View
40
a of quality of care and patient satisfaction
and other key variables in the original
u

Q
MDs' View

30
variables and greater than 10-point study (Mitchell et al., 1996). ​Table 2
difference for patient satisfaction). All of shows the correlation matrix of these
20
these units were specialized critical care variables. Nurses’
10
satisfaction were moderately correlated. However, care
All scores have been normalized to a 0-100 scale. Physician data not available for unit 9.
providers’ opinions did not correlate with patients’ views
of quality of care (​r=​ -.146 with nurses and ​r​=.103 with
physicians) or patients’ reports of satisfaction with care
Figure 2. Patients’, nurses’, and physicians’ ratings (​r​=- .212 with nurses, ​r=
​ .165 with physicians).
of patient satisfaction (N=25 units). If nurses and physicians did not accurately estimate
patient satisfaction, what did their scores indicate?
100 Similarly, if nurses and physicians had different views of
90 quality than did patients, what influenced their
80
perspectives? To answer this question, we examined
relationships among patients’, nurses’, and physicians’
70
ratings of quality of care and patient satisfaction with
other measures of unit processes and
n

and physicians’ views of unit quality of care and patient

60 40
0
o n
i
e
t

c
1 3 5 7 9 11 13 15 17 19 21 23 25 Unit ID
t
a a
f

50 30
P
s
i
t

S 20
t

10
 between nurses’ or physicians’ views of
unit quality or patient satisfaction and
(a) average severity of illness for
patients in the critical care unit as
Patients' View RNs' View
measured by the APACHE III
MDs' View
instrument, (b) average ICU or hospital
effectiveness. No correlation was found length of stay, (c) mean patient age, or
All scores have been normalized to a 0-100 scale. Physician data not available for unit 9.
as MD-RN collaboration and unit outcomes such as
nurse job satisfaction (see ​Table 2​). Physicians’ ratings
Table 2. Correlation Matrix of Views of Quality and Patient Satisfaction Among Patients, Nurses, and Physicians
1. Patients’ view of quality 1.000
2. RNs’ view of unit quality -.146 1.000
3. MDs’ view of unit quality .103 .489* 1.000
4. Patients’ satisfaction .986** -.121 .150 1.000
5. RNs’ view of patient satisfaction -.220 .608** .320 -.212 1.000
6. MDs’ view of patient satisfaction .134 .362 .847** .165 .513* 1.000
7. RNs’ view of RN-MD collaboration -.023 .798** .315 .002 .506** .284 1.000 8. MDs’ view of RN-MD collaboration .066 .476* .964** .124 .321 .845**
.310 1.000 9. RNs’ job satisfaction .019 .851** .438* .050 .418* .280 .726** .424* 1.000
* p<.05 (2-tailed)
** p<.01 (2-tailed)
176 ​Second Quarter 2002 Journal of Nursing Scholarship
collaboration on the critical care unit were positively
correlated to their ratings of unit quality (​r= ​ .964, ​p​<.01)
and patient satisfaction (​r​=.845, ​p< ​ .01). Nurse ratings of
MD RN collaboration were also strongly correlated to
nurse ratings of unit quality and patient satisfaction. In
addition, nurses’ reports of job satisfaction were
positively correlated to nurse ratings of unit quality
(​r​=.851, ​p<
​ .01) and patient satisfaction (​r​=.418; ​p<
​ .05).
Discussion and Implications
In an intensive case study of two critical care units
noted for high quality organizational and clinical
performance, patients’ and providers’ views of quality and
patient satisfaction had been remarkably similar (Mitchell,
1991). Nelson and colleagues (Nelson et al., 1992) noted
that hospital employees’ and patients’ ratings of
satisfaction correlated positively. However, that
conclusion appeared to be based on Rice’s study of
Veteran’s Administration neuropsychiatric hospitals,
which did not include elements of quality or satisfaction
with care that are characteristic of acute care general
hospitals (Rice et al., 1963). In our study of multiple
critical care units of varying organizational performance,
patients’ and care providers’ views of quality and patient
satisfaction were not equivalent, as indicated by the low
correlation between providers’ and patients’ views of care
quality and satisfaction.
Merkel found that advanced resident physicians were
unsuccessful in predicting their patients’ satisfaction with
(d) quality of care as measured by the
MEDICUS instrument (Mitchell et al.,
1996).
However, physicians’ and nurses’
ratings of unit quality and satisfaction
were strongly related to unit processes
such
of MD-RN
1 2 3 45 6 7 8 9
medical care, or in estimating the relative importance of
elements of patient satisfaction (Merkel, 1984). Lynn
found that patients’ and nurses’ views of important quality
indicators differed from those used in traditional
measures; nurses underestimated the degree to which
patients’ value quality nursing care (Lynn & McMillen,
1999). Hinshaw and Oakes (1974) found that patients,
nurses, and physicians had differing views of the key
predictors of quality nursing care, except for the
importance of technical competence (Hinshaw & Oakes,
1974). Furthermore, Sales and colleagues found that
what was defined as important for quality depended on
the discipline of the provider (Sales, Lurie, Moscovice, &
Goes, 1995; Sales, Moscovice, & Lurie, 1996).
Other investigators have noted that nurses, physicians,
and patients rated such attributes as education,
interpersonal relationships, participation in
decision-making, and needs fulfillment differently
(Harvey, Kazis, & Lee, 1999; Pettit & White, 1991).
Patients and providers may have different preferences
and perceptions of desired health outcomes in critical
illness (Gooding, Newcomb, & Mertens, 1999).
Patients’ current state of health has been found to be a
major factor in their ratings of quality and satisfaction
(Kane, Maciejewski, & Finch, 1997), but it has not been
well correlated with provider perceptions of outcome,
particularly in the psychosocial dimensions of health
(Becker, 1998). Severity of illness did not correlate with
patients’ or providers’ views of quality or satisfaction in
our study. Others have
Views of Quality
confirmed that severity of illness has not been
 consistently shown to influence patients’ views of
satisfaction and quality (Covinsky et al., 1998; Woodbury,
Tracy, & McKnight, 1998).
The use of professionals’ perceptions of patient
satisfaction and of perceived quality of care as proxies
for patients’ views indicates that professionals proceed
on invalid assumptions. When care providers estimate
patients’ views of quality, they may be projecting their
own views of organizational harmony or disharmony, as
indicated by the findings of our study. Clinicians who
report good working relationships between physicians
and nurses tended to overestimate patient views of
quality and satisfaction with care. However on units
where MD-RN collaboration was rated lower, clinicians
underestimated their patients’ perception of quality and
satisfaction.
Nurses’ satisfaction with their jobs appears to have a
more complex relationship with these variables. Although
job satisfaction was strongly related to nurses’ views of
unit quality, it was more modestly correlated with
estimates of patients’ satisfaction. This speculation is
supported by a recent report of staff perceptions of work
environment and quality of care following re-engineering
in a large acute care hospital. Although objective
evidence of quality of care did not change, staff
perceived it to be lower, in parallel with their increasing
dissatisfaction with their work environment (Woodward et
al., 1999). More important, nurse satisfaction with work
conditions has been compared with patient satisfaction
with care, and was found to be unrelated (Anderson,
Views of Quality
satisfaction and TQM implementation or indicators of a
supportive organizational culture.
Thus, the findings of recent research to evaluate
change in the health care environment are consistent
with our results. Organizational changes consistently
appear to affect staff attitudes but linkages to patient
outcomes, in particular patient satisfaction, are less
conclusive.
The second limitation to these findings is that data
were from one region of the United States. The study
with similar findings, indicating staff perceptions of
decreased quality in parallel with decreased morale and
satisfaction with the work environment, is from another
geographical region (Woodward et al., 1999), showing
that our findings may be applicable in other areas.
Conclusions
These findings should challenge those who would
claim to represent perceived quality of care or patient
satisfaction from the views of only health care
professionals. These data indicate that professionals and
patients had differing views of care in the same critical
care units. Patients were neither as satisfied as
professionals perceived them to be in units with better
Maloney, & Beard, 1998; Kangas, Kee, &
McKee-Waddle, 1999; Krugman & Preheim, 1999).
Two possible limitations to these data are their relative
age and the single geographical region from which the
data were obtained. Since these data were collected, the
health care environment has shown an accelerated rate
of organizational change. A recent review of the efforts of
hospital restructuring on care and outcomes (Aiken,
Clarke, & Sloane, 2000) showed that 57% of sampled
hospitals had been restructured resulting in decreased
nurse perceptions of resource adequacy, decreased
support for professional nursing practice provided by
nurse managers, and decreased status of nurses in the
hospital organization. Barry-Walker (2000) examined the
effects of a systems redesign on patient, financial, and
nurse outcomes. Although nurse morale, job satisfaction,
and perceptions of quality of patient care declined after
the systems were redesigned, the quality of two objective
aspects of patient care—the rate of patients’ falls and
rate of nurses’ medication errors—did not change
significantly. A review of research evaluating the effects
of hospital ownership on performance and outcomes
(Baker et al., 2000) showed that hospital ownership was
related to nurses’ job satisfaction and turnover but was
not consistently correlated with patient satisfaction.
Finally, a prospective cohort study to measure the effect
of total quality management (TQM), one of the
organizational trends popularized in the last decade, on
patient outcomes (Shortell et al., 2000) showed no
relationship between patient
Journal of Nursing Scholarship Second Quarter 2002 ​177  
nurse-physician collaboration and commu nication, nor
were they as dissatisfied as nurses and physicians
perceived them to be in less well-functioning units.
Neither view can be taken as the “best” measure of
quality or patient satisfaction, because patients and
professionals may have had different standards and
ways in which they viewed these characteristics of care.
As noted by Sales and colleagues, quality is in the eye of
the beholder (Sales et al., 1995). Any investigation of
quality and patient satisfaction must incorporate multiple
views.
References
Aiken, L.H., Clarke, S.P., & Sloane, D.M. ​(2000). Hospital
restructuring: Does it adversely affect care and outcomes. ​Journal of
Nursing Administration, 30​, 457-465.
Anderson, F.D., Maloney, J.P., & Beard, L.W. ​(1998). A descriptive,
correlational study of patient satisfaction, provider satisfaction, and
provider workload at an Army medical center. ​Military Medicine,
163​, 90-4.
Baker, C.M., Messmer, P.L., Gyurko, C.C., Domagala, S.E., Conly,
F.M., Eads, T.S., et al. ​(2000). Hospital ownership, performance,
and outcomes: Assessing the state-of-the-science. ​Journal of
Nursing Administration, 30​, 227-240.
Barry-Walker, J. (2000). ​The impact of systems redesign on staff,
patient, and financial outcomes. ​Journal of Nursing
Administration, 30 (2), 77- 89.
Becker, M. ​(1998). A US experience: Consumer responsive quality of
life measurement. ​Canadian Journal of Community Mental Health,
41-52​, 45-58.
Carson, S.S., Stocking, C., Podsadecki, T., Christenson, J.,
Pohlman, A., MacRae, S., et al. ​(1996). Effects of organizational
change in the medical intensive care unit of a teaching hospital: A
comparison of “open” and “closed” formats. ​JAMA, 276​, 322-328.
Charns, M.P., Stoelwinder, J.U., Millen, R.A., & Schaefer, M.J.
(1980). ​Coordination and patient unit effectiveness. ​Paper
presented at the annual meeting of the Academy of Management.
(Available from M.P. Charns, Management and Decision Research
Center 152-M, Boston Veteran’s Administration Medical Center,
Boston, MA).
Christensen, M., & Inguanzo, J.M. ​(1989, August 20). Smart
consumers present a marketing challenge. ​Hospitals, ​42-47.
Cleary, P.D., & McNeil, B.J. ​(1988). Patient satisfaction as an indicator
of quality care. ​Inquiry, 25​, 25-36.
Covinsky, K.E., Rosenthal, G.E., Chren, M.M., Justice, A.C.,
Fortinsky, R.H., Palmer, R.M., et al. ​(1998). The relation between
health status changes and patient satisfaction in older hospitalized
medical patients. ​Journal of General Internal Medicine, 13​,
223-229.
Gooding, T.D., Newcomb, L., & Mertens, K. ​(1999). Patient-centered
measurement at an academic medical center. ​Joint Commission
Journal on Quality Improvement, 25​, 343-51.
Harvey, R.M., Kazis, L., & Lee, A.F. ​(1999). Decision-making
preference and opportunity in VA ambulatory care patients:
Association with patient satisfaction. ​Research in Nursing and
Health, 22​, 39-48.
Hegyvary, S.T., Packard, N., & Jelinek, R.C. ​(1988). ​Viewpoint: A
new healthcare satisfaction survey. ​Unpublished report. Chicago:
Medicus System Corporation.
Hegyvary, S.T., Wood, H., & Jelinek, R.C. ​(1988). ​Quality of nursing
care methodology: Revision of an instrument. ​Unpublished
report. Chicago: Medicus System Corporation.
Hinshaw, A.S., & Oakes, D.L. ​(1974). Theoretical model-testing:
Patients’, nurses’, and physicians’ expectations for quality nursing.
Communicating Nursing Research, 6​, 163-189.
Kane, R.L., Maciejewski, M., & Finch, M. ​(1997). The relationship of
patient satisfaction with care and clinical outcomes. ​Medical Care, 35​,
714-730. ​Kangas, S., Kee, C.C., & McKee-Waddle, R. ​(1999).
Organizational factors, nurses’ job satisfaction, and patient satisfaction
with nursing care. ​Journal of Nursing Administration, 29​, 32-42.
178 ​Second Quarter 2002 Journal of Nursing Scholarship
Rubin, H.R., Gandek, B., Rogers, W.H., Kosinski, M., McHorney, C.A., &
Ware, J.E. Jr. ​(1993). Patients’ ratings of outpatient visits in different
practice settings: Results from the Medical Outcomes Study. ​JAMA, 270​,
835-840.
Sales, A., Lurie, N., Moscovice, I., & Goes, J. ​(1995). Is quality in the eye of
the beholder? ​Joint Commission Journal on Quality Improvement, 21​,
219-225.
Sales, A., Moscovice, I., & Lurie, N. ​(1996). Measuring seriousness of
hospital quality of care issues. ​Joint Commission Journal on Quality
Improvement, 22​, 811-816.
Shortell, S.M., Jones, R.H., Rademaker, A.W., Gillies, R. ., Dranove, D.S.,
Hughes, E.F.X., et al. ​(2000). Assessing the impact of total quality
management and organizational culture on multiple outcomes of care
for coronary artery bypass graft surgery patients. ​Medical Care, 38​, 207-
217.
Shortell, S.M., Zimmerman, J.E., Rousseau, D.M., Gillies, R.R., Wagner,
D.P., Draper, E.A., et al. ​(1994). The performance of intensive care units:
Does good management make a difference? ​Medical Care, 32​, 508-25.
Verran, J.A., Gerber, R.M., & Milton, D.A. ​(1995). Data aggregation:
Criteria for psychometric evaluation. ​Research in Nursing and Health,
18​, 77-80.
Verran, J.A., Mark, B., & Lamb, G. ​(1992). Psychometric examination of
instruments using aggregated data. ​Research in Nursing and Health, 15​,
237-240.
Woodbury, D., Tracy, D., & McKnight, E. ​(1998). Does considering severity
Knaus, W., Wagner, D., Draper, E., Zimmerman, J., Bergner, M.,
Bastos, P., et al. ​(1991). The APACHE III prognostic system: Risk
prediction of hospital mortality for critically ill hospitalized adults.
Chest, 100​, 1619- 1636.
Krugman, M., & Preheim, G. ​(1999). Longitudinal evaluation of
professional nursing practice redesign. ​Journal of Nursing
Administration, 29​, 10-20. ​Kurata, J.H., Nogawa, A.N., Phillips,
D.M., Hoffman, S., & Werblun, M.N. ​(1992). Patient and provider
satisfaction with medical care. ​Journal of Family Practice, 35​,
176-179.
Lynn, M.R., & McMillen, B.J. ​(1999). Do nurses know what patients
think is important in nursing care? ​Journal of Nursing Care Quality,
13​, 65-74. ​Merkel, W.T. ​(1984). Physician perception of patient
satisfaction: Do doctors
know which patients are satisfied? ​Medical Care, 22​, 453-459.
Mitchell, P.H. ​(1991). Clinical and organizational impact of multiple
changes in critical care: A case study. ​Dissertation Abstracts
International, 52/05​, 2847 (ATT 9131683).
Mitchell, P.H., Shannon, S.E., Cain, K.C., & Hegyvary, S.T. ​(1996).
Critical care outcomes: Linking structures, processes, and
organizational and clinical outcomes. ​American Journal of Critical
Care, 5​, 364-365.
Nelson, E.C., Rust, R.T., Zahorik, A., Rose, R.L., Batalden, P., &
Siemanski, B.A. ​(1992). Do patient perceptions of quality relate to
hospital financial performance? ​Journal Health Care Marketing, 12​,
6-13.
Oswald, S.L., Turner, D.E., Snipes, R.L., & Butler, D. ​(1998). Quality
determinants and hospital satisfaction: Perceptions of the facility and
staff might be key influencing factors. ​Marketing Health Services,
18​, 18-22.
Pettit, L.S., & White, C.L. ​(1991). Providers’ and consumers’
perceptions of quality health care. ​Journal of Nursing Staff
Development, 7​, 5-10. ​Rice, C.E., Berger, D.G., Klett, S.L., Sewall,
L.G., & Lemkau, P.V. ​(1963).
The ward evaluation scale. ​Journal of Clinical Psychology, 19​,
251. ​Rosenthal, G.E., & Shannon, S.E. ​(1997). The use of patient
perceptions in the evaluation of health-care delivery systems. ​Medical
Care, 35 (suppl. 11)​, NS58-NS-68.
Rousseau, D.M. ​(1985). Issues of level in organizational research:
Multi level and cross-level perspectives. ​Research in
Organizational Behavior, 7​, 1-37.
Views of Quality
 of illness improve interpretation of patient satisfaction data? ​Journal for
Healthcare Quality, 20​, 33-40.
Woodward, C.A., Shannon, H.S., Cunningham, C., McIntosh, J., Lendrum,
B., Rosenbloom, D., et al. ​(1999). The impact of re-engineering and other
cost reduction strategies on the staff of a large teaching hospital: A
longitudinal study. ​Medical Care, 37​, 556-559.

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