FOD MJP 7 mei 2014 Impact van beleidsbeslissingen op kwaliteit van zorg: resultaten van de RN4CAST-studie

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1 FOD MJP 7 mei 2014 Impact van beleidsbeslissingen p kwaliteit van zrg: resultaten van de RN4CAST-studie Prf. Walter Sermeus KU Leuven

2 Inhud Situering van de rl van het management in het kwaliteitsbeleid Casus RN4CAST studie Design Enkele beschrijvende gegevens Effecten verpleegkundige bestaffing p: Mrtaliteit verpleegkundige praktijk Patiëntentevredenheid jbtevredenheid Ksten-effectiviteit van verpleegkundige bestaffing

verpleegkundige bestaffing p: Mrtaliteit verpleegkundige praktijk

3 Cntext

4 Maatregelen t.a.v. persneel Zrgnet, 2014 resultaten bevraging 35 algemene ziekenhuizen

5 Swiss cheese mdel - J. Reasn We can t change the human cnditin, but we can change the cnditins under which humans wrk. Reasn, 1990

6 Inhud Situering van de rl van het management in het kwaliteitsbeleid Casus RN4CAST studie Design Enkele beschrijvende gegevens Effecten verpleegkundige bestaffing p: Mrtaliteit verpleegkundige praktijk Patiëntentevredenheid jbtevredenheid Ksten-effectiviteit van verpleegkundige bestaffing

Optimising the delivery f health care 16 partners: 12 Eurpean cuntries, USA, China,

7 RN4CAST STUDY 7th Framewrk Prgramme fr Research and Technlgical Develpment RN4CAST: nurse frecasting in Eurpe : 3 millin funding fr Health theme 3: Optimising the delivery f health care 16 partners: 12 Eurpean cuntries, USA, China, Suth-Africa, Btswana C-rdinatin: Leuven University (W. Sermeus), U. Pennsylvania (L. Aiken) 7

8 RN4CAST DESIGN Multicuntry, multilevel, crss-sectinal design t btain imprtant unmeasured factrs in frecasting mdels, cllected at the hspital, nursing unit and individual nurse and patient level: Nurse survey: wrking envirnment, quality & safety, staffing Patient survey: patient experiences with nursing staff, hspital, infrmatin Hspital survey: type f hspital, inflw & utflw Hspital Discharge data: ICD9/10, length-f-stay, adverse events, mrtality Setting At least 30 general acute hspitals in each Eurpean cuntry. At least 2 general surgical and internal medicine wards in each hspital. 8

experiences with nursing staff, hspital, infrmatin Hspital survey: type f hspital, inflw & utflw Hspital Discharge data: ICD9/10, length-f-stay,

SAMPLE EUROPE (2009-2010) - 12 cuntries Belgium, Finland, Germany, Greece, Ireland, Netherlands, Pland, Sweden, Nrway, Spain, Switzerland, UK 486 hspitals

In 181 hspitals Suth-Africa (2009-2010) 6 Prvinces Gauteng, Nrth-West, Free State, KwaZulu-Natal, Eastern Cape, Western Cape 62 hspitals 4657 nurses USA

9 SAMPLE EUROPE ( ) - 12 cuntries Belgium, Finland, Germany, Greece, Ireland, Netherlands, Pland, Sweden, Nrway, Spain, Switzerland, UK 486 hspitals nurses patients In 210 hspitals CHINA ( ) 9 Sites 6 prvinces, 2 municipalities, 1 autnmus regin 181 hspitals 9698 nurses 6494 patients In 181 hspitals Suth-Africa ( ) 6 Prvinces Gauteng, Nrth-West, Free State, KwaZulu-Natal, Eastern Cape, Western Cape 62 hspitals 4657 nurses USA ( ) - 4 states Pennsylvania, Califrnia, New Jersey, Flrida 617 hspitals nurses Millins f patients In 430 hspitals Sermeus et al., BMC Nursing 2011

10 Framewrk Framewrk: A nursing rganizatin mdel Dubis et al BMC Health Services Research

11 Main RN4CAST publicatins Sermeus et al. (2011). Nurse frecasting in Eurpe (RN4CAST): ratinale, design and methdlgy. BMC Nursing, 10 (1):6 Aiken et al. (2012). Patient safety, satisfactin and quality f hspital care: crss sectinal surveys f nurses and patients in 12 cuntries in Eurpe and the United States. British Medical Jurnal, Mar 20; 344: IJNS special issue (2013): RN4CAST - Nursing wrkfrce a glbal pririty area fr health plicy and health services research Ausserhfer D et al. (2014), Prevalence, patterns and predictrs f nursing care left undne in Eurpean hspitals: results frm the multicuntry crsssectinal RN4CAST study. BMJ Qual Saf Feb;23(2): Aiken et al. (2014). Nurse staffing and educatin and hspital mrtality in nine Eurpean cuntries: a retrspective bservatinal study. The Lancet, Feb

British Medical Jurnal, Mar 20; 344: IJNS special issue (2013): RN4CAST - Nursing wrkfrce a glbal pririty area fr health plicy and health services research Ausserhfer D et al.

12 Inhud Situering van de rl van het management in het kwaliteitsbeleid Casus RN4CAST studie Design Enkele beschrijvende gegevens Effecten verpleegkundige bestaffing p: Mrtaliteit verpleegkundige praktijk Patiëntentevredenheid jbtevredenheid Ksten-effectiviteit van verpleegkundige bestaffing

13 Nurse t Patient Ratis (3 shifts) Cuntry Mean 25th Pctl 50th Pctl 75th Pctl Belgium England Finland Germany Greece Ireland Netherlands Nrway Pland Spain Sweden Switzerland Aiken et al., IJNS, 2013

8 Ireland 6.9 6.2 6.8 7.7 Netherlands 7.0 6.4 7.2 7.7 Nrway 5.4 4.8 5.2 6.0 Pland 10.5 9.1 10.6 11.

14 Percent Bachelr prepared Nurses Aiken et al., IJNS, 2013

15 (Surce: based n Spitzer and Perrenud, J. Prf. Nursing, 2006 update) Nursing educatin in a selectin f Eurpean cuntries First Cycle: entry t prfessin Cuntry Vcatinal training Cllege/plytechnic University Iceland Bachelr 4y Ireland Bachelr 4y Malta Bachelr 4y Spain Bachelr 4y Italy Bachelr 3y Nrway Bachelr 3y Sweden Bachelr 3y UK Bachelr 3y Greece Bachelr 4y Bachelr 4y Prtugal Bachelr 4y Bachelr 4y Luxemburg Bachelr 4y Finland Bachelr 3,5y Denmark Bachelr 3,5y France Bachelr - 3 y Switzerland Diplma - 3y Bachelr 4y F: nly BA 4y Austria Diplma - 3y Bachelr 3y Netherlands Diplma - 4y Bachelr 4y Belgium Diplma - 3y Bachelr 3y Germany Diplma - 3y Bachelr 3y 15

Bachelr 4y Ireland Bachelr 4y Malta Bachelr 4y Spain Bachelr 4y Italy Bachelr 3y Nrway Bachelr 3y Sweden Bachelr 3y UK Bachelr 3y Greece Bachelr 4y Bachelr 4y

16 Nurses wrk envirnment Captures 5 dimensins: Staffing adequacy Nursing fundatins fr quality Nurse manager ability & leadership Nurse-physician relatins Nurse invlvement in hspital affairs Hspitals classified int quartiles by PES scres Ttal England Sweden Pland Nrway Netherlands Ireland Greece Finland Spain Germany Switzerland Belgium pr mixed better 0% 50% 100% 16 Aiken et al., IJNS, 2013

Hspitals classified int quartiles by PES scres Ttal England Sweden Pland Nrway Netherlands

17 Inhud Situering van de rl van het management in het kwaliteitsbeleid Casus RN4CAST studie Design Enkele beschrijvende gegevens Effecten verpleegkundige bestaffing p: Mrtaliteit verpleegkundige praktijk Patiëntentevredenheid jbtevredenheid Ksten-effectiviteit van verpleegkundige bestaffing

18 Effect f nurse staffing n patient mrtality 18 Aiken et al., The Lancet, 2014

19 Significant effect Aiken et al., The Lancet, 2014

20 Scpe f practice: Nursing Care Left Undne because f Lack f Time 20 Ausserhger et al., BMJ Q&S 2014

21 Scpe f practice: Nursing Care Left Undne because f Lack f Time 21 Ausserhger et al., BMJ Q&S 2014

22 Patient satisfactin rates (1-10) Aiken et al., BMJ, 2012

23 Relatinship f nurse staffing with patient satisfactin Aiken et al., BMJ, 2012

24 Jbsatisfactin f nurses in Eurpe Aiken et al., BMJ 2012

25 Hspitals with Better Wrk Envirnments: Lwer Nurse Burnut, in every cuntry Aiken et al., BMJ, Best

26 Effect f nurse staffing n nurse utcmes

27 Relatinship f nurse satisfactin and patient satisfactin Aiken et al., BMJ, 2012

28 Likelihd f Pr Patient Outcme Nurse burnut and patient satisfactin -- 24% - 27% Recmmend Hspital Rate Hspital 9 r Percent f Nurses with High Burnut 28 Aiken et al., BMJ 2012

29 Inhud Situering van de rl van het management in het kwaliteitsbeleid Casus RN4CAST studie Design Enkele beschrijvende gegevens Effecten verpleegkundige bestaffing p: Mrtaliteit verpleegkundige praktijk Patiëntentevredenheid jbtevredenheid Ksten-effectiviteit van verpleegkundige bestaffing

30 Is there a business case fr nursing? Surce: Rthberg, 2005

31 The Ecnmic Value f Prfessinal Nursing One RN mre will generate 72% f her salary in medical savings: less deaths, less cmplicatins, shrt length f stay, less medical csts, This is nly a partial estimate f the ecnmic value f nursing, mitting the intangible benefits such as: f reduced pain and suffering by patients and family members; benefits t the hspital such as imprved reputatin, reduced malpractice claims and payuts, and reduced cmpliance-related csts; the benefits f increased staffing related t imprved wrk envirnment (eg, reduced turnver); (Dall et al., Medical Care, 2009)

32 Aanbevelingen Investering in werkmgeving lnt Op patiëntenutcmes (vnl. Patiëntentevredenheid) Op jbtevredenheid en retentie Investeren in verpleegkundige bestaffing Reductie in aantal en kwalificatie van verpleegkundigen heeft impact p patiëntenutcmes / mrtaliteit Verpleegkundige bestaffing is een ksten-effectieve interventie 32

33 Meer inf: Dank vr uw aandacht

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