Hospital personnel perspectives on factors influencing acute care patient outcomes: a qualitative approach to model refinement

TL;DR

This study explores how hospital staff view factors affecting patient outcomes in acute care, emphasizing the role of community and hospital context.

Contribution

The study introduces a refined model highlighting the interconnectedness of community, hospital, and staffing factors in influencing patient outcomes.

Findings

Patient and hospital characteristics are nested within community characteristics, emphasizing contextual influence.

Staff and patient outcomes are directly related and influenced by broader hospital and community factors.

The model can help health systems evaluate how external factors impact care delivery.

Abstract

Health systems have long been interested in the best practices for staffing in the acute care setting. Studies on staffing often focus on registered nurses and nurse-to-patient staffing ratios. There were fewer studies on the relationship between interprofessional team members or contextual factors such as hospital and community characteristics and patient outcomes. This qualitative study aimed to refine an explanatory model by soliciting hospital personnel feedback on staffing and patient outcomes.

We conducted a qualitative study using semi-structured interviews and thematic analysis to understand hospital personnel’s perspectives and experiences of factors that affect acute care inpatient outcomes. Interviews were conducted in 2022 with 38 hospital personnel representing 19 hospitals across Washington state in the United States of America.

Findings support a model of characteristics impacting patient outcomes to include the complex and interconnected relationships between community, hospital, patient, and staffing characteristics. Within the model, patient characteristics were positioned into hospital characteristics, and in turn these were positioned within community characteristics to highlight the importance of setting and context when evaluating outcomes. Together, these factors influenced both staff characteristics and patient outcomes, but these two categories also share a direct relationship.

Findings can be applied to hospitals and health systems in a variety of contexts to examine how external factors such as community resource availability impact care delivery. Future research should expand on this work with specific attention to how staffing changes and interprofessional team composition can improve patient outcomes.

The online version contains supplementary material available at 10.1186/s12913-024-11271-x.

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