The Experts below are selected from a list of 132 Experts worldwide ranked by ideXlab platform
Linda H. Aiken - One of the best experts on this subject based on the ideXlab platform.
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organization of hospital nursing and 30 day readmissions in medicare patients undergoing surgery
Medical Care, 2015Co-Authors: Matthew D Mchugh, Linda H. AikenAbstract:BACKGROUND: Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing—a critical Organizational Component of hospital service system—in relation to readmissions. OBJECTIVES: To determine the relationships between hospital nursing factors—nurse work environment, nurse staffing, and nurse education—and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery. METHOD AND DESIGN: We linked Medicare patient discharge data, multistate nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in 4 states (California, Florida, New Jersey, and Pennsylvania). Risk-adjusted robust logistic regressions were used for analyses. RESULTS: The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03; 95% CI, 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97; 95% CI, 0.95-0.99). Administrative support to nursing practice (OR=0.96; 95% CI, 0.94-0.99) and nurse-physician relations (OR=0.97; 95% CI, 0.95-0.99) were 2 main attributes of the work environment that were associated with readmissions. CONCLUSIONS: Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties.
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the critical care work environment and nurse reported health care associated infections
American Journal of Critical Care, 2013Co-Authors: Deena Kelly, Ann Kutneylee, Eileen T Lake, Linda H. AikenAbstract:Health care–associated infections (HAIs) are one of the most common complications of care.1 HAIs are of particular concern in critically ill patients; according to estimates, almost half a million incidents of HAI occur each year in intensive care units (ICUs) alone.2 Increased susceptibility to HAIs in ICU patients is attributable in part to precarious clinical conditions,3 depressed immune function,4 and the need for invasive monitoring to ensure appropriate provision of care. The Centers for Disease Control and Prevention has made specific recommendations to aid in the prevention of central catheter–associated bloodstream infections (catheter-associated BSIs), urinary tract infections (UTIs), and ventilator-associated pneumonias (VAPs).5 The recommendations focus on specific actions to be implemented by staff members, including hand hygiene, aseptic insertion of catheters, and placing patients in a semirecumbent position during intubation.5 As the largest group of ICU clinicians who provide direct patient care, critical care nurses are well positioned to implement the recommendations and monitor patients for HAIs. Development of HAIs in acute care areas has been linked to Organizational factors, such as nurse staffing.6,7 In addition to staffing, a quality work environment—another Organizational Component of hospital nursing care—presumably provides critical care nurses the time and resources necessary to provide HAI preventive care. Evidence on the relationship between nurse organization, particularly the work environment, and HAIs in critical care units is limited. The work environment is defined as the Organizational characteristics of the workplace that facilitate or constrain professional nursing practice.8 Researchers have suggested that providing nurses with better resources and more time for patient care within a flat Organizational management structure might improve the patient-nurse interaction and quality of care. Indeed, the American Association of Critical-Care Nurses9 has endorsed the importance of a healthy work environment and the potential link between the environment and patient safety. In 2 descriptive studies,10,11 members of the association were surveyed on their perceptions of the workplace and the quality and safety of patient care. Approximately 86% of respondents reported that their unit provided excellent or good-quality care, but one quarter of these nurses indicated that the quality of care in their units during the past year had become worse.10 Almost half a million health care–associated infections occur each year in intensive care units. Inconsistencies noted in critical care nurses’ reports of quality and safety are also reflected in the ICU literature. Better communication between ICU nurses and physicians has been linked to fewer nurse-reported medication errors and greater job satisfaction.12,13 Greater variation in effective communication among providers in ICUs was associated with greater rates of VAP.14 Additionally, scores on the composite Practice Environment Scale of the Nursing Work Index (PES-NWI), a commonly used measure of nurses’ work environment, was not predictive of nurse-assessed VAP and catheter-associated sepsis.12 However, a more positive Organizational climate, a concept similar to the work environment, was significantly associated with higher odds of catheter-associated BSIs and lower odds of UTIs.15 The mixed evidence, limited in part by small sample sizes, restricted generalizability,12,15 and inconsistent reports of nurses10 indicate that more investigation is needed to understand how the critical care work environment may affect the frequency of HAIs. The purpose of our study was to describe critical care work environments and to determine whether or not the environments were associated with nurse-reported HAIs in a sample of critical care nurses in more than 300 hospitals in 4 states. We hypothesized that nurses in better work environments would be less likely to report frequent HAIs than would nurses in less favorable environments. We posited that a better critical care work environment would offer nurses more time, resources, and support, thereby increasing the number, duration, and quality of nurse-patient interactions. These potentially more frequent, longer, and better quality interactions might enable nurses to use adequate aseptic technique, enhance monitoring of intravenous insertion sites, identify clinical changes early, and prevent the development of a HAI.
Miia Martinsuo - One of the best experts on this subject based on the ideXlab platform.
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Industrial customers’ Organizational readiness for new advanced services
Journal of Manufacturing Technology Management, 2019Co-Authors: Eija Vaittinen, Miia MartinsuoAbstract:Purpose Manufacturing firms delivering complex products and systems are increasingly offering advanced data-based services. Customers, however, are not always willing to adopt manufacturers’ advanced services, so manufacturers need knowledge of how to promote customers’ service readiness. The purpose of this paper is to further develop the concept of service readiness by proposing a framework for industrial customers’ Organizational dimension of service readiness and by increasing the understanding of the conditions underpinning that service readiness. Design/methodology/approach This case study explores service readiness among customers of a manufacturer delivering complex systems and related services. Interviews were conducted within the company and among key customers as the potential users of those services. Findings Customers use versatile processes, engage multiple people and use different evaluation criteria when considering adoption of data-based services. The Organizational Component of service readiness involves requirements in the service context, supplier relations and Organizational habits and culture. Actions are proposed for manufacturers to promote customers’ readiness for new services. Research limitations/implications The research is limited through its qualitative design and case selection. Mapping of the Organizational dimension of service readiness further develops the concept of service readiness and offers a framework for further research. This research offers novel understanding of organization-level service adoption to complement individual-centric technology adoption. Practical implications New knowledge is offered to manufacturing firms about customers’ challenges and requirements in adopting advanced services. This knowledge will help manufacturers to support customers and develop the activities of their own salespeople when introducing advanced services. Originality/value The findings expose the contents of the Organizational dimension of customers’ service readiness. The study provides a more complete picture of service readiness and shows it to be a multilayered concept with interdependencies between its levels, between individuals in customer organizations and even between the manufacturer and the customer organization.
Deena Kelly - One of the best experts on this subject based on the ideXlab platform.
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the critical care work environment and nurse reported health care associated infections
American Journal of Critical Care, 2013Co-Authors: Deena Kelly, Ann Kutneylee, Eileen T Lake, Linda H. AikenAbstract:Health care–associated infections (HAIs) are one of the most common complications of care.1 HAIs are of particular concern in critically ill patients; according to estimates, almost half a million incidents of HAI occur each year in intensive care units (ICUs) alone.2 Increased susceptibility to HAIs in ICU patients is attributable in part to precarious clinical conditions,3 depressed immune function,4 and the need for invasive monitoring to ensure appropriate provision of care. The Centers for Disease Control and Prevention has made specific recommendations to aid in the prevention of central catheter–associated bloodstream infections (catheter-associated BSIs), urinary tract infections (UTIs), and ventilator-associated pneumonias (VAPs).5 The recommendations focus on specific actions to be implemented by staff members, including hand hygiene, aseptic insertion of catheters, and placing patients in a semirecumbent position during intubation.5 As the largest group of ICU clinicians who provide direct patient care, critical care nurses are well positioned to implement the recommendations and monitor patients for HAIs. Development of HAIs in acute care areas has been linked to Organizational factors, such as nurse staffing.6,7 In addition to staffing, a quality work environment—another Organizational Component of hospital nursing care—presumably provides critical care nurses the time and resources necessary to provide HAI preventive care. Evidence on the relationship between nurse organization, particularly the work environment, and HAIs in critical care units is limited. The work environment is defined as the Organizational characteristics of the workplace that facilitate or constrain professional nursing practice.8 Researchers have suggested that providing nurses with better resources and more time for patient care within a flat Organizational management structure might improve the patient-nurse interaction and quality of care. Indeed, the American Association of Critical-Care Nurses9 has endorsed the importance of a healthy work environment and the potential link between the environment and patient safety. In 2 descriptive studies,10,11 members of the association were surveyed on their perceptions of the workplace and the quality and safety of patient care. Approximately 86% of respondents reported that their unit provided excellent or good-quality care, but one quarter of these nurses indicated that the quality of care in their units during the past year had become worse.10 Almost half a million health care–associated infections occur each year in intensive care units. Inconsistencies noted in critical care nurses’ reports of quality and safety are also reflected in the ICU literature. Better communication between ICU nurses and physicians has been linked to fewer nurse-reported medication errors and greater job satisfaction.12,13 Greater variation in effective communication among providers in ICUs was associated with greater rates of VAP.14 Additionally, scores on the composite Practice Environment Scale of the Nursing Work Index (PES-NWI), a commonly used measure of nurses’ work environment, was not predictive of nurse-assessed VAP and catheter-associated sepsis.12 However, a more positive Organizational climate, a concept similar to the work environment, was significantly associated with higher odds of catheter-associated BSIs and lower odds of UTIs.15 The mixed evidence, limited in part by small sample sizes, restricted generalizability,12,15 and inconsistent reports of nurses10 indicate that more investigation is needed to understand how the critical care work environment may affect the frequency of HAIs. The purpose of our study was to describe critical care work environments and to determine whether or not the environments were associated with nurse-reported HAIs in a sample of critical care nurses in more than 300 hospitals in 4 states. We hypothesized that nurses in better work environments would be less likely to report frequent HAIs than would nurses in less favorable environments. We posited that a better critical care work environment would offer nurses more time, resources, and support, thereby increasing the number, duration, and quality of nurse-patient interactions. These potentially more frequent, longer, and better quality interactions might enable nurses to use adequate aseptic technique, enhance monitoring of intravenous insertion sites, identify clinical changes early, and prevent the development of a HAI.
Eija Vaittinen - One of the best experts on this subject based on the ideXlab platform.
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Industrial customers’ Organizational readiness for new advanced services
Journal of Manufacturing Technology Management, 2019Co-Authors: Eija Vaittinen, Miia MartinsuoAbstract:Purpose Manufacturing firms delivering complex products and systems are increasingly offering advanced data-based services. Customers, however, are not always willing to adopt manufacturers’ advanced services, so manufacturers need knowledge of how to promote customers’ service readiness. The purpose of this paper is to further develop the concept of service readiness by proposing a framework for industrial customers’ Organizational dimension of service readiness and by increasing the understanding of the conditions underpinning that service readiness. Design/methodology/approach This case study explores service readiness among customers of a manufacturer delivering complex systems and related services. Interviews were conducted within the company and among key customers as the potential users of those services. Findings Customers use versatile processes, engage multiple people and use different evaluation criteria when considering adoption of data-based services. The Organizational Component of service readiness involves requirements in the service context, supplier relations and Organizational habits and culture. Actions are proposed for manufacturers to promote customers’ readiness for new services. Research limitations/implications The research is limited through its qualitative design and case selection. Mapping of the Organizational dimension of service readiness further develops the concept of service readiness and offers a framework for further research. This research offers novel understanding of organization-level service adoption to complement individual-centric technology adoption. Practical implications New knowledge is offered to manufacturing firms about customers’ challenges and requirements in adopting advanced services. This knowledge will help manufacturers to support customers and develop the activities of their own salespeople when introducing advanced services. Originality/value The findings expose the contents of the Organizational dimension of customers’ service readiness. The study provides a more complete picture of service readiness and shows it to be a multilayered concept with interdependencies between its levels, between individuals in customer organizations and even between the manufacturer and the customer organization.
Matthew D Mchugh - One of the best experts on this subject based on the ideXlab platform.
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organization of hospital nursing and 30 day readmissions in medicare patients undergoing surgery
Medical Care, 2015Co-Authors: Matthew D Mchugh, Linda H. AikenAbstract:BACKGROUND: Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing—a critical Organizational Component of hospital service system—in relation to readmissions. OBJECTIVES: To determine the relationships between hospital nursing factors—nurse work environment, nurse staffing, and nurse education—and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery. METHOD AND DESIGN: We linked Medicare patient discharge data, multistate nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in 4 states (California, Florida, New Jersey, and Pennsylvania). Risk-adjusted robust logistic regressions were used for analyses. RESULTS: The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03; 95% CI, 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97; 95% CI, 0.95-0.99). Administrative support to nursing practice (OR=0.96; 95% CI, 0.94-0.99) and nurse-physician relations (OR=0.97; 95% CI, 0.95-0.99) were 2 main attributes of the work environment that were associated with readmissions. CONCLUSIONS: Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties.