Impact of the nursing work environment on patient satisfaction with care: A cluster-randomised organisational...

To investigate the hypothesis that an organisational intervention with health care workers would help improve patient satisfaction with care.

An organisational intervention with health care workers was implemented in 10 German hospitals. Wards were randomised either to the intervention or control arm. The intervention was participative and aimed to reduce the psychosocial workload, and improve the work environment and job performance of health care workers. It was hypothesised that patient satisfaction with care would also improve as a result of the intervention. A total of 1,664 patients from several wards in the participating hospitals were interviewed before and after the intervention. The research hypotheses were investigated with cumulative logit regression models on four dimensions of patient satisfaction, namely, trust in health care workers, received support, availability of health care workers and patient decisional control.

The analyses did not provide evidence that the intervention had a positive impact on patient trust (OR 1.21, 95% CI [0.79-1.85]), support (OR 1.28, 95% CI [0.82-1.99]), availability of health workers (OR 1.13, 95% CI [0.75-1.69]) and patient decisional control (OR 1.01, 95% CI [0.68-1.48]). On the contrary, the largest proportion of explained variance of the scales was related to education and self-rated health.

Individual patient characteristics were found to be the most influential factors of patient satisfaction appraisals. More work seems to be required to understand the mechanisms linking the nursing work environment and patient outcomes in order to inform effective organisational interventions.Registration number DRKS00021138, German Registry of Clinical Studies.