The Relationship of Organizational Variables and Patient Outcomes in a Home Healthcare Setting

Financial and regulatory changes in home healthcare pose a tremendous challenge to achieve patient outcomes that are sensitive to nursing care and patient satisfaction. This study described the relationship of patient, nurse, and agency characteristics, nursing care processes, nurses’ understanding of their roles, nurses' decision-making and patient outcomes. Research questions investigated the relationship among selected variables and patient outcomes, and whether the relationship differed based on agency ownership and location. In a convenience sample of 43 agencies components, 205 nurses reported their perceptions of their roles, decision-making, care processes, and patient outcomes, and 325 patients completed satisfaction surveys. Demographic information about nurses and patients was also collected. Findings indicated that nurses’ understanding of their role, length of employment, and agency ownership were related to nurses’ decision-making. Nurses employed by corporate agencies interacted more with supervisors and used more rules for nursing practice than nurses employed by state agencies. Nurses reported that 80% of patient outcomes were achieved and patients reported 92% satisfaction with care. Differences in patient outcomes or patient satisfaction were not related to agency ownership or location. Thus patients in the study received good care and were very satisfied no matter which agency provided the care whether in a rural or urban area. When all dimensions of nursing care processes and nurses' decision-making were analyzed, the resulting model accounted for 39% of patient satisfaction and 29% of nurses' perceptions of patient outcomes. Findings identified a method of combining the dimensions of nurses’ decision-making to fit the dimensions of nursing care processes. Three combinations emerged that produce the best outcomes: 1) when care was complex, nurses consulted with supervisors, 2) when patients had varying medical diagnoses, nurses used rules to guide decisions, and 3) when patients needed close monitoring, nurses collaborated with peers. Home healthcare managers may use this method of tailoring nurses’ decision-making strategies to fit the nursing care processes to improve patient outcomes.