HOW WIDE IS THE GAP IN DEFINING QUALITY CARE - COMPARISON OF PATIENT AND NURSE PERCEPTIONS OF IMPORTANT ASPECTS OF PATIENT-CARE

Objectives: The authors determine the importance that patients, nurses , and nurse managers place on aspects of care and measure nurses' care values based on their perceptions of their patients and nurse manager care values and their desire to meet these care expectations. Backgro und: The literature has documented gaps in how nurses and patients def ine quality and value specific care aspects, but little is known about the situation in the current continuous quality improvement and patie nt-centered care environment, which emphasizes a customer focus. Misun derstanding patients' values and expectations may impede service impro vement. Information about any existing gaps could help managers begin to devise patient satisfaction improvement strategies. Method: Two tho usand fifty-one medical-surgical patients, 1264 staff members, and 97 nurse managers from 17 randomly selected hospitals participated in stu dy activities related to selected aspects of patient care. Trained int erviewers surveyed patients by telephone within 26 days of discharge u sing a pretested instrument. Staff members and managers completed a co ordinated written tool. Descriptive and correlational statistics were used in individual and unit-level analyses. Results: Staff members per ceive correctly that patients value differently various aspects of car e but do not agree with their managers on patients' values of aspects of care. Unit staff members' and managers' beliefs regarding patients' care values did not match those of their patients (-14 to 0.11 and -0 .01 to 0.06 zero order correlations, respectively). Conclusions: A uni t's errors in defining patients' values may be self-reinforcing. Strat egies to reorient personnel, including adoption of those suggested by the diffusion of innovation literature, may help bridge the gap and ch ange practice.