THE PRACTICE ENVIRONMENT PROJECT - A PROCESS FOR OUTCOME EVALUATION

Objective: Evaluating the practice environment is essential to determi ne if the practice environment is conducive to the delivery of quality patient care. The Practice Environment Project (PEP) was created to p rovide a framework for current and ongoing evaluation of the practice environment. Background: Major changes in the delivery of patient care services have focused attention on the evaluation of the effectivenes s of these changes. The extent and type of change may vary throughout an institution. The identification of core variables to assess the eff ectiveness of these changes sets the framework for ongoing evaluation of new unit-based models for delivery of services. Methods: In part 1, quantitative data were collected from nursing staff members (job sati sfaction, collaboration with physicians, autonomy), physicians (qualit y of nursing care, collaboration with nurses), and patients (satisfact ion with nursing care). In part 2, focus groups were held with nursing personnel to discuss factors that affected the provision of services. Unit-based action plans were developed to manage barriers to the deli very of services. Results: Patients and physicians reported a high deg ree of satisfaction with patient care. Physicians reported a higher le vel of collaboration with nurses than that reported by nurses. Nurses reported a high degree of autonomy in practice; however, in other area s of job satisfaction (development and recognition), they suggested ar eas for improvement. Conclusions: The PEP created a mechanism to evalu ate the current state-of-the-practice environment by identifying core elements for evaluation of work redesign. It also provided a framework for managing barriers that disrupted the delivery of patient care ser vices.