Patients, nurses, and physicians have differing views of quality of critical care

Purpose: To compare patient, nurse, and physician assessments of quality of care and patient satisfaction in selected critical care units. Design: As part of a study of patient outcomes from critical care, data were collected between December 1991 and March 1993 from 489 patients, 518 nurses, and 515 physicians in 25 critical care units located in 14 hospitals in the U.S. Pacific Northwest. Methods: Views of patient satisfaction and quality of care were measured using standardized instruments. All data were aggregated to the unit level (N=25) and were normalized to a common scale for analysis. Findings: Physicians rated quality of care higher than did either patients or nurses within the same critical care unit, and nurses had the lowest perceptions of quality. Nurses and patients had similar views of patient satisfaction, but physicians tended to overestimate patients' satisfaction. However, physicians, nurses, and patients' scores varied considerably within and between units. Physicians' and nurses' views of quality and patient satisfaction were strongly related to processes such as MD-RN collaboration and outcomes such as nurses' job satisfaction. Conclusions: Patients, nurses, and physicians viewed quality of care and patient satisfaction differently. Nurses' and physicians' perspectives were more related to their views of the work environment than to organizational factors, patient characteristics, or commonly used outcome measures.