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Hospital quality improvement in context: a multilevel analysis of staff job evaluations

¹ Norwegian Health Services Research Centre, Oslo, Norway
² Institute of Community Medicine, University of Tromsø, Norway
³ Rikshospitalet University Hospital, Oslo, Norway
⁴ Akershus University Hospital, University of Oslo, Norway
⁵ Institute of Public Health and Community Medicine, University of Oslo, Norway

Correspondence to:
DrU Krogstad
Norwegian Health Services Research Centre, P O Box 7004, 0130 Oslo, Norway; unni.krogstad{at}nhsrc.no Objective: To investigate how much of the variance in data on nurse evaluation of different aspects of hospital work can be attributed to individual, ward, department and hospital levels, and to discuss the implication of the findings on quality improvement strategies.

Design and method: National survey data of work experiences were collected from hospital nurses working at 124 hospital wards in 36 departments in 15 hospitals across Norway during the autumn of 1998. The multilevel structure of the variation of nine indices of job satisfaction was explored by fitting four-level random intercept models (nurse, ward, department and hospital).

Results: A total of 2606 nurses (66%) responded. The indices showed varying clustering to organizational units. Intraclass correlations (ICCs) varied from 0.05 to 0.38, representing considerable higher level variation. The ward level was the dominating level for the clustering of nurses’ job aspect evaluations.

Conclusion: Multilevel modelling of staff work experiences may identify which improvement goals can be addressed at which organizational level. Improvement efforts should be directed specifically towards each aspect of work and at its most relevant organizational level. Strategies aimed at the micro-organizational level (ward management) rather than the individual level or the macro level (hospital top management) might prove worthwhile.

Keywords: multilevel analysis; organization of care; quality improvement; work experiences

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