The Practice Environment Project: A Process for Outcome Evaluation

Objective: Evaluating the practice environment is essential to determine if the practice environment is conducive to the delivery of quality patient care. The Practice Environment Project (PEP) was created to provide 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 effectiveness of these changes. The extent and type of change may vary throughout an institution. The identification of core variables to assess the effectiveness 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 satisfaction, collaboration with physicians, autonomy), physicians (quality of nursing care, collaboration with nurses), and patients (satisfaction 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 delivery of services. Results: Patients and physicians reported a high degree of satisfaction with patient care. Physicians reported a higher level of collaboration with nurses than that reported by nurses. Nurses reported a high degree of autonomy in practice; however, in other areas of job satisfaction (development and recognition), they suggested areas for improvement. Conclusions: The PEP created a mechanism to evaluate 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 services.