Objective
To derive a comprehensive list of nursing‐sensitive patient outcomes (NSPOs) from published research on nurse staffing levels and from expert opinion.
Data Sources/Study Setting
Published literature reviews and their primary studies analyzing the link between nurse staffing levels and NSPOs and interviews with 16 experts on nursing care.
Study Design
Umbrella review and expert interviews.
Data Collection/Extraction Methods
We screened three electronic databases for literature reviews on the association between nurse staffing levels and NSPOs. After screening 430 potentially relevant records, we included 15 literature reviews, derived a list of 22 unique NSPOs from them, and ranked these in a systematic fashion according to the strength of evidence existing for their association with nurse staffing. We extended this list of NSPOs based on data from expert interviews.
Principal Findings
Of the 22 NSPOs discussed in the 15 included literature reviews, we rated the strength of evidence for four as high, for five as moderate, and for 13 outcomes as low. Four additional NSPOs that have not been considered in literature were identified through expert interviews.
Conclusions
We identified strong evidence for a significant association between nurse staffing levels and NSPOs. Our results may guide researchers in selecting NSPOs they might wish to prioritize in future studies. In particular, rarely studied NSPOs as well as NSPOs that were only identified through expert interviews but have not been considered in literature so far should be subject to further research.
The idea of privatizing or corporatizing public enterprises to improve organizational performance is a central tenet of the new public management movement. Yet while privatization represents a well-established subject of inquiry, corporatization remains a research field scarcely trodden, leaving the public debate bereft of sound empirical evidence. Building on the contingency theory, principal-agent theory, and corporatization literatures, the purpose of this study is to help bridge this research gap by empirically assessing the postulated relationships on the antecedents and consequences of corporatization. Choosing public hospitals as research subjects, it builds on a comprehensive longitudinal dataset and proceeds in four steps: calculating efficiency scores using data envelopment analysis; investigating the antecedents of corporatization with logistic regression; constructing an appropriate control group consisting of noncorporatized public-law hospitals using genetic matching; and comparing changes in efficiency between corporatized and noncorporatized hospitals by means of a difference-in-difference approach. The results indicate that public-law hospitals were significantly more likely to be corporatized under certain circumstances, namely, in areas with a higher degree of spatial competition, during the years around a major change in the reimbursement system (2003–2005), and if they were legally dependent entities. In contrast, having lower baseline efficiency had no significant effect on the likelihood of corporatization. Furthermore, corporatization had a significantly positively effect on the efficiency of previously public-law hospitals. This effect was higher for hospitals that had been legally independent than for those that had been legally dependent. In sum, corporatization is likely an effective alternative to privatization, a finding that leads to a range of implications for practice and research.
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