title: Critical care outcomes: linking structures, processes, and organizational and clinical outcomes.
abstract: BACKGROUND
  Organizational structure and process are thought to affect patient care outcomes beyond the effects of expert clinical care.
  
  
  OBJECTIVE
  To test the hypothesis that a discretionary pattern of organizational structure and process factors is predictive of critical care unit performance, ie, desirable patient and organizational outcomes.
  
  
  METHODS
  Quality-of-care patient and organizational outcomes were evaluated in 25 critical care units. A single value representing each critical care unit's euclidian distance from a theoretically ideal pattern of discretionary function was determined and correlated with unit-level measures of outcomes (standardized mortality ratio, severity-adjusted length of stay, patient satisfaction, quality of nursing care, and nursing retention).
  
  
  RESULTS
  Distance from the ideal-type discretionary pattern predicted organizational but not clinical outcomes. Units closer to the ideal-type pattern had higher RN retention, and were viewed as better places to work, with higher-quality care by both nurses and physicians. Objectively measured quality of care, patient satisfaction, severity-adjusted mortality, and length of stay were not consistently related to better-structured units.
  
  
  CONCLUSIONS
  With experienced critical care practitioners, unit-level structure and process factors were better predictors of organizational outcomes than of clinical outcomes.
authors.affiliation: School of Nursing, University of Washington, Seattle, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Mitchell
authors.forename: S E
authors.initials: SE
authors.lastname: Shannon
authors.forename: K C
authors.initials: KC
authors.lastname: Cain
authors.forename: S T
authors.initials: ST
authors.lastname: Hegyvary
mesh_terms: D018806:APACHE; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015205:Northwestern United States; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011787:Quality of Health Care