Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol.
OBJECTIVE
With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs.


BACKGROUND
DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively.


METHODS
A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting quantitative and qualitative findings.


CONCLUSIONS
The research program will produce baseline data on nursing service context factors in Swiss acute care hospitals prior to DRG introduction as well as a theoretical model and a methodology to support nursing managers and hospital executive boards in distributing resources effectively. The study was approved by the ethics committees of Basel, Bern, Solothurn and Zürich.
Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Switzerland ; Institute of Nursing Science, University of Basel, Switzerland.
Rebecca
R
Spirig
Institute of Nursing Science, University of Basel, Switzerland ; Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, Bern University Hospital, Bern, Switzerland.
Elisabeth
E
Spichiger
Department of Nursing and Allied Health Professions, University Hospital Basel, Switzerland.
Jacqueline S
JS
Martin
Practice Development Unit, Department of Nursing and Allied Health Professions, University Hospital Basel, Switzerland.
Irena Anna
IA
Frei
Institute of Data Analysis and Process Design, School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland.
Marianne
M
Müller
Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Switzerland.
Michael
M
Kleinknecht
D000328:Adult; D001291:Attitude of Health Personnel; D064648:Critical Care Nursing / Q000191:economics / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D015276:Health Care Rationing / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009738:Nursing Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses' / Q000191:economics* / Q000706:statistics & numerical data; D013557:Switzerland; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult
DRG; nursing monitoring; nursing service context factors