title: Computerization and its contribution to care quality improvement: the nurses' perspective.
abstract: BACKGROUND
  Despite the widely held belief that the computerization of hospital medical systems contributes to improved patient care management, especially in the context of ordering medications and record keeping, extensive study of the attitudes of medical staff to computerization has found them to be negative. The views of nursing staff have been barely studied and so are unclear. The study reported here investigated the association between nurses' current computer use and skills, the extent of their involvement in quality control and improvement activities on the ward and their perception of the contribution of computerization to improving nursing care. The study was made in the context of a Joint Commission International Accreditation (JCIA) in a large tertiary medical center in Israel. The perception of the role of leadership commitment in the success of a quality initiative was also tested for.
  
  
  METHODS
  Two convenience samples were drawn from 33 clinical wards and units of the medical center. They were questioned at two time points, one before the JCIA and a second after JCIA completion. Of all nurses (N=489), 89 were paired to allow analysis of the study data in a before-and-after design. Thus, this study built three data sets: a pre-JCIA set, a post-JCIA set and a paired sample who completed the questionnaire both before and after JCIA. Data were collected by structured self-administered anonymous questionnaire.
  
  
  RESULTS
  After the JCIA the participants ranked the role of leadership in quality improvement, the extent of their own quality control activity, and the contribution of computers to quality improvement higher than before the JCIA. Significant Pearson correlations were found showing that the higher the rating given to quality improvement leadership the more nurses reported quality improvement activities undertaken by them and the higher nurses rated the impact of computerization on the quality of care. In a regression analysis quality improvement leadership and computer use/skills accounted for 30% of the variance in the perceived contribution of computerization to quality improvement.
  
  
  CONCLUSIONS
  (a) The present study is the first to show a relationship between organizational leadership and computer use by nurses for the purpose of improving clinical care. (b) The nurses' appreciation of the contribution computerization can make to data management and to clinical care quality improvement were both increased by the JCI accreditation process.
authors.affiliation: Rabin Medical Center, Clalit Health Services, Israel; Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: kaganily@post.tau.ac.il.
authors.forename: Ilya
authors.initials: I
authors.lastname: Kagan
authors.affiliation: Rabin Medical Center, Clalit Health Services, Israel. Electronic address: mfish@clalit.org.il.
authors.forename: Miri
authors.initials: M
authors.lastname: Fish
authors.affiliation: Rabin Medical Center, Clalit Health Services, Israel. Electronic address: nfarkash@clalit.org.il.
authors.forename: Naomi
authors.initials: N
authors.lastname: Farkash-Fink
authors.affiliation: Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel. Electronic address: sivia@post.tau.ac.il.
authors.forename: Sivia
authors.initials: S
authors.lastname: Barnoy
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003142:Communication; D005260:Female; D006751:Hospital Information Systems / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D058996:Quality Improvement
keywords: Care quality improvement; Computer use; Computerized information systems; Leadership; Nurses