Assessing context of care at the unit level of the organization

Abstract

This research explored methods of assessing organizational context of care at the work unit level. The purpose was to increase understanding of organizational perspectives and improve methods for contextual analysis in the study of clinical interventions and outcomes.A secondary analysis of data obtained from the Critical Care Nursing Systems Study was conducted to examine the organizational context of care at the unit level. The study compared two different methods of organizational analysis, observation and survey, based on the same theoretical framework of organizations, contingency theory.The study found that structured observation had a high percent agreement with standardized survey method for organizational analysis at the unit level. Observation, using structured guidelines to guide data collection, offers an alternative or supplement to the traditional survey method. Observation offers an "outsider's" view of the organizational and allows patient care activities to be assessed at the unit, versus individual level. The observational guidelines allow trained observers to provide a structured description of an organization at the unit level in multiple settings, thus allowing the clinical researcher to compare settings. Using observation and survey simultaneously provides methodological triangulation in examining organizations at the unit level.