In Search of Quality of Care in Hospitals: A Mixed-methods Approach on Practicing Nurses

Abstract

[EN] Understanding quality of care in the current healthcare context is a complex endeavor. Recent conceptual and empirical literature in healthcare management discusses challenges pertaining to quality of care, stressing the importance of individual professional input as effective predictors of such healthcare outcome. Nevertheless, evidence suggests a lack of input from several healthcare professional groups, such as nurses, being of importance to improve quality of care in the direct aftermath of the global pandemic. The goal of this paper is to study the role of the pervasive competitive culture found in healthcare and of knowledge management systems (as organizational factors of influence), and the contribution of workplace happiness (as an individual level of influence) in their contribution to quality of care in hospitals. We use a mixed-methods approach, combining a partial least-squares structural equation model (SEM-PLS) and a fuzzy-set qualitative comparative analysis (fsQCA) to study the linear and non-linear complexity between the variables. Data from the study comes after a survey conducted to 127 practicing nurses working in Portuguese hospitals. Quantitative results suggest a positive relationship between workplace happiness and quality of care. Similarly, findings also show that knowledge management systems positively influence quality of care. Qualitative findings, show a single complex configuration combining that contributes to top quality of care. On the other hand, results also present two complex configurations contributing to the lack of quality of care. Our work offers an original insight to healthcare managerial practice by providing an overview of both individual and combined organizational influences promoting quality of care. This research provides and discusses theoretical contributions driving future research, while acknowledging the study’s limitations.