Elder et al., 2003 reported that this study would suggest the importance of organizational culture and its impact on health care providers and patients care because of work environment. Total health care quality depends on team approach including members such as nurse, doctor, therapist and work environment. This group approached and identified as part of health care culture. Especially the term “organizational culture” in health care organizations are referred as a complex term includes characteristics among the people belong to same organisations. It also includes beliefs, values, routines, norms of behavior, sense making and traditions followed.
In patient view, the quality was framed based on patient’s condition. In addition to work load, other factors such as ineffective communication, inadequate supplies also taken into account to enhance the health care quality.
According to current situation, the importance of following factors were described regarding workload like Poor physical structures in the (wards) hospitals, many family needs, and ineffective communication.
Based on research report generated by Aiken et al., (2002), fewer License Practicing Nurse (LPN) hours could increase additional burdens on the Registered Nursing (RN) staff. This situation would rise, when LPNs are not available to provide patient care and to fill a supportive role in patient-care delivery. Then RN will have to handle the above mentioned extra responsibilities to her professional duties, in addition to other auxiliary duties.
Several reports have been proposed based on studies relevant to the relationship between nurse staffing and quality nursing care. Most of the results were not same and have contradictory; hence individual assessment regarding each health care parameter is still required. For example, most of the studies in early 1992, revealed that increasing nurse staffing in number was indirectly proportional to mortality (Marcin et al., 2005). This assertion was highly contradicted by Silber, Rosenbaum, and Ross in 1995. They concluded that when there were high number of RNs in response to number of patients, Rather it had led to an increase in the number of patients who experienced more complications and injury.
In 1980s, Patient Assessment and Information System (PAIS) were proposed in Victoria Hospital, Australia (Hovenga, 1996). This study is conducted based on hours of nursing for given PAIS category. From a number of works sampling studies with included time details for administrative work and indirect nursing care activities were taken as subject. The proposed particular nursing care groups were involved in 15 activities viz., direct patient care and indirect nursing care such as documentation. Within the PAIS model another study conducted by Gomez et al., 2008, 2003, dealt with patients categorization based on shift, daily, weekly, monthly, random or (Ad Hoc) basis to reflect the workload at a particular point in time, Software packages, such as E-care and Trend Care, involve nurses using care plans or clinical pathways, determining the time necessary for each unit of care and establishing patient requirements from these parameters.
A study from Blanchet et al., (2012) described a positive work environment would reflect on cordial relationships between staff, team work, autonomy, job satisfaction and low risk of burnout. For the past few years, according to De Lucia and Rengo, (2009) conclusion, there was a serious shortage of nurses. The main reason is the work environment where the nurses practices. Also the empirical human factors and ergonomic literature specific to nursing performance identified that nurses were working generally in poor environmental conditions. They concluded that nursing profession is overloaded and there was a nursing shortage. Individual nurses were overloaded. The other contributing factors for nurse shortage was due to technology and efficiency policies that extend the length of stay and nurses who have complex patient load (Birch et al., 2003).
Also an increased turnover of patients or “churn” had intensified the nursing workload even more. He found that after hospital restructuring in Ontario (Canada) patient throughput increased by 12% and inpatient episodes per bed increased by over 25%. (Unruh, 2000) reported that patient turnover (in their sample size of 205 hospitals) significantly increased from 1994 to 2001. Admission and discharge of patients mean extra documentation, patient education, general nursing and organizational duties, thereby increasing further nursing workload. The movement of patients within wards was considered as an additional factor contributing nursing workload. As a solution prescribed by the above study, it was necessary to move patients from one area to the other on a regular basis was recommended (e.g. from high to low acute areas).
Rokosova et al., (2005) demonstrated about the parameters must be followed for health equity in health care units. Health equity is the definite irreplaceable dimension in health care management, it includes race, ethnicity, age, gender, social class, culture, and ability to pay. Previously reported issues regarding persistent and unacceptable gap in health care access usage, also outcomes by race and ethnicity raises many questions on equity and social justice. This hospital equity had been considered as the biggest challenge in enhancing health care system in SHCOs to huge organisations. They also pointed out some of the mile stones need to be faced for hospital equity as followed,
• To increase and create awareness on hospital equity especially in clinical operations, provider practices, and in best care
• To create a cultural transformation an important element of hospital equity.
• To integrate the concept of equity throughout health care operations and
• Followed by in all other STEEEP dimensions for quality improvement and health care practices
• To eliminate health care inequities
Some of the challenges are prescribed by Corrigan et al., (2001) for the health care system improvement. Likewise in health care and academic organizations and purchasers of health care should pursue six major aims of health care viz., (i) Safety to avoid injuries to patients during health care, (ii) Timeliness to reduce waiting and unusual delays that can harm those who really need care at an emergency, (iii) Effectiveness to provide services mainly based on scientific knowledge who could benefit and refrain from providing services. (iv) Efficiency to avoid waste, including waste of equipment, supplies, ideas, and energy. (v) Equity to provide quality care that must not vary due to personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status (SES), (vi) Patient-centeredness is to provide care based on individual patient preferences and response, needs, and values, also ensuring the patient’s value in all the provided clinical decisions.