Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care

Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care by Gloria Glover MBA, Nova Southeastern University, 2007 BA, Florida Atlantic University, 2003 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Business Administration Walden University June 2019 Abstract The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysisThe value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = . 000, and R = . 203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (ß = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (ß = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (ß = -.176, t = 2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals’ financial viability. Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care by Gloria Glover MBA, Nova Southeastern University, 2007 BA, Florida Atlantic University, 2003 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Business Administration Walden University June 2019 Dedication I would like to dedicate this doctoral study to my family without their motivation, support and prayer I would not have been able to strive and complete this doctoral study process. With their love and support, I was assured that indeed all things are possible and never to give up even when it seems overwhelming. As well as the importance of striving for your hearts desires and knowing it will be fillfulled; regardless how long it takes. Because of God all things are possible. Acknowledgments First, the completion of this study would not have been possible without the Lord Almighty for providing me the opportunity and strength to complete this study. Second, I would like to thank my parents, Robert and Offiong, for their support and encouragement during this process. My sisters, Winnie, Margaret, Jenny, Ekong and Mimi who always found time within my busy schedule to spend time with me so I can enjoy the other things in life that wasn’t surrounded by work and the DBA program. I would like to thank, Toyeeb and Omua, for always being there for me and challenging me when I felt overwhelmed. This challenging journey would not have been possible without my committee for providing their time and energy. To my chair, Dr. Roger Mayer, thank you so much for all the support, guidance and mentoring. I truly appreciate your time and dedication that added to the success in my doctoral program. My second committee member, Dr. Cheryl Lentz, thank you for attention to detail and prompt feedback. Finally, I would like to thank the Rick Hayes, my academic advisor, Dr. Judith Blando, my URR, and Dr. Susan Davis, Program director, the support provided confirmed my decision in selecting Walden University was the right one.