• hospital environment;
  • nurses;
  • nurses–physician relationships;
  • patients;
  • quality of care;
  • survey

shen h.-c., chiu h.-t., lee p.-h., hu y.-c. & chang w.-y. (2011) Hospital environment, nurse–physician relationships, and quality of care: questionnaire survey. Journal of Advanced Nursing67(2), 349–358.


Aim.  This paper is a report of a study conducted to (a) to compare hospitalized patients’ and nurses’ perceptions of the hospital environment, nurse–physician relationships and quality of care; (b) to determine which factors best predict the quality of care from hospitalized patients' and nurses' perspectives; and (c) to assess the relationships among all variables.

Background.  Quality of care is a function of many factors and includes elements of the hospital environment and nurse–physician relationships. However, comparisons between patients’ and nurses’ perceptions are relatively limited.

Methods.  This was a cross-sectional study, and 575 patients and 220 nurses across 13 units completed questionnaires. Data were collected in 2009 and analysed using descriptive statistics, independent t-tests, stepwise regression and path analysis.

Results.  Overall, patients’ mean scores were statistically significantly higher than those of nurses on perception of hospital environment (3·05 vs. 2·65 points), nurse–physician relationships (7·88 vs. 6·53 points) and quality of care (7·91 vs. 6·63 points) (P < 0·001). Both the hospital environment and nurse–physician relationships were statistically significant predictors of quality of care. Path analysis showed that quality of care was affected by the hospital environment, nurse–physician relationships and years of education for patients (< 0·05). However, for nurses, quality of care was only directly affected by the hospital environment and nurse–physician relationships (< 0·05).

Conclusion.  These findings may help nursing leaders to ensure future excellent patient care by helping them to see which areas need improvement. They may also help nursing leaders to develop strategies to meet patients’ and nurses’ expectations.