Chances and risks of publication of quality data - the perspectives of Swiss physicians and nurses

Background The release of quality data from acute care hospitals to the general public is based on the aim to inform the public, to provide transparency and to foster quality-based competition among providers. Due to the expected mechanisms of action and possibly the adverse consequences of public quality comparison, it is a controversial topic. The perspective of physicians and nurses is of particular importance in this context. They are mainly responsible for the collection of quality-control data, and are directly confronted with the results of public comparison. The research focus of this qualitative study was to discover what the views and opinions of the Swiss physicians and nurses were regarding these issues. It was investigated as to how the two professional groups appraised the opportunities as well as the risks of the release of quality data in Switzerland. Methods A qualitative approach was chosen to answer the research question. For data collection, four focus groups were conducted with physicians and nurses who were employed in Swiss acute care hospitals. Qualitative content analysis was applied to the data. Results The results revealed that both occupational groups had a very critical and negative attitude regarding the recent developments. The perceived risks were dominating their view. In summary, their main concerns were: the reduction of complexity, the one-sided focus on measurable quality variables, risk selection, the threat of data manipulation and the abuse of published information by the media. An additional concern was that the impression is given that the complex construct of quality can be reduced to a few key figures, and it that it is constructed from a false message which then influences society and politics. This critical attitude is associated with the different value system and the professional self-concept that both physicians and nurses have, in comparison to the underlying principles of a market-based economy and the economic orientation of health care business. Conclusions The critical and negative attitude of Swiss physicians and nurses must, under all conditions, be heeded to and investigated regarding its impact on work motivation and identification with the profession. At the same time, the two professional groups are obligated to reflect upon their critical attitude and take a proactive role in the development of appropriate quality indicators for the publication of quality data in Switzerland.

A missing link between facilitation and plant species coexistence: nurses benefit generally rare species more than common ones

1. Positive interactions among plants can increase species richness by relaxing environmental filters and providing more heterogeneous environments. However, it is not known if facilitation could affect coexistence through other mechanisms. Most studies on plant coexistence focus on negative frequency-dependent mechanisms (decreasing the abundance of common species); here, we test if facilitation can enhance coexistence by giving species an advantage when rare. 2. To test our hypothesis, we used a global data set from drylands and alpine environments and measured the intensity of facilitation (based on co-occurrences with nurse plants) for 48 species present in at least 4 different sites and with a range of abundances in the field. We compared these results with the degree of facilitation experienced by species which are globally rare or common (according to the IUCN Red List), and with a larger data base including over 1200 co-occurrences of target species with their nurses. 3. Facilitation was stronger for rare species (i.e. those having lower local abundances or considered endangered by the IUCN) than for common species, and strongly decreased with the abundance of the facilitated species. These results hold after accounting for the distance of each species from its ecological optimum (i.e. the degree of functional stress it experiences). 4. Synthesis. Our results highlight that nurse plants not only increase the number of species able to colonize a given site, but may also promote species coexistence by preventing the local extinction of rare species. Our findings illustrate the role that nurse plants play in conserving endangered species and link the relationship between facilitation and diversity with coexistence theory. As such, they provide further mechanistic understanding on how facilitation maintains plant diversity.