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. 2025 Mar;72(1):e12981.
doi: 10.1111/inr.12981. Epub 2024 Apr 29.

Impact of clinical pathway implementation satisfaction, work engagement, and hospital-patient relationship on quality of care in Chinese nurses

Junlong Li  1   2 , Lijia Xiang  3 , Qin Li  2 , Jie Liu  2 , Jay Pan  1
Affiliations

Impact of clinical pathway implementation satisfaction, work engagement, and hospital-patient relationship on quality of care in Chinese nurses

Junlong Li et al. Int Nurs Rev. 2025 Mar.

Abstract

Aims: This study aimed to investigate how clinical pathway implementation satisfaction, work engagement, and hospital-patient relationship impact the quality of care that is provided by nurses in public hospitals.

Background: Clinical pathways are recommended as a form of quality improvement by broader healthcare systems and are widely used in the world. Nurses are the most involved group of healthcare professionals in the implementation of clinical pathways in public hospitals. So, it is important to investigate how their satisfaction with the process affects the quality of care they provide and influencing factors.

Methods: This descriptive cross-sectional study surveyed nurses practicing across seven tertiary public hospitals in Sichuan Province, China, online. The survey consisted of a questionnaire for the general characteristics of the participants and four Chinese maturity scales validated by previous studies: clinical pathway implementation satisfaction scale, work engagement scale, hospital-patient relationship perception scale, and quality of care scale. The bootstrap method was used to test a moderated mediation model using Hayes' PROCESS macro models 4 and 8. We followed STROBE guidelines to prepare the study report.

Results: A total of 880 nurses filled out the questionnaires, 821 of which were regarded as valid. Clinical pathway implementation satisfaction had a positive effect on quality of care (B = 0.873, P < 0.001). Work engagement played a mediation role between nurses' clinical pathway implementation satisfaction and the quality of care (effect = 0.080, Boot 95% CI = [0.023, 0.142]). This mediation model was moderated by the hospital-patient relationship (P < 0.01).

Conclusion: Clinical pathway implementation satisfaction may enhance the quality of care by work engagement of nurses. Moreover, a good hospital-patient relationship can enhance the positive impact of nurses' satisfaction on work engagement and health service quality.

Implications for nursing and nursing policy: Public hospital managers need to pay attention to nurses' evaluation of and perceptions toward clinical pathway implementation and then take corresponding measures to improve their satisfaction to enhance the quality of care. At the same time, the government, society, and hospitals also need to foster good hospital-patient relationships to ensure that nurses have a high level of work engagement that aids in providing high-quality care services.

Keywords: Clinical pathway; hospital–patient relationship; mediation; moderation; nurses; quality of care; work engagement.

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Conflict of interest statement

These authors have no potential conflicts of interest.

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