Study says Hospitals with Strong Safety Cultures Show Better Patient Outcomes

When hospital senior management supports the creation and maintenance of a strong safety culture, patient outcomes improve, staff productivity increases, and there is less clinical employee turnover, according to research reported in the Journal for Healthcare Quality, the peer reviewed publication of the National Association for Healthcare Quality (NAHQ).

For the study, lead author Diane Storer Brown, PhD RN FNAHQ FAAN, senior scientist, Collaborative Alliance for Nursing Outcomes and strategic leader, hospital accreditation programs, Kaiser Permanente Northern California, and colleagues examined nine California hospitals to explore linkages between staff perceptions of safety culture and ongoing measures of hospital nursing unit performance, such as structures, processes and adverse patient outcomes. Thirty-seven nursing units in the nine hospitals were analyzed. Safety culture perceptions were measured six months prior to data collection on nursing-unit performance, and the statistical relationships were determined with correlation and regression analyses.

The Agency for Healthcare Research defines safety culture as the product of individual and group values, attitudes, perceptions, competencies and patterns of behavior that determine the commitment to an organization’s health and safety management. Previous research has shown that hospitals with better safety climates overall had lower adverse events rates.

In 2002, the Institute of Medicine (IOM) issued a landmark study of medical errors in hospitals and recommended that a major leadership goal for hospitals should be creation of an organizational culture for safety. Further, passage of the Affordable Care Act in 2009 has placed major emphasis on making patients safer, and hospitals can be denied reimbursement from Medicare for care that is required to correct a medical error.

For this study, Brown explored the relationship between safety culture and adverse patient outcomes of care as represented by reported falls, falls with injury and hospital acquired pressure ulcers (HAPU) of stage 2 or greater. Results from the research showed:

  • Teamwork within units was inversely or negatively correlated with reported falls. So when teamwork was stronger fewer falls were reported, and when teamwork was weaker more falls were reported. The regression analysis showed that 20 percent the variance in reported falls was related to safety culture
  • Skill mix, staff turnover and workload intensity all demonstrated robust correlations with safety culture. But the most correlations across all domains were identified with workload intensity. Nursing units with higher workload intensity had higher safety culture perceptions.

“A strong safety culture allows nurses and other staff to function at a high level of productivity because of strong teamwork and management support and an environment that supports organizational learning, which allows staff to deal with time-intense patient-care activities,” said Brown. “When senior leaders prioritize and emphasize a safety culture, the structure and process of care are carried out in a way that patient outcomes may be improved.”

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