Safety Culture Related to Nursing Processes and Patient Outcomes
Nine hospitals and 37 nursing units participated in a recent study that explored the relationship between nursing metrics, patient outcomes, and safety culture. The Affordable Care Act of 2009 drew attention to the need for high-quality healthcare for Americans and to the costs of preventable conditions such as errors in medication and inpatient falls. Hospital acquired conditions (HAC) may provide clues about hospital safety culture (SC). Nevertheless, SC is complex and poorly understood, which complicates approaches to improve patient safety. The present study used two independent measures, the Hospital Survey of Patient SC (HSOPSC) and the Collaborative Alliance for Nursing Outcomes (CALNOC), to obtain data.
Results demonstrated a relationship between SC and adverse patient outcomes, such as inpatient falls. For instance, the number of falls reported was inversely related to teamwork within nursing units; patients experienced fewer falls in units with strong teamwork. Conversely a greater number of falls correlated with weak unit teamwork. Regression analyses showed that 20% of the variance in reported patient falls was related to SC, indicating the importance of this variable in overall SC. Though few findings related to “process of care,” fall protocol use was significant in this domain, and accounted for 62% of variance. Overall, the study demonstrated that SC was associated with structure, process, and outcome of care, and that these elements in particular were related to inpatient falls. Further, the study showed that significant costs are associated with adverse events and structural issues, such as staff turnover. The cost of every 1% of staff turnover was estimated at $300,000. Clearly, a business case can be made for safe and reliable care.
The study benefited from unit-level data, rather than administrative data, but may be limited due to the participation of hospitals that subscribe to CALNOC. CALNOC hospitals may self-select as environments that value patient safety.
Storer Brown D, Wolosin R. Safety culture relationships with hospital nursing sensitive metrics. J Healthcare Qual. 2013; 35(4): 61-74.
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