An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

• Published in: BMJ quality & safety 2014-09, Vol.23 (9), p.757-764
• Main Authors: Tvedt, Christine, Sjetne, Ingeborg Strømseng, Helgeland, Jon, Bukholm, Geir
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Clinical outcomes; Cross-Sectional Studies; Ecological studies; Fractures; Health administration; Health participants; Hospital Mortality; Hospitals; Hospitals - standards; Humans; Medical personnel; Medical sciences; Mortality; Norway; Nurses; Nursing; Nursing Staff, Hospital; Observational studies; Original Research; Patient Discharge - statistics & numerical data; Patient safety; Patient Safety - standards; Patient satisfaction; Patients; Probability; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Assurance, Health Care - methods; Quality of Health Care - standards; Safety; Stroke; Studies; Survival; Work environment; Workforce planning; Working conditions
• ISSN: 2044-5415; 2044-5423
• DOI: 10.1136/bmjqs-2013-002781

Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. Methods In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Results Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. Conclusions This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals.