Nursing News

Correlation Found Between Safety Culture and Patient Assessments of Care

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By Jennifer Larson, contributor 

September 21, 2012 - A new study funded by the Agency for Healthcare Research and Quality (AHRQ) has found a correlation between hospital patient safety culture and patients’ positive assessments of the care they receive in those hospitals.

“If you want to improve patient perceptions, you have to focus on what’s happening internally in the hospital. You have to focus on the culture,” said study co-author Joann Sorra, PhD, a researcher from the research corporation Westat.

The researchers looked at data from 73 hospitals that participate in AHRQ’s Hospital Survey on Patient Safety Culture (Hospital SOPS) and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS Hospital Survey). The first survey assesses adult inpatients about their hospital experiences, while the latter reflects hospital employees’ input on patient safety culture in their workplace.

They found that patients are paying attention, and picking up on the factors that are influencing their care. Patients in hospitals who have staff with more positive perceptions of the patient safety culture tend to report more positive assessments of the care that they’ve received.

Safety Culture and Patient Assessments of Care
Diane Pinakiewicz, MBA, president of the National Patient Safety Foundation, hopes that more organizations will focus on the patient experience and providing necessary support to staff, in light of this new research.

“It makes all the sense in the world that [patient safety culture] is going to have an impact on the patient experience,” said Diane Pinakiewicz, MBA, president of the National Patient Safety Foundation.

And that correlation could have significant implications for hospitals that are concerned about their patient satisfaction ratings.

“If you are doing something positively to affect patient safety culture, you’re going to improve your patient satisfaction scores,” Sorra said.

The researchers found that the two areas of patient safety culture found to be most closely related to the patients’ experiences of care were organizational learning/continuous improvement and teamwork within units. In addition, four patient experience measures had the most significant links to patient safety culture: communication with nurses, communication about medicines, responsiveness of hospital staff and hospital environment.

Teamwork--and a commitment to teamwork--is indeed vital, said Grena Porto, RN, MS, founder of QRS Healthcare Consulting in Hockessin, Del. She often works with health care organizations that want to make improvements in risk management, quality improvement and patient safety.  She subscribes to the importance of teamwork development programs--like the evidence-based program TeamSTEPPS, which Porto called “the gold standard”--that address critical issues such as leadership, communication and conflict resolution.

“You have to be committed not just to your own success but to the success of everyone else on the team,” she said. “Otherwise, the patient pays the price.”

James Battles, PhD, senior service fellow for patient safety with AHRQ’s Center for Quality Improvement and Patient Safety, has been part of AHRQ’s efforts to support the widespread implementation of TeamSTEPPS. When he works with teams, he advises them to look at their patients’ care experiences. He noted that some organizations have viewed patients from a customer service angle, but asserts that the patient experience should be viewed as a quality measure instead.

The combination of the SOPS and CAHPs data provides “some very powerful pieces of information” that strengthen the growing pantheon of tools used to measure quality, he added.

“If people are serious about improving quality, looking at these multiple measures will help them chart a course,” Battles said.

Pinakiewicz said she hopes that more organizations will appreciate the value of focusing on the patient experience, in light of this new research. “You will see things that are relevant to what you might want to focus on in order to improve the types of services you are delivering,” she said.

Organizations need to pay attention to their staff’s needs, as well, and evaluate the level of support they are providing, Pinakiewicz added.

“Everybody needs to be able to feel that they’re having the opportunity to do their best. You can only do that in a culture where you have openness and people are committed to working with each other in teams and are respectful of others,” she said.

People need to feel that it’s safe to speak up, added Porto. “All sorts of things are happening because someone is not going to speak up,” she said. “Why are they not going to speak up? Personal risk.”

But culture change can take time.

“It’s changing culture and changing the way that people within a culture interact with each other when it’s been established for a certain way for a very long time,” Pinakiewicz said. “It’s not an overnight thing.”

It could take years to change the culture of an organization, noted Maureen Dailey, DNSc, RN, CWOCN, senior policy fellow for the American Nurses Association (ANA).

“But what’s positive is that climate is something that you can change more readily…because it is a measure of culture experienced at the team level, where interprofessional teams work together to improve patient-centered outcomes,” she said.
Nurses can examine and use data at the unit level and find opportunities for improvement, she added. They can look at the structures and processes that are involved and find solutions that will lead to better patient outcomes, including reductions in the rate of pressure ulcers, injuries from falls and infections. 
One option she recommends is for facilities to participate in a nursing-sensitive data registry like the National Database of Nursing Quality Indicators (NDNQI), which is used in one of every three hospitals.  These types of registries are listed as a quality structural measure in CMS’s Hospital Compare site, which includes results from patient surveys about their recent hospital stays.

Although this particular study was a hospital-based study, Sorra recommended that organizations consider focusing on the unit level. Talk to unit leaders--they may not always be official managers, either--“and have them take ownership,” she said. Their needs may vary from the needs of other units and it will be more effective to get their input than to issue a top-down dictum.

“One size doesn’t necessarily fit all,” said Sorra.

For more information:
Read the original AHRQ study in the Journal of Patient Safety;
Access AHRQ’s resource guide on improving patient safety;
Visit ANA’s site on the National Database of Nursing Quality Indicators (NDNQI).



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