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According to a new study, while promoting a positive work environment has a measurable impact on patient safety, most hospitals have not improved the culture and operations of their organization.
Only 21% of the 535 hospitals surveyed improved their work environment scores by more than 10% and 7% of provider scores declined, according to data covering the period from 2005 to 2016 in the published Health Affairs study on Monday. Hospitals account for about a quarter of the country's outings.
Among the improved providers, the favorable hospital reports reported by patients increased by 11%. There was an 8% increase for patients who would recommend the hospital. The percentages of nurses reporting excellent care and a favorable safety score both increased by 15%.
When work environments deteriorated, fewer nurses (-19%) rated patient safety favorably.
"It is very surprising, given all the research and hundreds of published studies, not to pay more attention to nurses' work environment," said Linda Aiken, director the Center for Health Outcomes Research and Policy at the University of Pennsylvania. and the main author of the study. Despite millions of dollars invested in the problem, "patient safety is improving very slowly," she said.
The report builds on the 2003 Institute of Medicine study that found that having the appropriate number of nurses and an operational infrastructure to respond quickly to patients improved the numbers of patients. results. IOM's 1999 report, "To Err Is Human", shed light on the problem at the national level when it reported that as many as 98,000 people die each year in hospitals because of # 39; medical errors avoidable.
The institute has shown that hospitals can not prevent patients from suffering unless they modify the underlying working conditions of spending time at the bedside rather than looking for supplies or equipment. alleviate staff shortages, Aiken said. It is disappointing that further progress has not been made, she said.
Aiken cited a related study that she co-authored that found that patients receiving intensive care in hospitals with poor nurses' work environments had lower survival rates. 22% to those patients with good environments. Each additional patient added to the nurses' workload is associated with a 4% reduced survival after resuscitation at the hospital.
"Hospital administrators may underestimate the value of a good work environment," said Aiken. "Making an organizational change seems like a sweet thing compared to a" quick fix ", like buying new equipment, but there is so much evidence now that it's essential."
Contrary to the rhetoric of health officials, patient safety is not critical, according to research by Aiken and his cohorts. About one in five nurses surveyed said that management's actions showed that patient safety was not a top priority.
Half of the nurses agreed that "the staff feels that their mistakes are being blamed", while about 4 out of 10 agreed that "important information is lost when job changes" and that " things happen between the cracks ". More than a third of nurses said that "the staff do not feel free to question the authority".
These factors have contributed to 81% of nurses feeling that their work environment is less than excellent. Twenty-seven percent said that much of their last shift had been spent on alternatives to address operational failures such as broken or missing equipment and supplies. Thirty-one percent reported spending much of their last shift on tasks other than nursing. Nearly 7 out of 10 nurses were very dissatisfied with their work and 31% of them were about to run out.
The Institute of Medicine has made a handful of recommendations for improving care environments: creating management boards that focus on evidence-based security, leadership and management structures and processes; effective nursing leadership; adequate nursing staff; organizational support for continuous learning and improved decision-making; mechanisms for interprofessional collaboration; and work design that promotes safety.
This requires creating a culture of openness, mutual trust and respect between management and clinicians and making constant improvements. But administrators often do not involve front-line care providers in operational adjustments, Aiken said. In addition, the chaotic and fragmented nature of health care, coupled with the fear of condemning nurses, does not allow organizations to learn from their mistakes, she said.
In 2015-16, 60% of registered nurses surveyed said that the quality of care provided in their hospitals was poor and that 55% would not recommend their hospital to a family member or friend in need of care, according to l & # 39; study. Nearly 30% of nurses attributed an unfavorable assessment of their hospital to patient safety and infection prevention.
Thirty-two percent of patients rated their hospital as unfavorable and 30% would not recommend it to their family and friends in need. A little less than one in four patients reported that nurses did not always communicate well with them, while nearly 40% said they were not always getting help from their staff quickly. hospital and that the staff did not always explain the drugs before giving them. More than 30% of patients requiring pain treatment indicated that their pain was not always well controlled.
"Hospitals tend to be bureaucratic and hierarchical organizations," said Aiken. "Management makes decisions, but doctors and nurses do not have much to say, even though they often know what is not working and how to fix it at best."
Apart from the growing commitment of clinicians, some policy changes might help, she said. The hospital comparison tool of the CMS should include nursing staffing ratios of institutions and a measure of the hospital's work environment, Aiken said.
Sufficient number of nurses committing to the pipeline to run the hospitals, with the exception of some rural areas, said Aiken, noting that some 160,000 new nurses enter the labor market each year, compared with 70,000 about 15 years ago.
"It is almost entirely related to the fact that too few budget items are reserved for nurses or a poor working environment, so that no one stays in the hospital," she said.
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