Dissertation/Thesis Abstract

Patient Safety in United States Hospitals: A Culture-based Explanation of Variation in Outcomes
by Laam, Leslie A., Ph.D., University of Rochester, 2019, 214; 13856282
Abstract (Summary)

Preventable medical error remains the third leading cause of death in the United states despite concerted efforts to improve safety. Organizational culture in hospitals is an attribute that impacts quality and safety outcomes. Foundational to improvement efforts is the recommendation to create a culture of safety in healthcare organizations. In 2006, the Agency for Healthcare Research and Quality (AHRQ) developed a survey to measure patient safety culture (PSC). The survey identifies 12 values of PSC, which are presumed to be positive attributes of hospitals and groups within hospitals. Although the survey has been utilized by hundreds of U.S. hospitals to help them understand their PSC, there is a lack of knowledge regarding the pervasiveness of PSC values within and between hospitals, as well as limited knowledge about the relationship between PSC values and outcomes.

The goal of this study is to understand variation in patient safety culture values and safety outcomes among groups in United States hospitals from applied and theoretical perspectives. Three aims address this goal: 1) Describe the prevalence and variation of PSC values across hospitals; 2) Examine the relationships of PSC values and outcomes; and 3) Develop a dynamic systems model of PSC values and safety outcomes.

This study explored PSC across 672 hospitals in the U.S. as well as one health system in depth. Various methods were used to address each aim including: Descriptive statistical procedures, OLS regression modeling, negative binomial regression modeling, mixed-level random effects modeling of variance, and system dynamics modeling.

This study found that PSC values are present in varying degrees across hospitals and groups within hospitals. This is important because this study also found that PSC values are associated with safety outcomes, i.e. the presence of PSC values are associated with better patient outcomes. Understanding how patient safety cultures compare within and between hospitals can be used to inform decision-making at various levels of hospital leadership.

Finally, this study provided evidence that organizational leadership plays an important role in how a group may develop cultural values. A group's opportunity for learning may be impeded by inconsistent messages from external forces such as leadership.

Indexing (document details)
Advisor: Dolan, James
Commitee: Godlewski, George, Psek, Wayne, Seplaki, Christopher
School: University of Rochester
Department: Health Services Research and Policy
School Location: United States -- New York
Source: DAI-B 80/09(E), Dissertation Abstracts International
Subjects: Medical personnel, Health sciences, Public health
Keywords: Hospital culture, Organizational culture, Patient safety
Publication Number: 13856282
ISBN: 978-1-392-15077-1
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