Studies Cite Persistent Threat to Patient Safety, Hospital Work Environment and Present Improvement Options
Fatigue among residents and nurses, inadequate nurse staffing levels, and emergency department crowding pose serious risks to safety and quality in American hospitals, according to research discussed in the November 2007 supplement to The Joint Commission Journal on Quality and Patient Safety. Nurse turnover both contributes to these problems and is aggravated by them.
Articles in this special supplement of the Journal, supported by the Agency for Healthcare Research and Quality (AHRQ), also examine effects of the physical environment and organizational climate on quality and safety.
"To achieve quality care in and out of the hospital, providers need to pay more attention to the conditions affecting recruitment, retention and appropriate deployment of clinical caregivers," says Michael I. Harrison, PhD, a senior research scientist in the Center for Delivery, Organization and Markets at AHRQ, who served as guest editor of the issue.
In 1999, AHRQ joined with other federal agencies to identify gaps in knowledge about the effects of healthcare working conditions on the quality of clinical care and on the safety of caregivers and their patients. The articles in this supplement examine findings on key elements of the hospital environment, identify risks to safety and quality, and propose operational and policy solutions.
Because nurses provide the bulk of patient care in hospitals, most research on work environments has focused on them. Research in this supplement reveals that physicians and other caregivers share many of the problems encountered by nurses. The articles synthesize findings on key elements in the hospital work environment and highlight operational and policy challenges in each area.
Four articles spotlight the potential for harm from working conditions prevailing in many inpatient settings - including excessive work hours for nurses and physicians, inadequate nurse staffing levels, and crowding. The authors of the new articles call for changes in the organization of care to reduce these specific causes of harm. Two other articles describe effects of the physical environment and organizational climate on quality and safety and suggest possible improvements in these areas.
"Clinical practitioners - physicians, nurses and paraprofessionals - are the most critical resources in healthcare delivery, but their contribution is too often taken for granted. Besides focusing on hot topics such as technology and finance, providers, payers and policy makers need to ensure that clinicians work under conditions promoting safety and quality," according to Harrison.
Specific articles and recommended actions in this special supplement include the following:
- "Improving the Healthcare Work Environment: A Sociotechnical Systems Approach." The sociotechnical framework provides context for working conditions research reported in this issue and elsewhere. Articles in this supplement examine findings on key elements of the hospital work environment, identify risks to safety and quality, and propose operational and policy solutions.
- "Effects of Healthcare Provider Work Hours and Sleep Deprivation on Safety and Performance." The weight of the evidence strongly suggests that extended-duration work shifts significantly increase fatigue and impair performance and safety.
- "Effective Implementation of Work-Hour Limits and Systemic Improvements." Reduction of provider fatigue through work-hour limits, scientifically designed work schedules, and infrastructural changes are urgently needed.
- "Nurse Staffing in Acute Care Settings: Research Perspectives and Practice Implications." Healthcare managers and executives need to develop strategies for addressing increasingly likely shortfalls in the numbers and skill mix of nursing personnel.
- "Organizational Climate and Healthcare Outcomes." A literature review underscores the importance of promoting a positive organizational climate.
- "Enhancing Work Flow to Reduce Crowding." Case studies illustrate the experience of health systems in improving patient flow and reducing crowding by implementing operations management strategies - performance measurement, demand forecasting, flow redesign and capacity management.
- "The Role of the Physical Environment in Crossing the Quality Chasm." Evidence-based design findings can help hospital decision makers ensure that quality and safety are designed into new and refurbished facilities.
- "Improving the Healthcare Work Environment: Implications for Research, Practice, and Policy." The guest editor and his colleagues review the implications of the articles for practitioners and policy makers, and also identify challenges for further research.
Joint Commission Resources, Inc. (JCR), a not-for-profit affiliate of The Joint Commission, has been designated by The Joint Commission to publish publications and multimedia products. Learn more about Joint Commission Resources at www.jcrinc.com.
Source: Joint Commission Resources, Inc.