A new study suggests that many hospitals have failed to improve patient safety over the past 20 years, despite specific recommendations that would have increased the quality of care, leaving patients and nurses concerned.
Researchers from the Center for Health Outcomes and Policy Research of the University of Pennsylvania School of Nursing published a study in the November 2018 issue of the Health Affairs, which found only a one out of five hospitals showed significant work environment improvements, and even less improved patient safety.
The study involved 535 hospitals in four large states, evaluating procedures at two different points between 2005 and 2016. The primary focus was to determine if hostile work environments improved, which has a direct correlation to greater patient safety. The researchers looked at if hospitals improved key National Academy of Medicine (NAM) recommendations from 1999.
Survey data was collected from more than 53,000 registered nurses and more than 805,000 patients who received care at those facilities.
Overall, 30% of nurses gave the hospitals they work at unfavorable grades on patient safety. Furthermore, 55% of nurses said they would not recommend their hospital to a family member or friend who needed care.
The research also indicated only 21% of hospitals had sizable improvements of more than 10% in improved work environment scores. Comparatively, 71% of hospitals had no improvements and 7% had worse scores for work environment.
Among the hospitals that improved patient safety, there was only an 11% increase in nurses and patients who rated their hospital favorably. About 8% more nurses and patients said they would “definitely” recommend their hospital.
There was a 15% increase in favorable reporting among nurses for excellent quality of care and a 15% increase among nurses who gave their hospital a favorable grade on patient safety.
Similarly, among hospitals that had worsening work environments, there was a 19% drop among nurses who gave a favorable grade to their hospital for patient safety.
Failure to improve hospital work environments may be directly impacting progress on improving patient safety, according to the findings. Roughly 40% of patients said they did not always receive help quickly from hospital staff and 40% reported medication was not always explained before it was administered.
The study was a specific response to investigating whether recommended NAM standards were implemented after the 1999 study concluded a prevalence of medical errors was often the norm. The recommendations called for a national commitment to reduce patient harm.
One key NAM recommendation was ensuring hospitals are adequately staffed by nurses. This would allow nurses to spend their time focusing on direct patient care. That recommendation was not fully followed, resulting in many of the negative outcomes noted in the new study, the researchers concluded.