Penn study gives hospitals bad marks

A recent study led by University of Pennsylvania nursing professor Linda Aiken has found that hospitals have improved somewhat from the findings of a landmark report from the Institute of Medicine 20 years ago that determined that thousands of patients die in hospitals each year from preventable medical errors. Still, according to a new issue of Health Affairs devoted to that topic, various studies show that hospitals have more work to do.

Aiken and her team surveyed 535 hospitals in Pennsylvania, New Jersey, California and Florida. She found that 29.6 percent of nurses rated patient safety at those hospitals as "unfavorable." In addition, 54.9 percent of the nurses "would not definitely recommend their hospital." Additionally, 28.9 percent gave their hospital an unfavorable grade on infection prevention, 37.3 percent said that "important information is lost" during shift changes, 41.9 percent said that "things fall between the cracks" and 36.9 percent said that "staff do not feel free to question authority."

The researchers discovered some positive signs when they compared the results with those of 2005. On average, nurses responded more favorably about quality of care and patient safety at hospitals where they said the "clinical work environment" had improved since 2005. Work environment took into account factors including the degree of managerial support for nurses, staffing levels and amounts of resources and training.

At institutions where nurses said the work environment had improved, researchers found a 15 percent jump in the number of nurses who gave the hospitals favorable grades on patient safety — defined as an A or a B. Similarly, at hospitals where nurses said the work environment had worsened since 2005, researchers found a 19 percent drop in the number of nurses rating patient safety with an A or a B.

"To Err Is Human," the report that prompted the national conversation about patient safety, was published in 1999 by the Institute of Medicine, now called the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. It recommended improving the work environment for nurses by ensuring adequate numbers of staff.

Aiken explained that the new survey shows that progress on that issue has been uneven. As she said, "Our recent study of nurses and patients suggests that those recommendations have not been uniformly adopted by hospitals, which may be hampering progress toward improving patient safety and preventing patient harm."

According to the article in Health Affairs, “The Institute of Medicine concluded in ‘To Err Is Human’ in 1999 that transformation of nurse work environments was needed to reduce patient harm. We studied 535 hospitals in four large states at two points in time between 2005 and 2016 to determine the extent to which their work environments improved, and whether positive changes were associated with greater progress in patient safety. Survey data from thousands of nurses and patients showed that patient safety remains a serious concern. Only 21 percent of study hospitals showed sizable improvements (of more than 10 percent) in work environment scores, while 7 percent had worse scores. For hospitals in which clinical care environments improved, patients and nurses reported improvements in patient safety indicators. These included increases in percentages of patients rating their hospital favorably (a change of 11 percent) and stating that they would definitely recommend the hospital (8 percent) and in percentages of nurses reporting excellent quality of care (15 percent) and giving the hospital a favorable grade on patient safety (15 percent). Where work environments deteriorated, fewer nurses (–19 percent) gave a favorable grade on patient safety. Failure to improve hospital work environments may be hampering progress on patient safety.”