Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States

Abstract

Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses.Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals.Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measuresNurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). ResultsThe percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients' high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and Correspondence to: L H Aiken laiken@nursing.upenn.edu Extra material supplied by the author (see http://www.bmj.com/content/344/bmj.e1717?tab=related#webextra) Web RESEARCHpatient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended.Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction. IntroductionIn The precise measures taken by individual c...

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

“…None of the six studies that met our inclusion criteria showed significant associations between nurse staffing levels and nurse outcomes, although a number of other studies suggest that there are higher levels of job dissatisfaction and burnout amongst nurses where staffing levels are lower (e.g. Aiken et al, 2002, Aiken et al, 2012.…”

Towards an understanding of clinical nurses challenges that leads intention to leave

“…Aiken (18) , studied 10,319 nurses from 303 hospitals and concludes that adequate staffing and administrative support were among the most important factors for improving the job quality for nurses and patient care. (25) The findings of this study are in accordance with the results reported by Zuzelo (26) and Epstein, (27) who investigated hospital nurses and their professional ethical dilemmas similar to Range&Rotherham (28) and Mattozinho& Freitas (29) stating that ethical issues caused emotional burden among nurses and led to attrition.…”

“…Results of this study are consistent with the growing body of published research providing evidence that nursing care has a direct effect on patient's health outcomes and the quality of nursing care is influenced by nurses' fatigue, frustration, low perception of care quality and lastly, planning to leave the profession. (18) Stress and tension at work lead to job dissatisfaction and attrition. In contrast, a positive work environment helps retention of nurses with adequate staffing and resources.…”

Distress in working on dementia wards – A threat to compassionate care: A grounded theory study

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