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Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States
Aiken, L.H. Sermeus, W. Van den Heede, K. Sloane, D.M. Busse, R. McKee, M. Rafferty, A.M. Griffiths, P. Moreno-Casbas, M.T. Tishelman, C.
Aiken, L.H.
Sermeus, W.
Van den Heede, K.
Sloane, D.M.
Busse, R.
McKee, M.
Rafferty, A.M.
Griffiths, P.
Moreno-Casbas, M.T.
Tishelman, C.
Publication Date
2012-03-20
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© 2012 The Authors. This is an Open Access article distributed under the
terms of the Creative Commons Attribution Non-commercial License (http://creativecommons.org/licenses/by-nc/2.0/%20and%20http:/creativecommons.org/licenses/by-nc/2.0/legalcode), which permits use,
distribution, and reproduction in any medium, provided the original work is properly cited, the
use is non-commercial and is otherwise in compliance with the license.
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openAccess
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2012-01-25
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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 measures Nurse 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).
Results The 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 patient 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.
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Published version
Citation
Aiken LH, Sermeus W, Van den Heede K et al (2012) Patient safety, satisfaction, and
quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe
and the United States. British Medical Journal. 344: e1717.
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Notes
Dr McIntosh is a member of the the RN4CAST Consortium.