The University of Southampton
University of Southampton Institutional Repository

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

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States
Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States
Objective: Cost containment is exerting pressures on the hospital nurse workforce that may conflict with quality and safety improvement. Europe is an ideal laboratory for determining how to realign organisational behaviors to achieve good patient and workforce outcomes in a context of finite resources.
Design: Cross-sectional surveys of patients and nurses.
Setting: Nurses were surveyed in 488 general acute care hospitals in 12 European countries and 617 general acute care hospitals in the United States. Patients were surveyed in a subset of 210 of the European hospitals and 430 of the United States hospitals.
Participants: 33,659 nurses and 11,318 patients in Europe and 27,509 nurses and over 120,000 patients in the United States.
Measurements: Hospital staffing, nurse work environments, burnout, dissatisfaction, intentions to leave, patient safety, quality of care, patient satisfaction overall and with nursing care and willingness to recommend their 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 the percentage that gave their hospital a poor or failing safety grade (4% in Switzerland to 18% in Poland). High nurse burnout ranged from 10% (Netherlands) to 78% (Greece), job dissatisfaction from 11% (Netherlands) to 56% (Greece), and intent to leave from 14% (United States) to 49% (Finland and Greece). Percent of patients rating their hospitals highly varied considerably across countries from 35% (Spain) to 61% (Finland and Ireland), as did the percentage of patients that were willing to recommend their hospital (53% in Greece to 78% in Switzerland). Better work environments and lower patient-to-nurse ratios were associated with higher care quality and higher patient satisfaction. After adjusting for hospital and nurse characteristics, nurses in European hospitals 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 to give their hospitals poor or failing grades on patient safety (adjusted odds ratio 0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds on nurses reporting poor or fair quality car (adjusted odds ratios 1.11, 1.07 to 1.15) and poor or failing safety grades e (adjusted odds ratio 1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (adjusted odds ratio 1.16, 1.03 to 1.32) and to recommend their hospital (adjusted odds ratio 1.41, 1.22 to 1.62), while patients in hospitals with higher patient-to-nurse ratios were less likely to rate their hospital highly (adjusted odds ratio 0.94, 0.91 to 0.97) or recommend their hospital (adjusted odds ratio 0.95, 0.91 to 0.98). Findings were similar in the United States. Nurses and patients agreed on which hospitals provided good care and could be recommended.
Conclusions: Hospital care quality deficits were common in all countries. Improving hospital work environments may be a relatively low cost lever to produce safer and higher quality hospital care and higher patient satisfaction.
0959-8138
1-14
Aiken, Linda
c65194c2-956b-4ec2-8e18-862b3a7a35c4
Sermeus, Walter
42465ab5-e333-4fe8-9a80-c55f6c15a3ab
Van den Heede, Koen
7a8d8b29-7a82-4d70-98e6-54df4b9c2506
Sloane, Douglas M.
10494ba7-bfc5-48db-996e-6773a265864a
Busse, Reinhard
a46419f0-8c6f-417e-8b05-175567613dff
McKee, Martin
00241cff-34ff-4459-9263-c806a14deb6b
Bruyneel, Luk
b1dccbf8-34ee-4b11-b698-790131e1abb0
Rafferty, Anne
20adafed-5ef9-4855-9ba9-a5fa6ba46bda
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Tishelman, Carol
11d9dd11-f992-48d7-b8ef-a9f428a809d6
Moreno-Casbas, Maria Teresa
b0c80237-c1c2-4cfc-bb99-f9440407fdee
Scott, Anne
06ed79cc-e1da-44cf-a687-e915732f28ed
Brzostek, Tomasz
83d92b14-906e-4c82-bc88-325d856cd26c
Schwendimann, Rene
d56ff237-3786-47c6-92fe-a8d698d2dbb2
Schoonhoven, Lisette
93f67b5c-d879-45b9-aad1-0e1dba6c7ba3
Zikos, Dimitris
3f4ce41e-fac4-4bfd-9dae-9b10813519f4
Strømseng Sjetne, Ingeborg
a882c44d-ba2c-4738-b4bc-4f5866234c55
Smith, Herb
a394eba9-f4e5-4e84-b534-037cfc78d8fb
Kutney-Lee, Ann
a0969f48-67ec-4394-8078-4d7ef390737e
Aiken, Linda
c65194c2-956b-4ec2-8e18-862b3a7a35c4
Sermeus, Walter
42465ab5-e333-4fe8-9a80-c55f6c15a3ab
Van den Heede, Koen
7a8d8b29-7a82-4d70-98e6-54df4b9c2506
Sloane, Douglas M.
10494ba7-bfc5-48db-996e-6773a265864a
Busse, Reinhard
a46419f0-8c6f-417e-8b05-175567613dff
McKee, Martin
00241cff-34ff-4459-9263-c806a14deb6b
Bruyneel, Luk
b1dccbf8-34ee-4b11-b698-790131e1abb0
Rafferty, Anne
20adafed-5ef9-4855-9ba9-a5fa6ba46bda
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Tishelman, Carol
11d9dd11-f992-48d7-b8ef-a9f428a809d6
Moreno-Casbas, Maria Teresa
b0c80237-c1c2-4cfc-bb99-f9440407fdee
Scott, Anne
06ed79cc-e1da-44cf-a687-e915732f28ed
Brzostek, Tomasz
83d92b14-906e-4c82-bc88-325d856cd26c
Schwendimann, Rene
d56ff237-3786-47c6-92fe-a8d698d2dbb2
Schoonhoven, Lisette
93f67b5c-d879-45b9-aad1-0e1dba6c7ba3
Zikos, Dimitris
3f4ce41e-fac4-4bfd-9dae-9b10813519f4
Strømseng Sjetne, Ingeborg
a882c44d-ba2c-4738-b4bc-4f5866234c55
Smith, Herb
a394eba9-f4e5-4e84-b534-037cfc78d8fb
Kutney-Lee, Ann
a0969f48-67ec-4394-8078-4d7ef390737e

Aiken, Linda, Sermeus, Walter, Van den Heede, Koen, Sloane, Douglas M., Busse, Reinhard, McKee, Martin, Bruyneel, Luk, Rafferty, Anne, Griffiths, Peter, Tishelman, Carol, Moreno-Casbas, Maria Teresa, Scott, Anne, Brzostek, Tomasz, Schwendimann, Rene, Schoonhoven, Lisette, Zikos, Dimitris, Strømseng Sjetne, Ingeborg, Smith, Herb and Kutney-Lee, Ann (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, 44 (e1717), 1-14. (doi:10.1136/bmj.e1717).

Record type: Article

Abstract

Objective: Cost containment is exerting pressures on the hospital nurse workforce that may conflict with quality and safety improvement. Europe is an ideal laboratory for determining how to realign organisational behaviors to achieve good patient and workforce outcomes in a context of finite resources.
Design: Cross-sectional surveys of patients and nurses.
Setting: Nurses were surveyed in 488 general acute care hospitals in 12 European countries and 617 general acute care hospitals in the United States. Patients were surveyed in a subset of 210 of the European hospitals and 430 of the United States hospitals.
Participants: 33,659 nurses and 11,318 patients in Europe and 27,509 nurses and over 120,000 patients in the United States.
Measurements: Hospital staffing, nurse work environments, burnout, dissatisfaction, intentions to leave, patient safety, quality of care, patient satisfaction overall and with nursing care and willingness to recommend their 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 the percentage that gave their hospital a poor or failing safety grade (4% in Switzerland to 18% in Poland). High nurse burnout ranged from 10% (Netherlands) to 78% (Greece), job dissatisfaction from 11% (Netherlands) to 56% (Greece), and intent to leave from 14% (United States) to 49% (Finland and Greece). Percent of patients rating their hospitals highly varied considerably across countries from 35% (Spain) to 61% (Finland and Ireland), as did the percentage of patients that were willing to recommend their hospital (53% in Greece to 78% in Switzerland). Better work environments and lower patient-to-nurse ratios were associated with higher care quality and higher patient satisfaction. After adjusting for hospital and nurse characteristics, nurses in European hospitals 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 to give their hospitals poor or failing grades on patient safety (adjusted odds ratio 0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds on nurses reporting poor or fair quality car (adjusted odds ratios 1.11, 1.07 to 1.15) and poor or failing safety grades e (adjusted odds ratio 1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (adjusted odds ratio 1.16, 1.03 to 1.32) and to recommend their hospital (adjusted odds ratio 1.41, 1.22 to 1.62), while patients in hospitals with higher patient-to-nurse ratios were less likely to rate their hospital highly (adjusted odds ratio 0.94, 0.91 to 0.97) or recommend their hospital (adjusted odds ratio 0.95, 0.91 to 0.98). Findings were similar in the United States. Nurses and patients agreed on which hospitals provided good care and could be recommended.
Conclusions: Hospital care quality deficits were common in all countries. Improving hospital work environments may be a relatively low cost lever to produce safer and higher quality hospital care and higher patient satisfaction.

Text
BMJ_uploaded_Dec_22.docx - Author's Original
Download (110kB)

More information

e-pub ahead of print date: 20 March 2012
Organisations: Faculty of Health Sciences, Health Sciences

Identifiers

Local EPrints ID: 336300
URI: http://eprints.soton.ac.uk/id/eprint/336300
ISSN: 0959-8138
PURE UUID: 0577c094-5688-454c-8bac-a81118302d9e
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

Catalogue record

Date deposited: 21 Mar 2012 14:11
Last modified: 15 Mar 2024 03:37

Export record

Altmetrics

Contributors

Author: Linda Aiken
Author: Walter Sermeus
Author: Koen Van den Heede
Author: Douglas M. Sloane
Author: Reinhard Busse
Author: Martin McKee
Author: Luk Bruyneel
Author: Anne Rafferty
Author: Peter Griffiths ORCID iD
Author: Carol Tishelman
Author: Maria Teresa Moreno-Casbas
Author: Anne Scott
Author: Tomasz Brzostek
Author: Rene Schwendimann
Author: Lisette Schoonhoven
Author: Dimitris Zikos
Author: Ingeborg Strømseng Sjetne
Author: Herb Smith
Author: Ann Kutney-Lee

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×