Patient safety improvement in U.S. hospitals: applying an organizational learning model to explore conceptual and empirical considerations
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Hospitals face significant pressure to improve patient safety. This dissertation examines how organizational learning influences three processes critical to hospital efforts to identify, prioritize, and promote safety improvements. The first study, a systematic scoping review, investigates if and how safety toolkits identify learning mechanisms that are important for hospitals to achieve safety improvements. Fewer than half of the peer-reviewed toolkit articles (n=36) identified all of the organizational learning mechanisms required to optimize improvement from safety interventions. Further, articles rarely included all relevant measure types (staff perception, process, outcome) that assess and facilitate learning from the toolkit-based interventions in order to improve safety. The second study draws on in-depth qualitative interviews (sixteen informants at four hospitals) to describe how hospitals’ organizational learning capabilities relate to the identification of safety practices and information sources used to prioritize hospital safety improvements. Hospitals varied in the safety practices and information sources used to determine priorities. Hospitals with learning-oriented leadership or a supportive learning environment appear more likely to learn from multiple safety practices and various information sources. Barriers in organizational learning capabilities may hinder hospitals’ potential for improvement and thereby their safety performance. The third study explores whether a relationship exists between hospital staff perceptions of their organizational culture and staff involvement in large-scale adverse events (LSAEs) using survey data (209 respondents from six hospitals). Hospitals are often advised to modify their organizational cultures in order to promote safety. Respondent perceptions differed between respondents involved in an LSAE relative to those that were not involved in an LSAE on all ten cultural factors considered. Results from an adjusted logistic regression model indicated that one culture factor was key: less favorable respondent perceptions of employee engagement were associated with an increased likelihood of the respondent’s involvement with an LSAE. Hospitals with an organizational culture supportive of learning for safety improvement, and in particular more favorable employee engagement, appear to be better protected against the risks of LSAEs. Collectively, these studies highlight opportunities for hospitals to improve patient safety by managing their organizational learning capabilities. Future research should examine how hospitals develop their organizational learning capabilities.