Improving work environments in health care: test of a theoretical framework.
BACKGROUND
In light of high levels of staff turnover and variability in the quality of health care, much attention is currently being paid to the health care work environment and how it potentially relates to staff, patient, and organizational outcomes. Although some attention has been paid to staffing variables, more attention must be paid to improving the work environment for patient care.


OBJECTIVE
The purpose of this study was to empirically explore a theoretical model linking the work environment in the health care setting and how it might relate to work engagement, organizational commitment, and patient safety. This study also explored how the work environment influences staff psychological safety, which has been show to influence several variables important in health care.


METHODS
Clinical care providers at a large metropolitan hospital were surveyed using a mail methodology. The overall response rate was 42%. This study analyzed perceptions of staff who provided direct care to patients.


RESULTS
Using structural equation modeling, we found that different dimensions of the work environment were related to different outcome variables. For example, a climate for continuous quality improvement was positively related to organizational commitment and patient safety, and psychological safety partially mediated these relationships. Patient-centered care was positively related to commitment but negatively related to engagement.


CONCLUSIONS
Health care managers need to examine how organizational policies and practices are translated into the work environment and how these influence practices on the front lines of care. It appears that care provider perceptions of their work environments may be useful to consider for improvement efforts.
Health Services Management, Center for Health Ethics, School of Medicine, University of Missouri, Columbia, USA. RathertC@health.missouri.edu
Cheryl
C
Rathert
Ghadir
G
Ishqaidef
Douglas R
DR
May
D001291:Attitude of Health Personnel; D026686:Beneficence; D003430:Cross-Sectional Studies; D004779:Environment Design; D004991:Ethics, Institutional; D019538:Health Care Surveys; D006786:Hospitals, Urban / Q000458:organization & administration*; D006801:Humans; D007588:Job Satisfaction; D017146:Models, Organizational; D015205:Northwestern United States; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D016134:Organizational Policy; D018802:Patient-Centered Care / Q000458:organization & administration; D010558:Personnel Loyalty; D010559:Personnel Management / Q000379:methods*; D010564:Personnel, Hospital; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration