title: Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.
abstract: BACKGROUND
  Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators.
  
  
  OBJECTIVE
  What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality.
  
  
  METHODS
  The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses.
  
  
  RESULTS
  The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance.
  
  
  CONCLUSIONS
  This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay.
authors.affiliation: Research and Intervention Center for Healthy Organizations, McGill University Health Center, Montreal, Quebec, Canada. maxime.paquet@muhc.mcgill.ca
authors.forename: Maxime
authors.initials: M
authors.lastname: Paquet
authors.forename: François
authors.initials: F
authors.lastname: Courcy
authors.forename: Mélanie
authors.initials: M
authors.lastname: Lavoie-Tremblay
authors.forename: Serge
authors.initials: S
authors.lastname: Gagnon
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Maillet
mesh_terms: D000041:Absenteeism; D002170:Canada; D003657:Decision Making; D055318:Evidence-Based Nursing / Q000458:organization & administration*; D005544:Forecasting; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007588:Job Satisfaction; D008508:Medication Errors; D017146:Models, Organizational; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology*; D061214:Patient Safety; D010563:Personnel Turnover; D011584:Psychology; D011787:Quality of Health Care / Q000458:organization & administration*; D016526:Workload; D017132:Workplace / Q000523:psychology*