title: An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities.
abstract: BACKGROUND
  There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers' efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital.
  
  
  METHODS
  In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses' perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse-physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined.
  
  
  RESULTS
  Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival.
  
  
  CONCLUSIONS
  This study showed that perceived staffing adequacy and nurses' assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals.
authors.affiliation: Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Tvedt
authors.affiliation: Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Ingeborg Strømseng
authors.initials: IS
authors.lastname: Sjetne
authors.affiliation: Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Jon
authors.initials: J
authors.lastname: Helgeland
authors.affiliation: Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Aas, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Bukholm
mesh_terms: D003430:Cross-Sectional Studies; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009664:Norway; D009741:Nursing Staff, Hospital; D010351:Patient Discharge / Q000706:statistics & numerical data; D061214:Patient Safety / Q000592:standards; D011336:Probability; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care / Q000592:standards
keywords: health service research; mortality; nurse-reported outcome; organizational characteristics; patient safety; quality indicator; quality of care
references.citation: Qual Saf Health Care. 2005 Dec;14(6):438-42
references.pmid: 16326791
references.citation: J Nurs Adm. 2002 May;32(5):234-42
references.pmid: 12021564
references.citation: Ann Intern Med. 2011 May 17;154(10):693-6
references.pmid: 21576538
references.citation: J Nurs Adm. 2005 Apr;35(4):188-98
references.pmid: 15834258
references.citation: Milbank Q. 2002;80(3):569-93, v
references.pmid: 12233250
references.citation: Med Care. 2006 Mar;44(3):265-9
references.pmid: 16501398
references.citation: BMJ. 2012 Mar 20;344:e1717
references.pmid: 22434089
references.citation: Med Care. 2011 Aug;49(8):775-9
references.pmid: 21666511
references.citation: J Patient Saf. 2009 Sep;5(3):139-44
references.pmid: 19920453
references.citation: J Nurs Manag. 2010 Nov;18(8):901-13
references.pmid: 21073564
references.citation: Med Care. 2008 Jan;46(1):25-32
references.pmid: 18162852
references.citation: Qual Saf Health Care. 2006 Dec;15 Suppl 1:i50-8
references.pmid: 17142610
references.citation: BMC Health Serv Res. 2008 Apr 03;8:73
references.pmid: 18384695
references.citation: Int J Nurs Stud. 2009 Jul;46(7):920-7
references.pmid: 17229425
references.citation: Qual Saf Health Care. 2003 Dec;12 Suppl 2:ii2-7
references.pmid: 14645888
references.citation: J Adv Nurs. 2007 Jan;57(1):32-44
references.pmid: 17184372
references.citation: Med Care Res Rev. 2010 Jun;67(3):321-41
references.pmid: 19880671
references.citation: J Nurs Manag. 2011 Sep;19(6):700-13
references.pmid: 21899623
references.citation: Nurs Res. 2005 Mar-Apr;54(2):74-84
references.pmid: 15778649
references.citation: Med Care. 2007 Dec;45(12):1195-204
references.pmid: 18007170
references.citation: J Nurs Adm. 2012 Oct;42(10 Suppl):S17-26
references.pmid: 22976890
references.citation: BMJ. 2000 Mar 18;320(7237):768-70
references.pmid: 10720363
references.citation: Can J Nurs Res. 2002 Mar;33(4):71-88
references.pmid: 11998198
references.citation: BMC Health Serv Res. 2012 Oct 22;12:364
references.pmid: 23088745
references.citation: Med Care. 2011 Dec;49(12):1047-53
references.pmid: 21945978
references.citation: BMJ Open. 2012 Dec 20;2(6):
references.pmid: 23263021
references.citation: N Engl J Med. 2002 Apr 11;346(15):1128-37
references.pmid: 11948273
references.citation: Res Nurs Health. 2009 Apr;32(2):229-40
references.pmid: 19152405
references.citation: Jt Comm J Qual Saf. 2003 Aug;29(8):401-8
references.pmid: 12953604
references.citation: Jt Comm J Qual Improv. 2002 Sep;28(9):472-93
references.pmid: 12216343
references.citation: J Nurs Adm. 2009 Jul-Aug;39(7-8 Suppl):S45-51
references.pmid: 19641438
references.citation: Med Care. 2013 Jan;51(1):52-9
references.pmid: 23151591
references.citation: BMJ Qual Saf. 2013 Jul;22(7):563-70
references.pmid: 23426646
references.citation: Qual Saf Health Care. 2006 Feb;15(1):2-3
references.pmid: 16456201
references.citation: Res Nurs Health. 2012 Dec;35(6):566-75
references.pmid: 22911102