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ERIC Number: ED550539
Record Type: Non-Journal
Publication Date: 2012
Pages: 190
Abstractor: As Provided
ISBN: 978-1-2678-4873-4
Improving Hospital Quality and Patient Safety an Examination of Organizational Culture and Information Systems
Gardner, John Wallace
ProQuest LLC, Ph.D. Dissertation, The Ohio State University
This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process of care. Primary survey data from 272 hospitals across the U.S. is combined with process of care performance data reported by the Center for Medicare and Medicaid Services (CMS). The results indicate that general safety climate and quality practices establish an environment in which outcome-specific efforts enable process quality improvement. A split-group structural equation modeling (SEM) analysis shows the employment of practices focused on specific outcome goals is found to relate to higher quality of patient care in smaller hospitals, whereas a climate focused on specific outcome goals is found to relate to higher quality of patient care in larger hospitals. In Chapter 3, we test the influence of the adoption of healthcare information technologies (HIT) in relation to the use of data and analysis for organizational planning and error reduction. Secondary data on the levels of HIT adoption as reported by HIMSS and the Dorenfest Institute is combined with primary survey data from 2009 on the use and analysis of data in 272 U.S. hospitals; these data are combined with secondary data on hospital performance of process of care and patient satisfaction as reported by CMS. The results of hierarchical regression analyses indicate that HIT adoption and data use and analysis influence outcomes in different ways: hospitals with higher levels of HIT adoption and error data analysis are associated with higher process of care quality, while hospitals with higher levels of organizational data use are associated with higher patient satisfaction. Chapter 4 examines the use of information systems for developing higher reliability in care in relation to the effects of adhering to specified care and workarounds to limitations in HIT. Secondary data on HIT adoption, CMS process of care, and patient experience of care are combined with primary data from a 2012 survey of hospital quality and nurse directors. The primary survey data measures three key factors: 1) the extent to which care providers use information systems in a patient-focused manner, 2) the extent to which providers adhere to specified care, and 3) the extent to which providers work around limitations in information systems. The results indicate that the contextual factors of hospital size and level of HIT investment play a significant role in understanding the use of healthcare information systems (HIS). For example, the use of HIS with focused attention on the patient is found to have a positive and slightly significant association with process of care in hospitals with more IT adoption, but is found to have a negative association with patients' perceived experience of care in hospitals with less IT adoption. This research addresses a crossroads of practical and theoretical implications for the future of patient safety culture and the use of healthcare information systems. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page:]
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Publication Type: Dissertations/Theses - Doctoral Dissertations
Education Level: N/A
Audience: N/A
Language: English
Sponsor: N/A
Authoring Institution: N/A