The effect of health care working conditions on patient safety

Hickam DH, Severance S, Feldstein A
Record ID 32003000717
Authors' objectives:

The purpose of this report is to compile and summarize existing evidence on the aspects of the working environment that impact patient safety. Five categories of working conditions were evaluated: workforce staffing, workflow design, personal/social issues, physical environment, and organizational factors.

Authors' results and conclusions: The strongest evidence linking working conditions to aspects of patient safety is in the areas of workforce staffing and workflow design. Specific working conditions in these two categories affect both rates of medical errors and the incidence of patient outcomes related to patient safety. The patient outcomes affected include hospital-acquired infections, decubitis ulcers, and patient falls. There is not consistent evidence that working conditions affect the rates of preventable deaths in hospitals.
Authors' recommendations: The available evidence supports the recommendation that healthcare systems initiate demonstration projects and translational research to modify working conditions with the goal of improving patient safety. Specific areas in which such efforts are likely to be successful include: changes in nursing staffing, channeling high-risk technical procedures to high-volume physicians, avoidance of distractions in the healthcare workplace, and processes to improve information exchange between hospital and non-hospital settings. In addition, previous suggestive-but-inconclusive research indicates that limited investigations of workplace stress, lighting conditions, and organizational factors will clarify whether these additional working conditions affect patient safety.
Authors' methods: Systematic review
Project Status: Completed
Year Published: 2003
URL for published report:
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Health Facility Environment
  • Hospital Administration
  • Medical Errors
  • Personnel Management
  • Safety
  • Safety Management
  • Workload
  • Workplace
Organisation Name: Agency for Healthcare Research and Quality
Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;
Contact Name:
Contact Email:
Copyright: Agency for Healthcare Research and Quality (AHRQ)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.