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Methods Inf Med 2017; 56(S 01): e30-e38
DOI: 10.3414/ME16-01-0075
DOI: 10.3414/ME16-01-0075
Original Articles
The Impact of Information Culture on Patient Safety Outcomes
Development of a Structural Equation ModelFunding Part of this research received funding from the European Union’s Seventh Framework Program (FP7/2007-2013) under grant agreement n° 223468.
Further Information
Correspondence to:
Virpi Jylhä, PhD
Department of Health and Social Management
University of Eastern Finland
P.O. Box 1627
FI-70211 Kuopio
Finland
Email: virpi.jylha@hotus.fi
Publication History
received:
17 June 2016
accepted:
25 January 2017
Publication Date:
31 January 2018 (online)
Summary
Background: An organization’s information culture and information management practices create conditions for processing patient information in hospitals. Information management incidents are failures that could lead to adverse events for the patient if they are not detected.
Objectives: To test a theoretical model that links information culture in acute care hospitals to information management incidents and patient safety outcomes.
Methods: Reason’s model for the stages of development of organizational accidents was applied. Study data were collected from a cross-sectional survey of 909 RNs who work in medical or surgical units at 32 acute care hospitals in Finland. Structural equation modeling was used to assess how well the hypothesized model fit the study data.
Results: Fit indices indicated a good fit for the model. In total, 18 of the 32 paths tested were statistically significant. Documentation errors had the strongest total effect on patient safety outcomes. Organizational guidance positively affected information availability and utilization of electronic patient records, whereas the latter had the strongest total effect on the reduction of information delays.
Conclusions: Patient safety outcomes are associated with information management incidents and information culture. Further, the dimensions of the information culture create work conditions that generate errors in hospitals.
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Keywords
Information management - patient safety - adverse events - medication administration error - patient complaint - survey - health information technology
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References
- 1 Choo CW, Furness C, Paquette S, van den Berg H, Detlor B, Bergeron P. et al. Working with information: information management and culture in a professional services organization. J Inf Sci 2006; 32 (Suppl. 06) 491-510.
- 2 Choo CW, Bergeron P, Detlor B, Heaton L. Information culture and information use: An exploratory study of three organizations. J Am Soc Inf Sci Technol 2008; 59 (Suppl. 05) 792-804.
- 3 Choo CW. Information culture and organizational effectiveness. Int J Inf Manage 2013; 33 (Suppl. 05) 775-779.
- 4 Marchand DA, Kettinger WJM, Rollins JD. Information orientation: People, technology and the bottom line. Sloan Manage Rev 2000; 41 (Suppl. 04) 69-80.
- 5 Choo CW. Information Management for the Intelligent organization. The Art of Scanning the Environment. 3rd ed. Medford, New Jersey: Information Today, Inc.;; 2002
- 6 Jylhä V, Saranto K, Bates DW. Preventable adverse drug events and their causes and contributing factors: the analysis of register data. Int J Qual Health Care 2011; 23 (Suppl. 02) 187-197.
- 7 Jylhä V, Bates DW, Saranto K. Adverse events and near misses relating to information management in a hospital. HIM J 2016; 45 (Suppl. 02) 55-63.
- 8 Berdot S, Gillaizeau F, Caruba T, Prognon P, Du-rieux P, Sabatier B. Drug administration errors in hospital inpatients: a systematic review. PLoS One 2013; 8 (Suppl. 06) e68856.
- 9 Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Phar-macother 2013; 47 (Suppl. 02) 237-256.
- 10 Elliott M, Page K, Worrall-Carter L. Reason’s accident causation model: application to adverse events in acute care. Contemp Nurse 2012; 43 (Suppl. 01) 22-28.
- 11 Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf 2013; 36 (Suppl. 11) 1045-1067.
- 12 van Beuzekom M, Boer F, Akerboom S, Hudson P. Patient safety: latent risk factors. Br J Anaesth 2010; 105 (Suppl. 01) 52-59.
- 13 Reason JT. Understanding adverse events: the human factor. In: Vincent C. editor. Clinical Risk Management: Enhancing Patient Safety. 2nd ed. London: BMJ Books; 2001. p. 9-30.
- 14 Elliott M, Worrall-Carter L, Page K. Factors contributing to adverse events after ICU discharge: a survey of liaison nurses. Aust Crit Care 2013; 26 (Suppl. 02) 76-80.
- 15 Lederman RM, Parkes C. Systems failure in hospitals--using Reason’s model to predict problems in a prescribing information system. J Med Syst 2005; 29 (Suppl. 01) 33-43.
- 16 Nagpal K, Vats A, Lamb B, Ashrafian H, Sevdalis N, Vincent C. et al. Information Transfer and Communication in Surgery: A Systematic Review. Ann Surg 2010; 252 (Suppl. 02) 224-239.
- 17 Ong MS, Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf 2011; 37 (Suppl. 06) 274-284.
- 18 Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E. et al. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract 2015; 69 (Suppl. 11) 1257-1267.
- 19 Scott T, Mannion R, Marshall M, Davies H. Does organisational culture influence health care performance? A review of the evidence. J Health Serv Res Policy 2003; 8 (Suppl. 02) 105-117.
- 20 Westrum R. A typology of organisational cultures. Qual Saf Health Care 2004; 13 suppl 2 ii22-ii27.
- 21 Hartmann CW, Meterko M, Rosen AK, Shibei Zhao, Shokeen P, Singer S. et al. Relationship of Hospital Organizational Culture to Patient Safety Climate in the Veterans Health Administration. Med Care Res Rev 2009; 66 (Suppl. 03) 320-338.
- 22 MacIntosh-Murray A, Choo CW. Information behavior in the context of improving patient safety. J Am Soc Inf Sci Technol 2005; 56 (Suppl. 12) 1332-1345.
- 23 Sermeus W, Aiken L, Van dH, Rafferty AM, Griffiths P, Moreno-Casbas M. et al. Nurse Forecasting in Europe (RN4CAST): Rationale, design and methodology. BMC Nurs 2011; 10 (Suppl. 01) 6.
- 24 Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. A global perspective. 7th ed. Upper Saddle River (NJ): Pearson Education;; 2010
- 25 Schreiber JB. Core reporting practices in structural equation modeling. Research in Social and Administrative Pharmacy 2008; 4 (Suppl. 02) 83-97.
- 26 Lawton R, McEachan RRC, Giles SJ, Sirriyeh R, Watt IS, Wright J. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ Qual Saf. Epub 2012 March 15. doi: 10.1136/bmjqs-2011-000443.
- 27 Marchand DA, Kettinger WJ, Rollings JD. Information Orientation. The Link to Business Performance. New York: Oxford University Press;; 2002
- 28 Safran C, Reti S, Marin HF. editors. Do Electronic Information Systems Facilitate Errors in Medication Management?. In: Medinfo 2010 - Proceedings of the 13th World Congress on Medical Informatics. 2010
- 29 Bowman S. Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health Inf Manag 2013; 10: 1c.
- 30 American Health Information Management Association [Internet].. Appropriate use of the copy and paste functionality in electronic health records; 2014 [cited 2016 Nov 28]. Available from: http://bok.ahima.org/PdfView?oid=300306.
- 31 ECRI Institute, Health Technology Assessment Information Service [Internet].. Copy/Paste: Prevalence, Problems, and Best Practices; 2015 [cited 2016 Nov 28]. Available from: http://www.ecri.org/Resources/HIT/CP_Toolkit/CopyPaste_Litera-ture_final.pdf.
- 32 Braaf S, Manias E, Riley R. The role of documents and documentation in communication failure across the perioperative pathway. A literature review. Int J Nurs Stud 2011; 48 (Suppl. 08) 1024-1038.
- 33 Saranto K, Kinnunen UM, Kivekas E, Lappalainen AM, Liljamo P, Rajalahti E. et al. Impacts of structuring nursing records: a systematic review. Scand J Caring Sci 2014; 28 (Suppl. 04) 629-647.
- 34 Sondergaard SF, Lorentzen V, Sorensen EE, Frederiksen K. The documentation practice of perioperative nurses. A literature review. J Clin Nurs. Epub 2016 Jun 21. doi: 10.1111/jocn.13445.
- 35 Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians. J Am Med Inform Assoc 2007; 297 (Suppl. 08) 831-841.
- 36 Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT, Murad MH. Information Transfer at Hospital Discharge: A Systematic Review. J Patient Saf. Epub 2016 Jan 7. doi: 10.1097/ PTS.0000000000000248.
- 37 Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D, Thornlow DK. et al. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg 2012; 115 (Suppl. 01) 102-115.
- 38 Smeulers M, Lucas C, Vermeulen H. Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients. Cochrane Database Syst Rev 2014; 6: CD009979.
- 39 Braaf S, Riley R, Manias E. Failures in communication through documents and documentation across the perioperative pathway. J Clin Nurs 2015; 24 13-14 1874-1884.
- 40 Spence Laschinger HK, Leiter MP. The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement. J Nurs Adm 2006; 36 (Suppl. 05) 259-267.
- 41 Tervo-Heikkinen T, Partanen P, Aalto P, Vehvi-läinen-Julkunen K. Nurses’ work environment and nursing outcomes: A survey study among Finnish university hospital registered nurses. Int J Nurs Pract 2008; 14 (Suppl. 05) 357-365.
- 42 Kirwan M, Matthews A, Scott PA. The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach. Int J Nurs Stud 2013; 50 (Suppl. 02) 253-263.
- 43 Ausserhofer D, Schubert M, Desmedt M, Blegen MA, De Geest S, Schwendimann R. The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey. Int J Nurs Stud 2013; 50 (Suppl. 02) 240-252.
- 44 Tvedt C, Sjetne IS, Helgeland J, Bukholm G. A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety. BMJ Open 2012; 2 (Suppl. 06) e001967.
- 45 Maben J, Morrow E, Ball J, Robert G, Griffiths P. [Internet]. High quality care metrics for nursing. National Nursing Research Unit, King’s College London; 2012 [cited 2016 Nov 28]. Available from: http://eprints.soton.ac.uk/346019/1/High-Quality-Care-Metrics-for-Nursing----Nov-2012.pdf.
Correspondence to:
Virpi Jylhä, PhD
Department of Health and Social Management
University of Eastern Finland
P.O. Box 1627
FI-70211 Kuopio
Finland
Email: virpi.jylha@hotus.fi
-
References
- 1 Choo CW, Furness C, Paquette S, van den Berg H, Detlor B, Bergeron P. et al. Working with information: information management and culture in a professional services organization. J Inf Sci 2006; 32 (Suppl. 06) 491-510.
- 2 Choo CW, Bergeron P, Detlor B, Heaton L. Information culture and information use: An exploratory study of three organizations. J Am Soc Inf Sci Technol 2008; 59 (Suppl. 05) 792-804.
- 3 Choo CW. Information culture and organizational effectiveness. Int J Inf Manage 2013; 33 (Suppl. 05) 775-779.
- 4 Marchand DA, Kettinger WJM, Rollins JD. Information orientation: People, technology and the bottom line. Sloan Manage Rev 2000; 41 (Suppl. 04) 69-80.
- 5 Choo CW. Information Management for the Intelligent organization. The Art of Scanning the Environment. 3rd ed. Medford, New Jersey: Information Today, Inc.;; 2002
- 6 Jylhä V, Saranto K, Bates DW. Preventable adverse drug events and their causes and contributing factors: the analysis of register data. Int J Qual Health Care 2011; 23 (Suppl. 02) 187-197.
- 7 Jylhä V, Bates DW, Saranto K. Adverse events and near misses relating to information management in a hospital. HIM J 2016; 45 (Suppl. 02) 55-63.
- 8 Berdot S, Gillaizeau F, Caruba T, Prognon P, Du-rieux P, Sabatier B. Drug administration errors in hospital inpatients: a systematic review. PLoS One 2013; 8 (Suppl. 06) e68856.
- 9 Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Phar-macother 2013; 47 (Suppl. 02) 237-256.
- 10 Elliott M, Page K, Worrall-Carter L. Reason’s accident causation model: application to adverse events in acute care. Contemp Nurse 2012; 43 (Suppl. 01) 22-28.
- 11 Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf 2013; 36 (Suppl. 11) 1045-1067.
- 12 van Beuzekom M, Boer F, Akerboom S, Hudson P. Patient safety: latent risk factors. Br J Anaesth 2010; 105 (Suppl. 01) 52-59.
- 13 Reason JT. Understanding adverse events: the human factor. In: Vincent C. editor. Clinical Risk Management: Enhancing Patient Safety. 2nd ed. London: BMJ Books; 2001. p. 9-30.
- 14 Elliott M, Worrall-Carter L, Page K. Factors contributing to adverse events after ICU discharge: a survey of liaison nurses. Aust Crit Care 2013; 26 (Suppl. 02) 76-80.
- 15 Lederman RM, Parkes C. Systems failure in hospitals--using Reason’s model to predict problems in a prescribing information system. J Med Syst 2005; 29 (Suppl. 01) 33-43.
- 16 Nagpal K, Vats A, Lamb B, Ashrafian H, Sevdalis N, Vincent C. et al. Information Transfer and Communication in Surgery: A Systematic Review. Ann Surg 2010; 252 (Suppl. 02) 224-239.
- 17 Ong MS, Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf 2011; 37 (Suppl. 06) 274-284.
- 18 Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E. et al. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract 2015; 69 (Suppl. 11) 1257-1267.
- 19 Scott T, Mannion R, Marshall M, Davies H. Does organisational culture influence health care performance? A review of the evidence. J Health Serv Res Policy 2003; 8 (Suppl. 02) 105-117.
- 20 Westrum R. A typology of organisational cultures. Qual Saf Health Care 2004; 13 suppl 2 ii22-ii27.
- 21 Hartmann CW, Meterko M, Rosen AK, Shibei Zhao, Shokeen P, Singer S. et al. Relationship of Hospital Organizational Culture to Patient Safety Climate in the Veterans Health Administration. Med Care Res Rev 2009; 66 (Suppl. 03) 320-338.
- 22 MacIntosh-Murray A, Choo CW. Information behavior in the context of improving patient safety. J Am Soc Inf Sci Technol 2005; 56 (Suppl. 12) 1332-1345.
- 23 Sermeus W, Aiken L, Van dH, Rafferty AM, Griffiths P, Moreno-Casbas M. et al. Nurse Forecasting in Europe (RN4CAST): Rationale, design and methodology. BMC Nurs 2011; 10 (Suppl. 01) 6.
- 24 Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. A global perspective. 7th ed. Upper Saddle River (NJ): Pearson Education;; 2010
- 25 Schreiber JB. Core reporting practices in structural equation modeling. Research in Social and Administrative Pharmacy 2008; 4 (Suppl. 02) 83-97.
- 26 Lawton R, McEachan RRC, Giles SJ, Sirriyeh R, Watt IS, Wright J. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ Qual Saf. Epub 2012 March 15. doi: 10.1136/bmjqs-2011-000443.
- 27 Marchand DA, Kettinger WJ, Rollings JD. Information Orientation. The Link to Business Performance. New York: Oxford University Press;; 2002
- 28 Safran C, Reti S, Marin HF. editors. Do Electronic Information Systems Facilitate Errors in Medication Management?. In: Medinfo 2010 - Proceedings of the 13th World Congress on Medical Informatics. 2010
- 29 Bowman S. Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health Inf Manag 2013; 10: 1c.
- 30 American Health Information Management Association [Internet].. Appropriate use of the copy and paste functionality in electronic health records; 2014 [cited 2016 Nov 28]. Available from: http://bok.ahima.org/PdfView?oid=300306.
- 31 ECRI Institute, Health Technology Assessment Information Service [Internet].. Copy/Paste: Prevalence, Problems, and Best Practices; 2015 [cited 2016 Nov 28]. Available from: http://www.ecri.org/Resources/HIT/CP_Toolkit/CopyPaste_Litera-ture_final.pdf.
- 32 Braaf S, Manias E, Riley R. The role of documents and documentation in communication failure across the perioperative pathway. A literature review. Int J Nurs Stud 2011; 48 (Suppl. 08) 1024-1038.
- 33 Saranto K, Kinnunen UM, Kivekas E, Lappalainen AM, Liljamo P, Rajalahti E. et al. Impacts of structuring nursing records: a systematic review. Scand J Caring Sci 2014; 28 (Suppl. 04) 629-647.
- 34 Sondergaard SF, Lorentzen V, Sorensen EE, Frederiksen K. The documentation practice of perioperative nurses. A literature review. J Clin Nurs. Epub 2016 Jun 21. doi: 10.1111/jocn.13445.
- 35 Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians. J Am Med Inform Assoc 2007; 297 (Suppl. 08) 831-841.
- 36 Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT, Murad MH. Information Transfer at Hospital Discharge: A Systematic Review. J Patient Saf. Epub 2016 Jan 7. doi: 10.1097/ PTS.0000000000000248.
- 37 Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D, Thornlow DK. et al. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg 2012; 115 (Suppl. 01) 102-115.
- 38 Smeulers M, Lucas C, Vermeulen H. Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients. Cochrane Database Syst Rev 2014; 6: CD009979.
- 39 Braaf S, Riley R, Manias E. Failures in communication through documents and documentation across the perioperative pathway. J Clin Nurs 2015; 24 13-14 1874-1884.
- 40 Spence Laschinger HK, Leiter MP. The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement. J Nurs Adm 2006; 36 (Suppl. 05) 259-267.
- 41 Tervo-Heikkinen T, Partanen P, Aalto P, Vehvi-läinen-Julkunen K. Nurses’ work environment and nursing outcomes: A survey study among Finnish university hospital registered nurses. Int J Nurs Pract 2008; 14 (Suppl. 05) 357-365.
- 42 Kirwan M, Matthews A, Scott PA. The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach. Int J Nurs Stud 2013; 50 (Suppl. 02) 253-263.
- 43 Ausserhofer D, Schubert M, Desmedt M, Blegen MA, De Geest S, Schwendimann R. The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey. Int J Nurs Stud 2013; 50 (Suppl. 02) 240-252.
- 44 Tvedt C, Sjetne IS, Helgeland J, Bukholm G. A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety. BMJ Open 2012; 2 (Suppl. 06) e001967.
- 45 Maben J, Morrow E, Ball J, Robert G, Griffiths P. [Internet]. High quality care metrics for nursing. National Nursing Research Unit, King’s College London; 2012 [cited 2016 Nov 28]. Available from: http://eprints.soton.ac.uk/346019/1/High-Quality-Care-Metrics-for-Nursing----Nov-2012.pdf.