Organizational health and patient safety: A systematic review

Background: Demise from preventable medical errors has been described as the third leading cause of death in the United States. Many mitigating efforts have been applied unsuccessfully at the point of care. Further recognition of these errors as symptoms of underlying organizational-level issues is needed in order to provide safe patient-centered care. The objective of this systematic review was to describe current knowledge regarding the communication of organizational-level issues that influence organizational health and compromise patient safety. Methods: A comprehensive literature review was done to discover pertinent scientific literature regarding organizational-level factors that impact organizational health and patient safety. The literature search was done in August of 2019 using the CINAHL, PubMed, and Cochrane Library databases using the key terms “hospital”, “organizational culture”, “organizational health”, “communication”, “adverse events”, “error”, and “system-level”. Inclusion criteria included articles which were peer-reviewed, published between 2009-2019, concerned humans, and written in English. Findings that were books, book reviews, commentaries, literature reviews, letters to the Editor, non-English, or presentation abstracts were excluded. Thematic analysis was applied to literature sources that fit inclusion criteria and held pertinence to the delineated area of research. Bias was limited through bracketing of values and preconceived opinions to promote neutrality. Results: A total of 31 articles were reviewed. Analysis revealed that hospitals are complex and evident of changes that are unpredictable and nonlinear. Organizational-level factors such as communication, environment, human factors, interdisciplinary collaboration, leadership, and culture influence patient safety. Limitations of the evidence included the finding that less than half of the studies used a guiding theory, only two quantitative studies accounted for confounding variables, the majority of the qualitative studies did not address issues of trustworthiness or bias, and there was not a standardized definition of adverse events used across studies. Conclusions: Further research regarding personnel perceptions, communication methods and content, and distinguishable features of organizational-level events are needed.