Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Siri Wiig, University of Stavanger
- Second opponent: Senior Adviser Christian von Plessen, Direction Générale de la Santé
- Third member and chair of the evaluation committee: Professor Anthony S. Wagstaff, University of Oslo
Chair of the Defence
Associate Professor Maren Falch Lindberg, University of Oslo
Principal Supervisor
Director South-Eastern Norway Health Authority, Ole Tjomsland
Summary
Despite significant efforts to improve patient safety, patients continue to suffer preventable harm and improvement has been slow. The fact that the pandemic degraded staff wellness so quickly, might affect patient safety and quality of care, and suggests that our healthcare system lacks a sufficiently resilient safety culture.
Patient survival probability and patient safety culture vary by hospital unit. Staff’s perception of their work environment might explain some of this variation.
The aim of this thesis is to investigate how work environments might affect patient safety. Standardized interventions are seen as key steps in enhancing the work environment while accreditation is the evaluation of compliance to performance standards.
We assessed the effects of accreditation on patient safety and quality of care using a systematic review. A cross sectional study of staff explored the associations between work environment factors and patient survival by analyzing seven-day survival rates in Norwegian hospitals. Further analysis of staff survey data and data from the national safety culture survey in a longitudinal study assessed how work environments could predict the units’ safety culture.
The systematic review revealed a lack of robust studies with a controlled design leading to weak conclusions to support the effectiveness of hospital accreditation on improvement in patient safety and quality of care. The self-reported nurses’ workload and manager engagement where the two work environmental factors significantly associated with patient mortality. Interestingly, no association was found between physicians’ perceptions of their work environment and mortality.
Building a system that ensures resilience requires leadership to create psychological safe conditions for staff to report advert events and where staff are empowered and feel supported to improve the unit’s safety climate to a mature level.
Additional information
Contact the research support staff.