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      What is the role of transformational leadership, work environment and patient safety culture for person‐centred care? A cross‐sectional study in Norwegian nursing homes and home care services

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          Abstract

          Aim

          To examine how transformational leadership, job demands, job resources and patient safety culture contribute in explaining person‐centred care in nursing homes and home care services.

          Design

          Cross‐sectional study.

          Methods

          Healthcare professionals in four Norwegian nursing homes ( N = 165) and four home care services ( N = 139) participated in 2018. Multiple regression analyses were used to examine to what degree transformational leadership, job demands, job resources and patient safety culture dimensions predicted person‐centred care.

          Results

          Transformational leadership, job demands and job resources explained 41% of the variance in person‐centred care, with work pace as the strongest predictor ( β = 0.39 p < .001). The patient safety culture dimensions explained 57.5% of the variance in person‐centred care, with staffing being the strongest predictor ( β = 0.31 p < .001). There were small differences between nursing homes and home care. In total, transformational leadership, pace of work, staffing and factors related to communication were the strongest predictors for person‐centred care.

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          Most cited references41

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          A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

          Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.
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            Patient-centered care and outcomes: a systematic review of the literature.

            Patient-centered care (PCC) has been studied for several decades. Yet a clear definition of PCC is lacking, as is an understanding of how specific PCC processes relate to patient outcomes. We conducted a systematic review of the PCC literature to examine the evidence for PCC and outcomes. Three databases were searched for all years through September 2012. We retained 40 articles for the analysis. Results found mixed relationships between PCC and clinical outcomes, that is, some studies found significant relationships between specific elements of PCC and outcomes but others found no relationship. There was stronger evidence for positive influences of PCC on satisfaction and self-management. Future research should examine specific dimensions of PCC and how they relate to technical care quality, particularly some dimensions that have not been studied extensively. Future research also should identify moderating and mediating variables in the PPC-outcomes relationship.
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              Association between organisational and workplace cultures, and patient outcomes: systematic review

              Design and objectives Every organisation has a unique culture. There is a widely held view that a positive organisational culture is related to positive patient outcomes. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, we systematically reviewed and synthesised the evidence on the extent to which organisational and workplace cultures are associated with patient outcomes. Setting A variety of healthcare facilities, including hospitals, general practices, pharmacies, military hospitals, aged care facilities, mental health and other healthcare contexts. Participants The articles included were heterogeneous in terms of participants. This was expected as we allowed scope for wide-ranging health contexts to be included in the review. Primary and secondary outcome measures Patient outcomes, inclusive of specific outcomes such as pain level, as well as broader outcomes such as patient experience. Results The search strategy identified 2049 relevant articles. A review of abstracts using the inclusion criteria yielded 204 articles eligible for full-text review. Sixty-two articles were included in the final analysis. We assessed studies for risk of bias and quality of evidence. The majority of studies (84%) were from North America or Europe, and conducted in hospital settings (89%). They were largely quantitative (94%) and cross-sectional (81%). The review identified four interventional studies, and no randomised controlled trials, but many good quality social science studies. We found that overall, positive organisational and workplace cultures were consistently associated with a wide range of patient outcomes such as reduced mortality rates, falls, hospital acquired infections and increased patient satisfaction. Conclusions Synthesised, although there was no level 1 evidence, our review found a consistently positive association held between culture and outcomes across multiple studies, settings and countries. This supports the argument in favour of activities that promote positive cultures in order to enhance outcomes in healthcare organisations.
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                Author and article information

                Contributors
                eline.ree@uis.no
                Journal
                Nurs Open
                Nurs Open
                10.1002/(ISSN)2054-1058
                NOP2
                Nursing Open
                John Wiley and Sons Inc. (Hoboken )
                2054-1058
                13 August 2020
                November 2020
                : 7
                : 6 ( doiID: 10.1002/nop2.v7.6 )
                : 1988-1996
                Affiliations
                [ 1 ] SHARE – Centre for Resilience in Healthcare Faculty of Health Sciences University of Stavanger Stavanger Norway
                Author notes
                [*] [* ] Correspondence

                Eline Ree, SHARE – Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N‐4036 Stavanger, Norway.

                Email: eline.ree@ 123456uis.no

                Author information
                https://orcid.org/0000-0002-4268-5533
                Article
                NOP2592
                10.1002/nop2.592
                7544868
                33072384
                3256a505-4f84-40f6-815e-57e1df3405ac
                © 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 April 2020
                : 03 July 2020
                : 23 July 2020
                Page count
                Figures: 0, Tables: 4, Pages: 9, Words: 7072
                Funding
                Funded by: Norges Forskningsråd , open-funder-registry 10.13039/501100005416;
                Award ID: 256681
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                November 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.2 mode:remove_FC converted:08.10.2020

                home care services,job demands,job resources,nursing homes,patient safety culture,person‐centred care,transformational leadership

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