The Influence of Hospital Physician Integration on Culture of Patient Safety.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101233393 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1549-8425 (Electronic) Linking ISSN: 15498417 NLM ISO Abbreviation: J Patient Saf Subsets: MEDLINE

Original Publication: Philadelphia, Pa. : Lippincott Williams & Wilkins, c2005-

Patient Safety* ; Organizational Culture* ; Safety Management*/organization & administration; Humans ; Cross-Sectional Studies ; United States ; Communication ; Medical Errors/prevention & control ; Physicians/psychology ; Physicians/statistics & numerical data ; Leadership

Background: Medical errors are responsible for a large number of deaths every year in the Unites States. Hospitals use various strategies including leadership, staffing, and structural changes to deal with this concerning issue. Hospital physician integration is a structural strategy to possibly improve patient safety. Using the conceptual lens of Donabedian's Structure Process Outcome model, this study aims to investigate how hospital physician integration affects organizational, management, and communication attributes of patient safety culture.
Methods: A pooled cross sectional study design using the Hospital Survey on Patient Safety Culture, the American Hospital Association data, and Area Health Resource File was used to analyze the relationship between hospital physician integration and organizational and management patient safety culture attributes. The dataset comprised of hospital level data from 2021 and 2022 for patient safety culture and hospital characteristics and contained a final sample of 205 observations. The independent variable was levels of integration across five levels. Three attributes of safety culture were chosen-positive perceptions of communication openness, organizational learning, and hospital management support for patient safety. The control variables were organizational characteristics. Multivariable linear regression was used as the analytic method.
Results: Findings demonstrated a statistically significant correlation between higher level of hospital physician integration and positive perceptions of hospital management support for patient safety. There are 0.063 higher positive perceptions of hospital management support for patient safety for higher levels of integration compared with lower levels of integration ( P < 0.05). Perceptions of communication openness and organizational learning did not demonstrate a statistically significant correlation with any level of hospital physician integration.
Conclusions: Hospital physician integration and hospital management support for patient safety were moderately but significantly related. Hospital physician integration allows resources to become available for physician. As physicians take on management roles management of resources and eventually performance can improve, there is a need for future research in this area to examine if integration is a step in the right direction to overcome the challenges of patient safety and if investments in resources and training can be beneficial to safety culture.
Competing Interests: The authors report no conflict of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Agency for Healthcare Research and Quality. What Is Patient Safety Culture? Rockville, MD: Agency for Healthcare Research and Quality. Available at: https://www.ahrq.gov/sops/about/patient-safety-culture.html . Accessed July 1, 2024.
Burman M, Newman S, Fildes B. Evaluating the effectiveness of workplace interventions in improving safety culture: a systematic review. Saf Sci . 2019;115:376–392.
Churruca K, Ellis LA, Pomare C, et al. Dimensions of safety culture: a systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals. BMJ Open . 2021;11:e043982.
Kakemam E, Ghafari M, Rouzbahani M, et al. The association of professionalism and systems thinking on patient safety competency: a structural equation model. J Nurs Manag . 2022;30:817–826.
Wagner A, Rieger MA, Manser T, et al. Healthcare professionals’ perspectives on working conditions, leadership, and safety climate: a cross-sectional study. BMC Health Serv Res . 2019;19:53.
Amado GC, Ferreira DC, Nunes AM. Vertical integration in healthcare: what does literature say about improvements on quality, access, efficiency, and costs containment? Int J Health Plann Manage . 2022;37:1252–1298.
Upadhyay S, Weech-Maldonado R, Opoku-Agyeman W. The effects of hospital-physician financial integration on adverse incident rate: an agency theory perspective. Health Serv Manage Res . 2021;34:199–207.
Heeringa J, Mutti A, Furukawa MF, et al. Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures. Int J Integr Care . 2020;20:2.
Weiner J. Physician-Hospital Relationships: Integration ≠ Alignment . Philadelphia, PA. Penn LDI Leonard Davis Institute of Health Economics; 2018. Available at: https://ldi.upenn.edu/our-work/research-updates/physician-hospital-relationships-integration-%E2%89%A0-alignment/ . Accessed June 10, 2024.
Rep. Rangel CB [D N 15. H.R.3590 - 111th Congress (2009-2010): Patient Protection and Affordable Care Act. CONGRESS.GOV. 2010. Available at: https://www.congress.gov/bill/111th-congress/house-bill/3590 . Accessed June 11, 2024.
Morrisey MA, Alexander JA, Ohsfeldt RL. Physician integration strategies and hospital output. A comparison of rural and urban institutions. Med Care . 1990;28:586–603.
Kane-Urrabaza C. Management’s role in shaping organizational culture. J Nurs Manag . 2006;14:188–194.
Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect hospital quality, operational efficiency, and financial performance? Health Care Manage Rev . 2019;44:256–262.
Lammers E. The effect of hospital-physician integration on health information technology adoption. Health Econ . 2013;22:1215–1229.
Burns LR, Muller RW. Hospital-physician collaboration: landscape of economic integration and impact on clinical integration. Milbank Q . 2008;86:375–434.
Post B, Buchmueller T, Ryan AM. Vertical integration of hospitals and physicians: economic theory and empirical evidence on spending and quality. Med Care Res Rev . 2018;75:399–433.
Lemieux-Charles L, Leatt P. Hospital-physician integration: case studies of community hospitals. Health Serv Manage Res . 1992;5:82–98.
Lin H, McCarthy I, Richards M, Whaley C. Owning the Agent: Hospital Influence on Physician Behaviors . NBER Working Paper No. 28859. Cambridge, MA: National Bureau of Economic Research; 2021.
Tawfik DS, Scheid A, Profit J, et al. Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis. Ann Intern Med . 2019;171:555–567.
Moore L, Lavoie A, Bourgeois G, et al. Donabedian’s structure-process-outcome quality of care model: validation in an integrated trauma system. J Trauma Acute Care Surg . 2015;78:1168–1175.
Jia H. Hospital-Physician Integration and Physician Collaboration: Implications for Care Efficiency and Outcomes. PhD dissertation, University of Tennessee . Published online 2022.
Blegen MA, Gearhart S, O’Brien R, et al. AHRQ’s hospital survey on patient safety culture: psychometric analyses. J Patient Saf . 2009;5:139–144.
Campione J, Famolaro T. Promising practices for improving hospital patient safety culture. Jt Comm J Qual Patient Saf . 2018;44:23–32.
Famolaro T, Yount N, Burns W, et al. Hospital Survey on Patient Safety Culture: 2016 User Comparative Database Report . Rockville, MD. PSNet Patient Safety Network; 2014. Available at: https://psnet.ahrq.gov/issue/hospital-survey-patient-safety-culture-2016-user-comparative-database-report . Accessed July 1, 2024.
Upadhyay S, Stephenson AL, Smith DG. Readmission rates and their impact on hospital financial performance: a study of Washington hospitals. Inquiry . 2019;56:004695801986038.
StataCorp. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC; 2023.
Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Serv Res . 2014;14:61.
Cole DA, Bersick E, Skarbek A, et al. The courage to speak out: a study describing nurses’ attitudes to report unsafe practices in patient care. J Nurs Manag . 2019;27:1176–1181.
Miller J. What happens when private equity takes over a hospital. Available at: https://hms.harvard.edu/news/what-happens-when-private-equity-takes-over-hospital . Accessed July 10, 2024.
Post B, Hollenbeck BK, Norton EC, et al. Hospital-physician integration and clinical volume in traditional Medicare. Health Serv Res . 2024;59:e14172.
Lyman B, Jacobs JD, Hammond EL, et al. Organizational learning in hospitals: a realist review. J Adv Nurs . 2019;75:2352–2377.
Little D, Hardwick M, Graham R, et al. Learning from error: a nuclear medicine events and learning meeting. Nucl Med Commun . 2022;43:855–859.
Cuellar AE, Gertler PJ. Strategic integration of hospitals and physicians. J Health Econ . 2006;25:1–28.
Machta RM, Maurer KA, Jones DJ, et al. A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes. Health Care Manage Rev . 2019;44:159–173.
Goes JB, Zhan C. The effects of hospital-physician integration strategies on hospital financial performance. Health Serv Res . 1995;30:507–530.
Alexander JA, Morrisey MA. Hospital-physician integration and hospital costs. Inquiry . 1988;25:388–401.
National Steering Committee for Patient Safety. Institute for Healthcare Improvement. Available at: https://www.ihi.org/networks/initiatives/national-steering-committee-patient-safety . Accessed July 2, 2024.

Date Created: 20241014 Date Completed: 20241120 Latest Revision: 20241120

20241120

10.1097/PTS.0000000000001280

39400202