Exploring Workload, Teamwork, and Quality of Care: A Study of Patient Safety Culture in Medical Offices in the United States

Abstract
Title of Thesis: Exploring Workload, Teamwork, and Quality of Care: A Study of Patient Safety Culture in Medical Offices in the United States
Author: Osmarly SEJOUR
Thesis advised by: Nai-Wen Kuo (Dean of College of Management, Director of Research Center for Global Health Security at Taipei Medical University, Professor in School of Health Care Administration)

Background: Patient safety has emerged as a prominent concern over the past few decades, with a strong emphasis on improving safety and quality of care to reduce adverse health outcomes. Patient safety as a comprehensive framework encompasses various activities, processes, behaviors, and technologies to mitigate risks and minimize avoidable harm as much as possible. Therefore, a patient safety culture is a proactive strategy to manage risks and ensure adequate adherence to care standards. Several measures and criteria have been developed to evaluate healthcare services and their influential factors. The Agency for Healthcare Research and Quality (AHRQ) is one of the notable institutions providing assessment tools for patient safety culture. These provided assessment tools evaluate critical influencing factors such as workload and teamwork.
Purpose: The main objective of this thesis was to retrospectively investigate the interrelationships between workload, teamwork, and quality of care within the context of patient safety culture in medical offices across the United States by using data from the AHRQ database for medical offices from 2017 to 2022.
Method: Secondary analysis of data from the AHRQ database over 2 periods. The variables under investigation encompass overall perceptions of patient safety, overall ratings of quality of care, work pressure and pace, teamwork, staff position, tenure, and hours worked from 2017 to 2022. The 2020 dataset represents the pre-pandemic, and the 2022 dataset represents the pandemic period. This research focused on medical offices as the selected healthcare facilities. We used SAS version 9.4 to perform the statistical analysis.
Results: We analyzed data from 12869 respondents in the 2020 dataset and 18240 respondents in the 2022 dataset to test our hypotheses. We tested our hypotheses by performing bivariate analysis using simple linear regression or ANOVA models. Our findings show that factors such as work pressure and pace, teamwork, tenure, and staff position are significantly associated with the overall perceptions of patient safety and quality and the ratings on the quality of care and patient safety. These results held for both periods, with all p<0.001, which is less than our significance level of 0.05. However, we observed that the number of hours worked weekly was not associated with the overall perceptions of patient safety and quality in either period. The p-values were 0.181 in 2020 and 0.503 in 2022. Nevertheless, it was associated with the overall quality of care and patient safety ratings. We also found that the R2 or η2 values varied between the two periods for each tested hypothesis, indicating differences in the proportion of variance explained by the models in each period despite the consistent p-values.
Conclusion: The results of this study emphasize the significant association of work pressure and pace with the healthcare professionals' perceptions of safety and care quality. However, the number of hours worked per week is not associated with these perceptions substantially. This suggests that when employees feel overwhelmed, stressed, or rushed, it negatively affects how they view the care they provide and their ability to maintain safety standards. These findings indicate that the working conditions, such as pressure and pace, are more crucial than the hours worked. Therefore, it is essential to continuously implement strategies to optimize staffing, improve workflow management, and provide adequate support to reduce stress and maintain a manageable work pace, along with training and policies on stress and time management.
Keywords: workload, work intensity, work pressure, work pace, teamwork, quality of care, patient safety, patient safety culture.