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17 For example, Clarke 18 pointed out that organizational climate refers to an atmosphere, which is a moveable set of perceptions related to working and practice conditions, many of which can be directly influenced by managers and organizational leaders. 16 Organizational climate has been likened to a weather pattern. Organizational climate refers to members’ shared perceptions of organizational features like decisionmaking, leadership, and norms about work, including opportunities for advancement and collaboration.
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14, 15 Organizational culture is typically thought of as evolving over the course of time and difficult to change. Culture broadly relates to the norms, values, beliefs, and assumptions shared by members of an organization or a distinctive subculture within an organization. Throughout the body of patient safety and occupational health literature, authors refer to concepts of organizational climate and culture as well as safety climate and culture. 13 Therefore, understanding organizational aspects that promote patient safety is also very important. 12 Furthermore, with increased discussions about pay-for-performance and mandatory reporting of certain adverse patient safety events, providers may have increased financial as well as other incentives to improve patient safety. 11 While in some instances there is extra payment made by insurers to hospitals for these adverse events, it has been estimated to be considerably less than the total cost of the resources used. Using Agency for Healthcare Research and Quality (AHRQ) patient safety indicators, researchers estimated the excess length of stay for postoperative sepsis to be approximately 11 days at a cost of almost $60,000 per patient. 10 Clearly, understanding organizational aspects that promote a stable workforce is important.īesides the obvious harm to patients, preventable adverse health care events related to patient safety have major financial consequences for the patient, the provider, the insurer, and often the family and/or caregivers. Using multiple databases in an academic medical center, other analysts found the low-end estimate for the cost of employee turnover accounted for greater than 5 percent of the annual operating budget. While these cost estimates rely on nurse manager reports of decreased productivity, clearly there are avoidable organizational monetary and human costs related to high turnover of desirable employees. 8 More recently, Jones 9 estimated the total turnover costs of one hospital-based RN to range from $62,000 to $67,000 depending on the service line. 7 Past estimates of the cost to replace one medical-surgical registered nurse (RN) range between $30,000 and $50,000 and replacement costs for critical care nurses are closer to $65,000. 6 These turnover rates are much higher than those for other health care professionals, which are estimated to average 2.3 percent per year. hospitals, nursing turnover has been reported to range from 15 percent to 36 percent per year.
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High turnover has been recognized as a problem in many service industries, including health care. Most important, improving the work environment may also improve the quality and safety of patient care. 3, 4 Improving the environment in which nurses work may attract new students to nursing as well as engage current professionals in developing innovative models of care delivery that will help retain and nurture future generations of nurses. 2 As noted in recent reports by the International Council of Nursing and the Institute of Medicine, one of the reasons for the current and future shortages of nurses relates to the work environment. economy, and nursing is the largest occupation within the industry, with more than 2.4 million jobs and the highest projected growth. Health care is the second-fastest growing sector of the U.S. As a result, researchers, policymakers, and providers have intensified their efforts to understand and change organizational conditions, components, and processes of health care systems as they relate to patient safety. The way to improve safety is to learn about causes of error and use this knowledge to design systems of care to “… make errors less common and less harmful when they do occur” 1 (p.78). Maintaining a safe environment reflects a level of compassion and vigilance for patient welfare that is as important as any other aspect of competent health care.