Background: Delivering high reliable safe care within complex health systems has become a global priority. Limited efforts have been made on improving nursing care in order to optimize the outcomes of acute patient care in Malaysia.
Aim of the study/ Purpose: This study empirically investigated the impact of hospital nurse staffing and work environment on the quality of care and patient safety in medical surgical wards in Malaysian private hospitals. The mediating effect of patient-centeredness on the quality of care and patient safety was also investigated.
Procedures/ Methods: A cross-sectional survey was carried out on 12 hospitals. Data was collected from 652 nurses via questionnaires. Multi-stage stratified sampling was used. Hayes SPSS-macro regression analyses were conducted to explore the mediating effects of patient-centeredness between the relationships of hospital nurse staffing and work environment on care outcomes. Staffing refers to duty length and patient ratio. Nurses asked to indicate the duty length and the total number of patients assigned to them in their last working shift. Items developed by Planetree and Picker Institutes have been used for measuring patient-centered care. The work environment construct was measured using the PES-NWI, which is validated internationally. The outcomes of care refer to the quality and patient safety metrics. Nurses were asked to rate the overall quality of care, level of patient safety and presence of medical error. A five-point scale with 95% confidence interval and 0.05 p value were considered significant.
Results: Patient-centeredness mediated the effect of hospital nurse staffing on both the quality (F=2.97, P=0.000, Beta coefficient of Path b= 0.74) and patient safety (F=2.97, P=0.000, Beta coefficient of Path b= 0.62). Patient-centeredness mediated the effect of nurse work environment on both the quality (F=67.65, P=0.000, Beta coefficient of Path b= 0.42) and patient safety (F=67.65, P=0.000, Beta coefficient of Path b= 0.43).
Conclusion: Patient-centered care is a positive mediator and showed a dual function; it supressed the effect of staffing up to a point and complements the effect of work environment on care outcomes. Patient-centeredness helps to mitigate some of the negative effects of hospital nurse staffing inadequacy and working long shifts on the outcomes of care. The study provides an input for hospital managers, leaders, decision-makers that nurse to be assigned for less than 10 patients and working less than 10 hour shifts (8 hours shift type is recommended) in Malaysian hospitals. Further, policymakers need to maintain adequate staffing, healthy work environments, and to instill the culture of patient-centeredness in order to deliver high quality and safer care.