The Impact of Organizational Context and Structure on Patient Safety Outcomes

Friday, 3 August 2012: 8:30 AM

Chang-Chiao Hung, PhD
Department of Nursing, Chang Gung University of Science and Technology, ChiaYi, Taiwan

Learning Objective 1: The learner will be able to know organizational and structural characteristics that have been shown to affect patient safety.

Learning Objective 2: The learner will be able to get directions in developing a nursing practice structure.


Although efforts to identify factors that influence patient safety have focused on the organizational level (macro-level), only a few studies have been conducted. Thus, there is limited information on patient safety based on a macro-level perspective. This study was conducted to explore the relationships between macro-level factors and patient safety.


Structural contingency theory was used as the framework for the study. A cross-sectional design was used and data were collected through self-administered questionnaires. A total of 1,300 staff nurses and 64 head nurses who worked in one medical center and two local hospitals in southern Taiwan were invited to participate in the study. The survey package was distributed to head nurses and nurses. After filling out the questionnaire, the participants returned questionnaire by sending to the researcher. Data were aggregated from the individual to the unit level, and path analysis of structural equation modeling (SEM) was used to examine the hypothesized model.


Sixty-two head nurses (96.8%) and 977 staff nurses (72%) completed and returned the questionnaire. Reliabilities for all instruments used in the current study ranged from 0.71 to 0.83. Eta-squared coefficient (h2), inter-item consistency (rwg), and F ratio showed that data at the individual level were appropriate to aggregate to the unit level. Path analysis shown significant positive relationship between professional autonomy and medication errors (b = .25,p< .05), and professional autonomy enhances the effect of unit size on medication errors. No relationship was found between participation in decision making and formalization and patient safety.


This study provides support for the use of macro-level approaches to examine patient safety issues, and also provide some direction for head nurses in developing a nursing practice structure.