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Table 3 Key findings for organisational-wide interventions

From: Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review

Extracted organisational factors Interventions Patient outcomes Process outcomes Organisational factors correlated with patient outcomes
Staff morale and organisational climate [31, 32] Multi-faceted patient safety Improved monitoring of vital signs [32] Significant improvement in one measure of staff perception of organisational climate (p < 0.01) [32] None reported
Significant improvement in one measure of patient satisfaction (cleanliness of the bathrooms) in the intervention hospitals [32].
Significant decrease in one measure of staff perception of organisational climate (p < 0.01) [31]
Organisational culture [35] Electronic health record Decrease of 16% in Clinical quality indicator (CQI) for initial antibiotic dose within 4 h of hospital arrival for pneumonia patients (p < 0.001) between intervention and follow-up. Decrease of 3% in CQI for chest pain pathway-discharged within 23 h of admission (p < 0.023) for one of three hospitals between intervention and follow-up [35]. Least-squares adjusted means for group culture decreased from 21.8 to 20.0 after 12 months [35] Several strong (>0.94) correlations between changes in culture scores and changes in quality indicators at three acute care facilities [35]
Least-squares adjusted means for hierarchical culture increased from 30.0 to 31.9 after 12 months (change only significant in one of five hospitals for group culture and two of five hospitals for hierarchical culture) [35]
Appropriate discharge of patients with chest pain negatively correlated with developmental culture [35]
Use of antibiotics within 4 h of admission positively associated with rational culture and quality management, and negatively related to group culture and human resource utilisation [35]
Decreased patient satisfaction for two of three hospitals between intervention and follow-up (1%, p < 0.003 and 2%, p < 0.019)[35].
Patient satisfaction positively correlated with group culture and negatively correlated with rational culture [35]
Patient safety culture [33, 34, 37] Hand hygiene National incidence rates of methicillin resistant SAB were stable for the 18 months prior to NHHI (Jul 2007–2008; p = 0.366) but declined after implementation (2009–2010; p = 0.008) [33] For sites new to ‘5 Moments’ audit tool, hand hygiene compliance increased from 43.6% to 67.8% after 2 years (P < 0.001) [33] None reported
Multi-faceted patient safety
Reduction in nosocomial infections associated with MRSA and VRE in the intervention hospital between baseline and follow up phases for were both significantly greater than change in comparison hospital (P < 0.0001) [37] Frequency of hand washing in study hospital was more than double that in control at 6 month follow-up [37]
During initial phase of the interventions, results from safety culture survey worsened. However, as initiative progressed, there was improvement [34]
Following the intervention, SSEs per 10,000 adjusted patient days significantly decreased from a mean of 0.9 to 0.3 (p < 0.0001). Days between SSEs increased from a mean of 19.4 to 55.2 (p < 0.0001) [34]
Organisational and clinical Leadership [3135, 37] Multi-faceted patient safety Improved monitoring of vital signs [32] Least-squares adjusted means for leadership showed decrease in the leadership scale after 12 months of electronic health record implementation from 3.63 to 3.54, but only significant (p < 0.05) in one of five hospitals [35] None reported
Hand hygiene Significant improvement in one measure of patient satisfaction (cleanliness of the bathrooms) in the intervention hospitals [32].
Electronic health record
National incidence rates of methicillin resistant SAB were stable for the 18 months prior to NHHI (Jul 2007–2008; p = 0.366) but declined after implementation (2009–2010; p = 0.008) [33]
Following the intervention, SSEs per 10,000 adjusted patient days significantly decreased from a mean of 0.9 to 0.3 (p < 0.0001). Days between SSEs increased from a mean of 19.4 to 55.2 (p < 0.0001) [34]
Decrease of 16% in Clinical quality indicator (CQI) for initial antibiotic dose within 4 h of hospital arrival for pneumonia patients (p < 0.001) between intervention and follow-up. Decrease of 3% in CQI for chest pain pathway-discharged within 23 h of admission (p < 0.023) for one of three hospitals between intervention and follow-up [35].
Decreased patient satisfaction for two of three hospitals between intervention and follow-up (1%, p < 0.003 and 2%, p < 0.019) [35].
Reduction in nosocomial infections associated with MRSA and VRE in the intervention hospital between baseline and follow up phases for were both significantly greater than change in comparison hospital (P < 0.0001) [37]
Education, training and assessment [3135, 37] Multi-faceted patient safety Improved monitoring of vital signs [32] Standardised hand hygiene ‘5 moments’ auditing tool and audit training implemented across hospitals [33] None reported
Hand hygiene
Electronic health record
Significant improvement in one measure of patient satisfaction (cleanliness of the bathrooms) in the intervention hospitals [32]. Least-squares adjusted means for human resources utilisation after 12 months of electronic health record implementation increased for two of the five hospitals (from 3.05 to 3.18 and from 3.38 to 3.57, respectively (P < 0.05)) [35]
National incidence rates of methicillin resistant SAB were stable for the 18 months prior to NHHI (Jul 2007–2008; p = 0.366) but declined after implementation (2009–2010; p = 0.008) [33]
Decrease of 16% in Clinical quality indicator (CQI) for initial antibiotic dose within 4 h of hospital arrival for pneumonia patients (p < 0.001) between intervention and follow-up. Decrease of 3% in CQI for chest pain pathway-discharged within 23 h of admission (p < 0.023) for one of three hospitals between intervention and follow-up [35].
Decreased patient satisfaction for two of three hospitals between intervention and follow-up (1%, p < 0.003 and 2%, p < 0.019) [35].
Reduction in nosocomial infections associated with MRSA and VRE in the intervention hospital between baseline and follow up phases for were both significantly greater than change in comparison hospital (P < 0.0001) [37]
Promoting and awareness of the intervention [33, 34] Multi-faceted patient safety National incidence rates of methicillin resistant SAB were stable for the 18 months prior to NHHI (Jul 2007–2008; p = 0.366) but declined after implementation (2009–2010; p = 0.008) [33] None reported None reported
Hand hygiene  
   Following the intervention, SSEs per 10,000 adjusted patient days significantly decreased from a mean of 0.9 to 0.3 (p < 0.0001). Days between SSEs increased from a mean of 19.4 to 55.2 (p < 0.0001) [34]