Executive VP and CEO, UTMB Health System

Dissertation Title

Assessing system congruence by analyzing the relationship between employee and patient driven outputs.

Dissertation Abstract

Patients are at risk for employee driven preventable adverse events during hospital stays. These adverse events are varied and include such things as medication errors, pressure ulcers, hospital acquired infections, and falls. Preventable adverse events continue at alarming frequency despite significant academic, regulatory, and management attention to the topic over the past 14 years since the Institute of Medicine's (IOM) To Err is Human report. In addition to being at risk for preventable adverse events, patients experience aspects of the health care system such as ease of access, employee attitude, skill and efficiency of staff, and perceived value. Although purporting to measure different aspects of the care experience, preventable adverse events and patient perceptions are both outputs of the health care system.

Based on the open systems theory, the organizational congruence model suggests that the non-desired outputs of the system (e.g., preventable adverse events and less-than-expected patient experiences) are due to a lack of system congruence or fit among the tasks performed, the staff performing the tasks, and the formal and informal structures. Using data from Denver Health, a large academic safety net hospital in Denver, CO, this study found that these two system outputs were significantly correlated. The study further found that using multiple regression a statistically significant predictive model could be constructed with patient perceptions of care as the DV and preventable adverse events as the IV while controlling for select explanatory variables. Finally, the study determined that preventable adverse events fully or partially mediated select RN staffing control variables correlation with patient experience.

These findings suggest that at Denver Health good inpatient service is not divorced from good clinical quality. Management, therefore, would be well-advised to study patient experience and preventable adverse event data in combination in order to better understand important insights from one aspect of care that may help them improve another.