Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

The impact of nurse working hours on patient safety culture: a cross-national survey including Japan, the United States and Chinese Taiwan using the Hospital Survey on Patient Safety Culture

Yinghui Wu1, Shigeru Fujita1, Kanako Seto1, Shinya Ito1, Kunichika Matsumoto1, Chiu-Chin Huang2 and Tomonori Hasegawa1*

Author Affiliations

1 Division of Health Policy & Health Service Research, Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan

2 Department of Senior Citizen Service Management, Ming-Hsin University of Science and Technology, Hsinchu, Taiwan

For all author emails, please log on.

BMC Health Services Research 2013, 13:394  doi:10.1186/1472-6963-13-394

Published: 7 October 2013

Abstract

Background

A positive patient safety culture (PSC) is one of the most critical components to improve healthcare quality and safety. The Hospital Survey on Patient Safety Culture (HSOPS), developed by the US Agency for Healthcare Research and Quality, has been used to assess PSC in 31 countries. However, little is known about the impact of nurse working hours on PSC. We hypothesized that long nurse working hours would deteriorate PSC, and that the deterioration patterns would vary between countries. Moreover, the common trends observed in Japan, the US and Chinese Taiwan may be useful to improve PSC in other countries. The purpose of this study was to clarify the impact of long nurse working hours on PSC in Japan, the US, and Chinese Taiwan using HSOPS.

Methods

The HSOPS questionnaire measures 12 sub-dimensions of PSC, with higher scores indicating a more positive PSC. Odds ratios (ORs) were calculated using a generalized linear mixed model to evaluate the impact of working hours on PSC outcome measures (patient safety grade and number of events reported). Tukey’s test and Cohen’s d values were used to verify the relationships between nurse working hours and the 12 sub-dimensions of PSC.

Results

Nurses working ≥60 h/week in Japan and the US had a significantly lower OR for patient safety grade than those working <40 h/week. In the three countries, nurses working ≥40 h/week had a significantly higher OR for the number of events reported. The mean score on ‘staffing’ was significantly lower in the ≥60-h group than in the <40-h group in all the three countries. The mean score for ‘teamwork within units’ was significantly lower in the ≥60-h group than in the <40-h group in Japan and Chinese Taiwan.

Conclusions

Patient safety grade deteriorated and the number of events reported increased with long working hours. Among the 12 sub-dimensions of PSC, long working hours had an impact on ‘staffing’ and ‘teamwork within units’ in Japan, the US and Chinese Taiwan.

Keywords:
Patient safety; Patient safety culture; Nurse working hours; Adverse events