Do hospital standardized mortality ratios measure patient safety? HSMRs in the Winnipeg Regional Health Authority.
ABSTRACT The Canadian Institute for Health Information began publishing hospital standardized mortality ratio (HSMR) data for select Canadian hospitals in November 2007. This paper describes the experience of the Winnipeg Regional Health Authority in assessing the validity of the HSMR through statistical analysis, coding definitions and chart audits. We found a lack of empirical evidence supporting the use of the HSMR in measuring reductions in preventable deaths. We also found that limitations in standardization as well as differences in palliative care coding and place of death make inter-facility comparisons of HSMRs invalid. The results of our chart audit show that the HSMR is not a sensitive measure of adverse events as defined by "unexpected death" in the Canadian Adverse Events Study. It should not be viewed as an important indicator of patient safety or quality of care. We discuss the cumulative sum statistic as an alternative to the HSMR in monitoring in-hospital mortality.
- SourceAvailable from: May Nawal Lutfiyya
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ABSTRACT: This study investigates the mediation effects of the four components of psychological empowerment on the relationship between high performance work systems (HPWS) and perceptions of patient care quality among hospital employees. To test this relationship 541 hospital employees in a large regional Australian health service were surveyed. Regression analysis findings demonstrated that psychological empowerment fully mediated the relationship between HPWS and the perception of the quality of patient care. Three of the four individual components of psychological empowerment — autonomy, competence and meaning — fully mediated the relationship between HPWS and the perception of quality of care; the fourth — impact — was non-significant. This study demonstrates the need to recognise that the quality of patient care is influenced not only by clinicians but also by allowing all hospital employees to exercise concern through their work. Healthcare managers need to focus on ensuring HRM strategy, policy and processes support the implementation of HPWS at the unit level.Asia Pacific Journal of Human Resources 11/2010; 48(3):319-337. · 0.86 Impact Factor