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Improving work environments in health care: Test of a theoretical framework

Rathert, Cheryl; Ishqaidef, Ghadir; May, Douglas R.

doi: 10.1097/HMR.0b013e3181abce2b

Background: In light of high levels of staff turnover and variability in the quality of health care, much attention is currently being paid to the health care work environment and how it potentially relates to staff, patient, and organizational outcomes. Although some attention has been paid to staffing variables, more attention must be paid to improving the work environment for patient care.

Purposes: The purpose of this study was to empirically explore a theoretical model linking the work environment in the health care setting and how it might relate to work engagement, organizational commitment, and patient safety. This study also explored how the work environment influences staff psychological safety, which has been show to influence several variables important in health care.

Methodology: Clinical care providers at a large metropolitan hospital were surveyed using a mail methodology. The overall response rate was 42%. This study analyzed perceptions of staff who provided direct care to patients.

Findings: Using structural equation modeling, we found that different dimensions of the work environment were related to different outcome variables. For example, a climate for continuous quality improvement was positively related to organizational commitment and patient safety, and psychological safety partially mediated these relationships. Patient-centered care was positively related to commitment but negatively related to engagement.

Practice Implications: Health care managers need to examine how organizational policies and practices are translated into the work environment and how these influence practices on the front lines of care. It appears that care provider perceptions of their work environments may be useful to consider for improvement efforts.

Cheryl Rathert, PhD, is Assistant Professor, Health Services Management, Senior Scholar, Center for Health Ethics, School of Medicine, University of Missouri, Columbia. E-mail:

Ghadir Ishqaidef, BA, is PhD Student, The School of Business, The University of Kansas, Lawrence. E-mail:

Douglas R. May, PhD, is Professor and Co-Director, International Center for Ethics in Business, The School of Business, The University of Kansas, Lawrence. E-mail:

This article awarded Best Paper for the 2008 Annual Meeting of the Academy of Management, Health Care Management Division, August 8-3, 2008, Anaheim, California. This research was funded by a University of Missouri, Columbia, Research Council grant, and the University of Missouri Center for Health Care Quality provided additional support.

© 2009 Lippincott Williams & Wilkins, Inc.