Towards a Quality Care Climate Perspective: A Systematic Review of Associations Among Patient Experience, Patient Outcomes, and Organisational Climate Factors in Hospitals

TL;DR

This review explores how hospital climate factors affect patient experiences and outcomes, finding mostly positive relationships and suggesting a need for a comprehensive quality care framework.

Contribution

The study proposes a new quality care climate framework based on patient perspectives and identifies gaps in current research methods.

Findings

Positive associations were found between patient experience and patient outcomes.

The review highlights the need for a unified theory on quality-oriented care climate.

Longitudinal studies linking subjective and objective patient outcomes are recommended.

Abstract

Objective (study question): The main purpose of this systematic review was to conduct a qualitative synthesis of quantitative studies among patient experience, patient outcomes, and organisational climate factors. The review sought to answer the following research questions: (i) What are the main directions, dominant methods, and theories on the associations among these concepts? (ii) What theoretical propositions can be made? Data sources/study setting (w/hospital/institution setting anonymised): The study involved a search for literature in PubMed, PsychINFO, Medline, CINAHL, Academic Search Premier, Scopus, and Web of Science between 2007 and 2022 with the guidance of a librarian. The search was limited to English language and to human adult inpatients. Study design: This study primarily employed a systematic review method, following the guidelines in the PRISMA statement. Data collection/extraction methods: Articles were screened and excluded first on title and abstract, and then on fulltexts. Quality assessments were done on remaining articles using the National Institutes of Health (NIH) quality assessment tool for observational, cohort and cross-sectional studies. Data was extracted from articles that met the inclusion criteria and passed the checks. Principal findings: The search identified 11,571 records that were checked for duplications. After removing duplicates and applying the eligibility criteria, a final list of 220 articles were included for the qualitative synthesis. Results showed that the relationships among the concepts were more conclusive and generally positive rather than negative, especially between patient experience and patient outcomes. The review, however, showed areas that required more attention such as an encompassing quality-oriented care climate theory, validation of patient-reported instruments, and longitudinal studies linking subjective patient outcomes to objective patient outcomes. Conclusions: The review shows that conclusions can be drawn on the relationships among the variables, indicating that favourable factors in the hospitals, as perceived by patients, have positive implications for patient experiences and their outcomes. Based on this, an argument for an encompassing framework on quality care climate from the patients’ perspectives was made to enhance understanding of these relationships. Limitations: Among others, this review is limited by the search restriction to quantitative studies or studies that employed mainly quantitative tools to assess associations or changes. Funding: This study received no external funding. Registration: PROSPERO ID- CRD42021291787.

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