Mortality Rates

The diffusion of a culture of openness in hospitals is associate with lower hospital mortality, according to a study conduct among 137 acute trusts in England by Veronica Toffolutti (Bocconi University and London School of Hygiene & Tropical Medicine) and David Stuckler (Bocconi University) published in Health Affairs.

The number of deaths

Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scale to the size of that population, per unit of time. Mortality rate is typically express in units of deaths per 1,000 individuals per year; thus, a mortality rate of 9.5 (out of 1,000) in a population of 1,000 would mean 9.5 deaths per year in that entire population, or 0.95% out of the total.

Hospital openness, define as an environment in; which staff freely speak up if they see something that may negatively affect a patient and feel free to question those with more authority; hence has already link with many positive outputs, such as better patient safety or better understanding of patients’ care goals; but this is the first time that an association with mortality rates has demonstrate.

The authors link data on hospital mortality rates with hospital openness scores; so for 137 acute trusts in England in the period 2012-14. They use the Summary Hospital-level Mortality Indicator (SHMI) as a measure of mortality; also design a standardize openness indicator that draws on staff surveys from the Picker Institute Europe’s National Staff Survey. (An acute trust is an organization within the English NHS; so that includes one or more hospitals providing secondary health care services).

Lower mortality rates

Two positive findings were highlight in the study. First, fostering openness translates into lower mortality rates; hence a one-point increase in the standardize openness score is associate with a 6.48 percent decrease in hospital mortality rates. Second, as far England is concern; so openness is increasing: the score was 13.63 in 2012 and 16.49 in 2014.
Part of the effect is due to the higher responsiveness of open organizations; so the correlation between the standardize openness indicator and the percentage of staff reporting that the trust took action after an error is very high (0.84). The single component of our indicator that most affects mortality rates is good hospital procedures for reporting errors, near misses, and incidents», Dr. Toffolutti says & laquo Moreover, as defensive medical practices could stymie openness», she continues.
Laquo preventing the blame game that holds practitioners responsible for errors; so in favor of institutional responsibility, could help the shift to a greater culture of openness. The results show that greater openness in the English NHS corresponds to improve health care quality and suggests that the reforms undertaken since 2016 – in part as a consequence of the results of the 2013 Francis Inquiry – are a step in the right direction.