The Impact of Internal Service Quality on Nurse Inefficiency and Medical Errors

Abstract

Despite over a decade of attention on reducing medical errors sparked by the Institute of Medicine report, medical errors in hospitals remain prevalent. A plethora of potential solutions are suggested, yet their adoption rate is slow, partly due to implementation challenges, such as the tradeoff between efficiency and safety. Drawing on the theories of swift, even flow and conservation of resources, we propose a new avenue for addressing medical errors — improving internal service quality (ISQ), which is the quality of service provided by support departments such as housekeeping, and materials management. Using 13 months of panel data from five nursing units that gather weekly data on ISQ delivered by 11 support departments, we find that a one standard deviation increase in ISQ is associated with nearly two fewer patients who suffer a hospital-acquired pressure ulcer or patient fall on a unit each month, which equates to near elimination of those two types of medical errors. The one standard deviation increase in ISQ is further associated with a 5% reduction in nurse inefficiency and a financial benefit as high as $7 million if the increased nurse efficiency could be converted into additional patient days. Our paper makes a theoretical contribution to health care performance improvement literature by demonstrating that improving ISQ can simultaneously reduce medical errors and nurse inefficiency. From a practice standpoint, as support staff have lower wages than nurses, improving ISQ can be a cost effective strategy for hospital managers seeking to reduce inefficiency and medical errors.

Keywords: internal service quality, medical errors, productivity, panel data