Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes

PurposeWe used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units.MethodsUsing a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days. Patient outcome data were collected via a separate survey. Results of the staff survey were used to represent the communication networks for each unit in ORA. We then used ORA's analysis capability to generate communication metrics for each unit. ORA's visualization capability was used to better understand the metrics.ResultsWe identified communication patterns that correlated with two safety (falls and medication errors) and three quality (e.g., symptom management, complex self care, and patient satisfaction) outcome measures. Communication patterns differed substantially by shift.ConclusionThe results demonstrate the utility of ORA for healthcare research and the relationship of nursing unit communication patterns to patient safety and quality outcomes.

It is well known that communication issues contribute to errors in health care, but most research has focused on person-to-person communication (e.g., doctor–nurse). Social network analysis can be used to study small group communication, but it is not adequate for large groups. We used ORA, a dynamic network analysis tool, to study communication networks on nursing units and how they might affect patient quality and safety outcomes. The study, which was conducted in 7 nursing units in 3 southwestern hospitals, found that specific communication patterns (as measured by ORA metrics) corresponded to high or low levels of patient safety and quality outcomes. However, the patterns differed for specific outcomes, suggesting that an intervention that might modify the communication pattern to improve a particular patient outcome might actually make another outcome worse.