Report: Gap Widens in Patient Perceptions of Inpatient vs. Outpatient Safety
While patient perceptions in outpatient settings are rising, nearly half of all staff and almost one-third of inpatients report low perceptions of safety, according to Press Ganey data. Reports of violence against nurses are also rising.
Press Ganey conducts surveys that help healthcare organizations improve the safety, quality and experience of patient care. The new report analyzes Press Ganey's integrated dataset of safety outcomes, event reporting, workforce culture, and patient perceptions representing 12 million patient encounters, 1 million healthcare employees, as well as over 550,000 reported safety events in 2023.
Key findings from the report include:
The gap in patient perceptions of safety in inpatient and outpatient settings is now 2.5 times wider than pre-pandemic. While patients in medical practices and ambulatory settings felt substantially safer in 2023 (81.9 percent) compared to pre-pandemic levels (78.1 percent), perceptions of safety in hospitals continue to fall. In 2023, only 68.5 percent of hospital patients felt “very safe,” a 5.1 percent decline over the same period.
Following record lows in 2021, workplace safety culture is increasing. Employee views of safety within their organization have risen 1.2 percent over the last two years, including the belief that there is adequate unit staffing and that mistakes can be reported without fear, but nearly half of employees still report low perceptions of safety culture—with a large gap between how senior management (4.53) and nurses (3.95) perceive safety culture.
Reported assaults against nursing personnel saw a 5 percent increase year over year. In 2023, the rate of reported assaults against nurses increased to 2.71 per 100 nursing personnel, from 2.59 in 2022. While this might indicate a growing willingness to report incidents, the 16,975 assaults on record last year averaged to 1.89 per hour.
Safety outcomes show continued momentum. The biggest improvement was seen in catheter-associated urinary tract infection (CAUTI) which are now better than pre-pandemic levels, followed by ventilator-associated events (VAE), central line-associated bloodstream infections (CLABSI), and hospital-acquired pressure injuries (HAPI).
“While many aspects of safety are moving in the right direction, some measures continue to be of concern and highlight critical gaps that leaders should address,” said Tejal Gandhi, M.P.H., chief safety and transformation officer at Press Ganey, in a statement. “Healthcare organizations that do best on safety embrace a holistic approach, with safety as a core value grounded in both patient and employee experiences. In doing so, they can foster a culture of high reliability, drive stronger, more consistent, and equitable safety outcomes, and make progress toward the goal of zero harm.”
In another recent report on the workforce, Press Ganey data found:
Nationally, employee engagement is on the way up for the first time since the pandemic, rising from 4.02 to 4.04 (out of 5). Employee engagement is a measure related to an employee’s connection to and satisfaction with the workplace, intent to stay, and a likelihood to recommend their employer. Nearly half of all healthcare roles improved on engagement last year, with physicians, registered nurses, security, licensed technical and skilled maintenance roles showing gains.
Clinical RN metrics are cause for cautious optimism. Nurses are the backbone of healthcare, yet data consistently highlights the challenges they face in the workplace—a fact that hasn’t changed in the past year. However, engagement among this group is now rising, up +0.04 to 3.89—proving that, when organizations focus on critical groups and prioritize strategies that address their needs, positive change can happen.
High turnover continues, with 1-in 5 healthcare employees leaving within a 12-month period. Newer employees are more at risk, with data showing turnover jumping to 1-in-4 among those in their first two years with an organization. Mirroring this broader trend, 19 percent of RNs who were at an organization in 2022 also left in 2023—rising to 25 percent for other nursing roles.
One-third of the workforce are still not engaged, leading to continued retention risk. Disengaged employees are two times as likely to leave as their highly engaged peers. Turnover from non-engaged employees can cost an average organization around $25 million per year.
