The Impact of Internal Service Quality on Preventable Adverse Events in Hospitals

Provision of safe, timely care to hospital patients requires services from multiple support departments, such as environmental services and pharmacy. However, few studies have examined the impact of the service quality of internal support departments on clinical performance. The lack of studies linking internal service quality (ISQ) to clinical performance creates a gap in healthcare operations management theory and-from a practice standpoint-might contribute to underinvestment in the quality of services delivered by internal support departments. To address these issues, we test whether higher ISQ is associated with a lower rate of adverse events. We leverage a unique dataset from a hospital that developed a measure of ISQ provided by support departments. Using over a year's worth of monthly data on the average ISQ delivered by 11 support departments to five nursing units, we test the impact of ISQ on two nursing-sensitive adverse events: patient falls with injury and hospital-acquired pressure ulcers. We find support for our hypothesis that higher levels of ISQ are associated with lower rates of adverse events, controlling for patient acuity and other confounding factors. Our results show that improving the overall average ISQ received by a nursing unit by 0.1 on a 5-point scale has almost the same benefit for reducing adverse events as would increasing staffing on that unit by one full-time equivalent nurse. Our study has important implications for theory and practice as it points to a fruitful, cost effective, and yet underutilized avenue for reducing adverse events experienced by hospital patients.