The association between healthcare staff engagement and patient safety outcomes: a systematic review and meta-analysis

Janes, Gillian ORCID: https://orcid.org/0000-0002-1609-5898, Mills, Thomas, Budworth, Luke, Johnson, Judith and Lawton, Rebecca (2021) The association between healthcare staff engagement and patient safety outcomes: a systematic review and meta-analysis. Journal of Patient Safety, 17 (3). pp. 207-216. ISSN 1549-8417

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Abstract

Objectives Despite decades of research, improving healthcare safety remains a global priority. Individual studies have demonstrated links between staff engagement and care quality but until now, any relationship between engagement and patient safety outcomes has been more speculative. This systematic review and meta-analysis therefore assessed this relationship and explored if the way these variables were defined and measured had any differential effect. Methods Following systematic searches of Medline, CINAHL, PsycInfo, Embase, Cochrane Library and NIHR Journals databases, narrative and random effects meta-analysis were completed, with pooled effect sizes expressed as Pearson’s r. Results Fourteen studies met the inclusion criteria, 11 of which were suitable for meta-analysis. Meta-analyses indicated a small but consistent, statistically significant relationship between staff engagement and patient safety (all outcomes) (11 studies) (r = 0.22; 95% CI: 0.07-0.36; n = 30,490) and two patient safety outcome categories: patient safety culture (7 studies) (r = 0.22; 95% CI: 0.01-0.41; n = 27,857) and errors/adverse events (4 studies) (r = -0.20; 95% CI: -0.26 - -0.13; n = 2633). The specific approach to conceptualising engagement did not affect the strength of the findings. Conclusion This is the first review to demonstrate a significant relationship between engagement and both safety culture scores and errors/adverse events. Despite a limited and evolving evidence base we cautiously conclude that increasing staff engagement could be an effective means of enhancing patient safety. Further research is needed to determine causality and clarify the nature of the staff engagement/patient safety relationship at individual and unit/work-group level.