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Open Communication Linked to Lower Hospital Mortality

MedicalResearch.com Interview with:
Veronica Toffolutti PhD

Postdoctoral researcher working with Professor David Stuckler
Department of Sociology
Bocconi University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Openness has been linked with better patient safety and better understanding of patients’ care goals. In addition, more open environments appear to be linked with positively ranked quality of teamwork, which in turns lead to better health care.

Yet if the expected benefits are to be achieved, it is necessary to show that greater openness actually corresponds to improvements in performance or lower mortality rates. To the best of our knowledge our is the first study to show an association between hospital mortality and openness and more precisely one point increase in the standardized openness score leads to a decrease of 6.48% in the hospital mortality rates. With the term openness we refer to an environment in which communication among patients, staff members and managers is open and transparent. 

MedicalResearch.com: What should readers take away from your report? 

Response: These results have several implications for policy.

  • First, our results are consistent with the hypothesis that improving openness boosted healthcare quality, measured in terms of hospital-specific mortality rates and error reporting.
  • Second, after the English NHS institutionalized a focus on openness, it appears that openness increased in acute hospitals, from 13.63 in 2012, to 16.49 in 2014, the most recent year for which data are available.
  • Moreover, as defensive medical practices could stymie openness preventing the blame game that holds practitioners responsible for errors, in favor of institutional responsibility, could help the shift to a greater culture of openness.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should explore progress in NHS hospitals in moving from a culture of blaming practitioners to one of holding institutions responsible for errors as part of the shift to a greater culture of openness. 


A Culture Of Openness Is Associated With Lower Mortality Rates Among 137 English National Health Service Acute Trusts

Veronica Toffolutti and David Stuckler

Health Affairs 2019 38:5, 844-850

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Last Updated on May 9, 2019 by Marie Benz MD FAAD