Importance of work environments on hospital outcomes in nine countries

Linda H. Aiken, Douglas M. Sloane, Sean Clarke, Lusine Poghosyan, Eunhee Cho, Liming You, Mary Finlayson, Masako Kanai-Pak, Yupin Aungsuroch

Research output: Contribution to journalArticlepeer-review


Purpose: To determine the effect of hospital work environments on hospital outcomes across multiple countries. Design: Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009. Main Outcome Measures: Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care. Results: High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes. Conclusions: Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.

Original languageEnglish (US)
Article numbermzr022
Pages (from-to)357-364
Number of pages8
JournalInternational Journal for Quality in Health Care
Issue number4
StatePublished - Aug 2011


  • And quality of care
  • Hospital work environments
  • Nurse burnout
  • Nurse job satisfaction

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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