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Objectives:

The purpose of this report is to compile and summarize existing evidence on the aspects of the working environment that impact patient safety. Five categories of working conditions were evaluated: workforce staffing, workflow design, personal/social issues, physical environment, and organizational factors.

Search Strategy:

Five bibliographic databases were searched; the databases were chosen to include citations from both the healthcare and non-healthcare literature. The databases included MEDLINE (with HealthSTAR), CINAHL, PsycINFO, EBSCO, and the Campbell Collaboration. Searches were conducted back to 1980 for MEDLINE and EBSCO, back to 1982 for CINAHL, and back to 1984 for PsycINFO. Additional studies were identified through hand searches of reference lists and selected tables of contents. Unpublished studies were identified through discussions with content experts.

Selection Criteria:

The criterion for inclusion in the literature review was that the article addressed patient safety or human performance, together with predetermined definitions of working conditions. Studies with no original data were excluded unless they were systematic literature reviews. Selection criteria were tested through dual reviews by a second investigator.

Data Collection and Analysis:

The articles included in the general literature review guided the definition of subcategories within the five main categories of working conditions. The quality of the evidence in individual studies was assessed through separate ratings of study design and execution. For each of the working-condition categories, six key questions were addressed to classify the …