All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Christy H Lemak

Dean G Smith

Elizabeth Malcolm

Tapan S Mehta

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


The purpose of this dissertation is to explore factors that influence patient safety culture and patient safety outcomes, and whether patient safety culture affects hospital performance. The findings of these studies have important implications to hospital managers in the context of macro environmental changes regarding quality and safety. As managers look for ways to improve patient safety, results from this dissertation suggest strategies (for example, RN staffing; EHR presence) that may help improve safety culture and hospital performance. Specifically, having at least basic EHR as compared to not having any EHR supports safety culture to positively influence quality and financial performance. Additionally, RN staffing influences safety culture perceptions via higher perception of teamwork across units and handoffs. However, hospital-physician financial integration does not positively influence patient safety outcomes and hospitalist staffing has no effect on safety culture. Taken together, findings from these studies will assist hospital managers as they choose relevant strategies to improve patient safety and ultimately performance.