The Association Between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and Meta-Analysis.

The 3 unit-level studies unsuitable for meta-analysis consistently supported these findings, all reporting highly significant, moderate to strong correlations of r = 0.65 (safety culture) and 0.56 (frequency of incident reporting; P < 0.01) 28 ; r = 0.69, 0.57, and 0.44 (safety culture at 3 time points; P < 0.001) 29 ; and β = 0.75 (safety culture; P < 0.001). 37 Engagement-as-State and Patient Safety Outcomes Four studies addressed this relationship, with 2 using mixed staff groups 30 , 34 and 2 using doctors only. 33 , 39 One was of fair 30 and the other 3 were of poor quality. 33 , 34 , 39 All were suitable for meta-analysis.

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When stratified by outcome type, the significance of the effect size of pooled errors outcome was unaffected in leave-one-out analyses, but the safety culture outcome became marginally nonsignificant when excluding 3 studies. 27 , 31 , 38 When studies were stratified by engagement concept, leave-one out analyses rendered the pooled effect sizes for engagement-as-state marginally nonsignificant when 1 study 33 was excluded and similarly for engagement-as-practice in respect of 5 studies. 27 , 31 , 35 , 36 , 38 All leave-one-out analyses effects were in the same direction as the main analyses; thus, lack of significance may have been driven by type II error given the small number of studies and moderate effect sizes.

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