Effects of hospital nurses' internalized dominant values, organizational silence, horizontal violence, and organizational communication on patient safety

Recent studies have identified common problems with patient safety in hospitals and medical institutions have responded, prioritizing service quality and performance, including patient safety. However, the factors influencing safety for hospital patients are still being examined and clarified. We aimed to investigate how hospital nurses' internalized dominant values, organizational silence, horizontal violence, and organizational communication satisfaction can affect patient safety and to construct and verify a hypothetical model describing the relationships between these factors. The participant sample included 301 hospital nurses from four large (≥500 beds) general hospitals in Gyeonggi-do, South Korea. Data were collected through questionnaires from October to November 2018 and analyzed using SPSS 25.0 and AMOS 22.0. Factors that had direct effects on patient safety were organizational silence (β = -.130, p < .05) and organizational communication satisfaction (β = .209, p < .001). Factors that had indirect effects on patient safety were internalized dominant values and horizontal violence. The explanatory power of these variables for patient safety was 7.9%. The results indicate that organizational silence, horizontal violence, and organizational communication satisfaction fully mediated the relationship between nurses' internalized dominant values and patient safety. Our findings may be useful to hospital administrators and managers in identifying and analyzing these organizational characteristics in their institutions. Further, the model described in the results may be used to inform the development of educational programs and strategies to improve patient safety by reducing organizational silence and horizontal violence and improving organizational communication.