Periodic Reporting for period 1 - HONEST (The Effects of wages on patient safety outcomes)
Berichtszeitraum: 2022-02-01 bis 2024-01-31
Summary of the context, including the problem being addressed and why it is important for society:
High-quality care in hospitals depends on skilled and stable teams of nurses and doctors. However, the world faces a serious shortage of healthcare professionals—5.9 million nurses and 4.3 million doctors are needed globally. This problem is worsened by many older workers retiring and younger professionals leaving the field due to low wages, unattractive job conditions, and limited career growth. The COVID-19 pandemic has made these issues even more pressing, straining hospital systems, disrupting care, and putting patient safety at risk.
Wages play a vital role in attracting and keeping healthcare workers, making them a key factor in addressing staff shortages. In hospitals, salaries make up 62% of overall expenses, with nurses and doctors accounting for the largest share of the workforce—40% and 15%, respectively. Understanding what influences wages and how they impact patient safety is essential to create strategies for a stronger and more sustainable healthcare system.
Overall objectives:
This project aims to:
1) Understand what drives nurse and doctor wages in Swiss hospitals and identify the key factors influencing wage levels.
2) Examine the connection between wages and patient safety, focusing on mortality rates within 30 days of hospital admission as a key indicator.
Conclusion of the action:
Our research reveals that nurse wages are significantly influenced not only by their education and the wages of doctors but also by age, highlighting financial rewards for experienced nurses. While rewarding seniority can motivate experienced nurses, it may discourage younger nurses whose efforts are not equally recognised. This suggests that workplaces should also consider models that reward performance and individual skills instead of relying only on pay systems based on seniority. Such changes could help retain younger healthcare workers, attract new talent, and strengthen hospital teams to tackle staff shortages.
We found a small connection between higher doctor wages and lower death rates within 30 days of hospital admission but no such connection for nurse wages. We think factors like the number of staff available might influence how wages affect patient safety, and we are looking into this further. To better understand these connections and confirm our findings, more research using detailed information about individual workers' wages—which is not currently available—is needed. This could help hospitals use their resources more wisely, improve patient safety, and benefit everyone in society.
High-quality care in hospitals depends on skilled and stable teams of nurses and doctors. However, the world faces a serious shortage of healthcare professionals—5.9 million nurses and 4.3 million doctors are needed globally. This problem is worsened by many older workers retiring and younger professionals leaving the field due to low wages, unattractive job conditions, and limited career growth. The COVID-19 pandemic has made these issues even more pressing, straining hospital systems, disrupting care, and putting patient safety at risk.
Wages play a vital role in attracting and keeping healthcare workers, making them a key factor in addressing staff shortages. In hospitals, salaries make up 62% of overall expenses, with nurses and doctors accounting for the largest share of the workforce—40% and 15%, respectively. Understanding what influences wages and how they impact patient safety is essential to create strategies for a stronger and more sustainable healthcare system.
Overall objectives:
This project aims to:
1) Understand what drives nurse and doctor wages in Swiss hospitals and identify the key factors influencing wage levels.
2) Examine the connection between wages and patient safety, focusing on mortality rates within 30 days of hospital admission as a key indicator.
Conclusion of the action:
Our research reveals that nurse wages are significantly influenced not only by their education and the wages of doctors but also by age, highlighting financial rewards for experienced nurses. While rewarding seniority can motivate experienced nurses, it may discourage younger nurses whose efforts are not equally recognised. This suggests that workplaces should also consider models that reward performance and individual skills instead of relying only on pay systems based on seniority. Such changes could help retain younger healthcare workers, attract new talent, and strengthen hospital teams to tackle staff shortages.
We found a small connection between higher doctor wages and lower death rates within 30 days of hospital admission but no such connection for nurse wages. We think factors like the number of staff available might influence how wages affect patient safety, and we are looking into this further. To better understand these connections and confirm our findings, more research using detailed information about individual workers' wages—which is not currently available—is needed. This could help hospitals use their resources more wisely, improve patient safety, and benefit everyone in society.
First objective:
For the first objective, we used data collected from 2014 to 2020 by the Federal Statistical Office, focusing on Swiss acute care and specialised hospitals, as well as the nurses and doctors working in them. Using this de-identified data, we conducted descriptive analysis and used an advanced statistical method, mixed-effect regression analysis, to identify the key factors that influence wages for nurses and doctors.
We analysed data from 161 to 173 hospitals each year over seven years (2014–2020), including 524,263 nurses and 176,896 doctors. We found that nurses’ wages were mostly influenced by their age, the number of registered nurses, and the wages of doctors. For doctors, wages were most affected by the number of residents and medical students and the wages of nurses.
Second objective:
For the second objective, we used the same data as in the first objective, focusing on the year 2019. We also included patient data from the same period and hospitals, linking all the information using anonymized hospital identification numbers. We analyzed the data to identify patterns, presenting counts and percentages for categories and averages for numerical data. To examine the relationship between nurse and doctor wages (grouped by hospital) and 30-day patient death rates, we used a statistical method called Generalized Additive Mixed Model (GAMM). We also repeated the same analysis using data from 2018 and 2020 to check the consistency of our results.
We examined 2019 data from 1,015,995 adult hospital admissions and 94,364 healthcare workers (69,112 nurses and 25,252 doctors) across 82 acute care hospitals. In 2019, 2.3% of patients died within 30 days of admission. We found a small connection between higher doctor wages and slightly lower death rates, reducing the risk by 2%. However, no similar link was found between nurse wages and 30-day death rates.
Exploitation and dissemination of results:
The study results were regularly shared with the HONEST Stakeholder Group, which included key Swiss policymakers and stakeholders. Findings were presented at prominent events such as the Nursing Data Symposium (Lucerne, Switzerland), the AcademyHealth Annual Research Meeting (Baltimore, USA), and the Wennberg International Collaborative Research Meeting (Oslo, Norway). Dissemination within the University of Basel included presentations at the INS-spiration Meeting and the Antelope Career Camp, while broader outreach efforts featured presentations to the Sounding Board of Swiss Policymakers, the International Labour Organization, and the University of Kansas.
The results were also disseminated through the HONEST project websites to reach a wider audience.
For the first objective, we used data collected from 2014 to 2020 by the Federal Statistical Office, focusing on Swiss acute care and specialised hospitals, as well as the nurses and doctors working in them. Using this de-identified data, we conducted descriptive analysis and used an advanced statistical method, mixed-effect regression analysis, to identify the key factors that influence wages for nurses and doctors.
We analysed data from 161 to 173 hospitals each year over seven years (2014–2020), including 524,263 nurses and 176,896 doctors. We found that nurses’ wages were mostly influenced by their age, the number of registered nurses, and the wages of doctors. For doctors, wages were most affected by the number of residents and medical students and the wages of nurses.
Second objective:
For the second objective, we used the same data as in the first objective, focusing on the year 2019. We also included patient data from the same period and hospitals, linking all the information using anonymized hospital identification numbers. We analyzed the data to identify patterns, presenting counts and percentages for categories and averages for numerical data. To examine the relationship between nurse and doctor wages (grouped by hospital) and 30-day patient death rates, we used a statistical method called Generalized Additive Mixed Model (GAMM). We also repeated the same analysis using data from 2018 and 2020 to check the consistency of our results.
We examined 2019 data from 1,015,995 adult hospital admissions and 94,364 healthcare workers (69,112 nurses and 25,252 doctors) across 82 acute care hospitals. In 2019, 2.3% of patients died within 30 days of admission. We found a small connection between higher doctor wages and slightly lower death rates, reducing the risk by 2%. However, no similar link was found between nurse wages and 30-day death rates.
Exploitation and dissemination of results:
The study results were regularly shared with the HONEST Stakeholder Group, which included key Swiss policymakers and stakeholders. Findings were presented at prominent events such as the Nursing Data Symposium (Lucerne, Switzerland), the AcademyHealth Annual Research Meeting (Baltimore, USA), and the Wennberg International Collaborative Research Meeting (Oslo, Norway). Dissemination within the University of Basel included presentations at the INS-spiration Meeting and the Antelope Career Camp, while broader outreach efforts featured presentations to the Sounding Board of Swiss Policymakers, the International Labour Organization, and the University of Kansas.
The results were also disseminated through the HONEST project websites to reach a wider audience.
Progress beyond state of the art:
The HONEST project makes important progress in understanding how healthcare workers' pay impacts the healthcare system and patient outcomes. It is one of the first studies to examine what influences wages for both nurses and doctors across Swiss hospitals, using detailed national data. The findings reveal that factors like age, the mix of staff roles, and how nurses’ and doctors’ wages relate to each other play a key role. This challenges traditional pay models based solely on seniority and suggests that fairer, more balanced wages could help address global shortages of healthcare workers. The study also breaks new ground by exploring the link between wages and patient safety, focusing on 30-day mortality rates. It found that higher doctor wages were slightly associated with lower patient death rates, while no link was seen for nurses. This raises important questions about how staffing levels and working conditions may affect patient care, which are now being further investigated.
Potential impact, including socio-economic and the wider societal implications of the project:
HONEST highlights the importance of fair pay to attract and keep skilled healthcare workers, helping to address global shortages of nurses and doctors and reduce staff turnover. This leads to better, more consistent care for patients and a more stable healthcare workforce. The project also focuses on wage fairness, calling for more transparent and equal pay systems to create a more motivated and inclusive work environment. By studying the link between wages and patient outcomes, HONEST provides valuable insights to improve working conditions and strengthen healthcare systems both nationally and internationally.
The HONEST project makes important progress in understanding how healthcare workers' pay impacts the healthcare system and patient outcomes. It is one of the first studies to examine what influences wages for both nurses and doctors across Swiss hospitals, using detailed national data. The findings reveal that factors like age, the mix of staff roles, and how nurses’ and doctors’ wages relate to each other play a key role. This challenges traditional pay models based solely on seniority and suggests that fairer, more balanced wages could help address global shortages of healthcare workers. The study also breaks new ground by exploring the link between wages and patient safety, focusing on 30-day mortality rates. It found that higher doctor wages were slightly associated with lower patient death rates, while no link was seen for nurses. This raises important questions about how staffing levels and working conditions may affect patient care, which are now being further investigated.
Potential impact, including socio-economic and the wider societal implications of the project:
HONEST highlights the importance of fair pay to attract and keep skilled healthcare workers, helping to address global shortages of nurses and doctors and reduce staff turnover. This leads to better, more consistent care for patients and a more stable healthcare workforce. The project also focuses on wage fairness, calling for more transparent and equal pay systems to create a more motivated and inclusive work environment. By studying the link between wages and patient outcomes, HONEST provides valuable insights to improve working conditions and strengthen healthcare systems both nationally and internationally.