Date of Award


Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Jacqueline Fawcett

Second Advisor

Patricia Reid Ponte

Third Advisor

Ling Shi


Background: Interest and efforts in the health care industry to be transparent by collecting and publicly reporting performance measures about healthcare quality and cost has increased in recent years. The National Quality Forum (NQF) endorsed a set of 15 national quality measures for nursing-sensitive care that could be used for public accountability and quality improvement, including measures of patient falls and falls with injury. Patient falls have been among the largest category of reported incidents in hospitals, and are a serious concern for healthcare leaders and healthcare team members. In 2006, Massachusetts hospitals began voluntarily publicly reporting the nurse sensitive measures of patient falls and falls with injury through the Patients First initiative.

Purpose: The purpose of this study was to evaluate effects of the voluntary public reporting program, Patients First, on the nurse sensitive measures of patient falls and falls with injury and the quality improvement interventions implemented to prevent patient falls.

Method: A policy evaluation study was conducted to determine the effectiveness of the Patients First policy over the period of 2006 - 2009. Data collection and evaluation were guided by the Conceptual Model for Nursing and Health Policy (CMNHP) Guidelines for Policy and Program Evaluation (Fawcett & Russell, 2001). The study was conducted at Level 2 of the revised CMNHP focusing on the outcomes - effectiveness of the policy (Fawcett & Russell, 2005). In this mixed method study design, falls and falls with injury over time and data about interventions for fall prevention that were implemented were collected from chief nursing officers.

Results: The overall fall rate demonstrated a decreasing trend and the overall fall with injury rate demonstrated a decreasing movement after the implementation of the voluntary public reporting program, Patients First. Chief nursing officers indicated that public reporting of falls and falls with injury indirectly and directly led to the implementation of fall prevention intervention strategies.

Conclusion: The public reporting of falls prompted action to be taken that stimulated change and increased knowledge of fall and fall prevention in hospitals, and served to advance quality and safety in hospitals.

Included in

Nursing Commons