Hypothesis Formalization: Empirical Findings, Software Limitations, and Design Implications

Data analysis requires translating higher level questions and hypotheses into computable statistical models. We present a mixed-methods study aimed at identifying the steps, considerations, and challenges involved in operationalizing hypotheses into statistical models, a process we refer to as hypothesis formalization . In a formative content analysis of 50 research papers, we find that researchers highlight decomposing a hypothesis into sub-hypotheses, selecting proxy variables, and formulating statistical models based on data collection design as key steps. In a lab study, we find that analysts fixated on implementation and shaped their analyses to fit familiar approaches, even if sub-optimal. In an analysis of software tools, we find that tools provide inconsistent, low-level abstractions that may limit the statistical models analysts use to formalize hypotheses. Based on these observations, we characterize hypothesis formalization as a dual-search process balancing conceptual and statistical considerations constrained by data and computation and discuss implications for future tools.

Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.