Sleep Behaviors and Quality of Care Among Public‐Sector Healthcare Workers: Cross‐Sectional and Prospective Associations

Previous research has shown the effect of healthcare workers' sleep on their safety and health outcomes. The association between healthcare workers' sleep and the quality of care (QOC) has not been systematically investigated. A large survey was collected from a prospective cohort of healthcare workers at five public-sector facilities in the northeastern U.S. in 2018 and again in 2021. Sleep characteristics assessed were short sleep duration (≤ 6 h/day), sleep disturbances, and sleep at two or more episodes. Among 1553 healthcare workers (mean age 46.4 years, 61.5% female) who completed the 2021 survey, sleep risk factors (range 0-3, sleep disturbances or short duration or at ≥ 2 episodes) were cross-sectionally associated with a linearly increasing prevalence of poor QOC on the unit and in the last shift, and deteriorated QOC over the past year. Two or more sleep risk factors were associated with all poor QOC outcomes after adjusting for covariates. Among 428 healthcare workers who completed both surveys, two or more sleep risk factors at baseline were associated with a 133%-196% increase in reported deterioration of QOC at follow-up, but not in poor QOC on the unit or in the last shift, after adjusting for covariates. Healthcare workers' sleep behaviors were significantly associated with QOC outcomes cross-sectionally and prospectively. Evidence-based interventions at individual and organizational levels to improve healthcare workers' sleep would likely benefit QOC.