Objective. To examine the relationship between measures of hospital safety climate and hospital performance on selected Patient Safety Indicators (PSIs). Data Sources. Primary data from a 2004 survey of hospital personnel. Secondary data from the 2005 Medicare Provider Analysis and Review File and 2004 American Hospital Association's Annual Survey of Hospitals. Study Design. A cross‐sectional study of 91 hospitals. Data Collection. Negative binomial regressions used an unweighted, risk‐adjusted PSI composite as dependent variable and safety climate scores and controls as independent variables. Some specifications included interpersonal, work unit, and organizational safety climate dimensions. Others included separate measures for senior managers and frontline personnel's safety climate perceptions. Principal Findings. Hospitals with better safety climate overall had lower relative incidence of PSIs, as did hospitals with better scores on safety climate dimensions measuring interpersonal beliefs regarding shame and blame. Frontline personnel's perceptions of better safety climate predicted lower risk of experiencing PSIs, but senior manager perceptions did not. Conclusions. The results link hospital safety climate to indicators of potential safety events. Some aspects of safety climate are more closely related to safety events than others. Perceptions about safety climate among some groups, such as frontline staff, are more closely related than perceptions in other groups.

Objective. To describe the development of an instrument for assessing workforce perceptions of hospital safety culture and to assess its reliability and validity. Data Sources/Study Setting. Primary data collected between March 2004 and May 2005. Personnel from 105 U.S. hospitals completed a 38-item paper and pencil survey. We received 21,496 completed questionnaires, representing a 51 percent response rate. Study Design. Based on review of existing safety climate surveys, we developed a list of key topics pertinent to maintaining a culture of safety in high-reliability organizations. We developed a draft questionnaire to address these topics and pilot tested it in four preliminary studies of hospital personnel. We modified the questionnaire based on experience and respondent feedback, and distributed the revised version to 42,249 hospital workers. Data Collection. We randomly divided respondents into derivation and validation samples. We applied exploratory factor analysis to responses in the derivation sample. We used those results to create scales in the validation sample, which we subjected to multitrait analysis (MTA). Principal Findings. We identified nine constructs, three organizational factors, two unit factors, three individual factors, and one additional factor. Constructs demonstrated substantial convergent and discriminant validity in the MTA. Cronbach's a coefficients ranged from 0.50 to 0.89. Conclusions. It is possible to measure key salient features of hospital safety climate using a valid and reliable 38-item survey and appropriate hospital sample sizes. This instrument may be used in further studies to better understand the impact of safety climate on patient safety outcomes.Key Words. Safety culture, safety climate, survey, psychometric evaluation r Health Research and Educational Trust DOI: 10.1111/j. 1475-6773.2007.00706.x 1999 Since the Institute of Medicine's identification of safety culture as a key determinant of the ability of health care organizations to address and reduce risks to patients due to medical care (Institute of Medicine 2001), initiatives to improve and measure safety culture have proliferated (McCarthy and Blumenthal 2006). Recognition of the critical need to assess safety culture and the impact of innovative interventions aimed at improving it has led to the development of surveys designed to measure hospital worker perceptions of safety culture or ''safety climate.'' Instruments vary according to length, dimensions covered, intended sample population (hospital-wide or unit-level personnel), and extent of psychometric evaluation. Assessments of these early attempts to measure safety climate agree that more consideration of the psychometric factors in the design and selection of health care safety climate instruments is appropriate (Nieva and Sorra 2003;Colla et al. 2005;Flin et al. 2006;Singla et al. 2006). This paper describes the development and psychometric evaluation of the Patient Safety Climate in Healthcare Organizations (PSCHO) survey (appendix A), which ha...

Safety climate and organizational culture are positively related. Results support strategies that promote group orientation and reduced hierarchy, including use of multidisciplinary team training, continuous quality improvement tools, and human resource practices and policies.

Senior managers perceived patient safety climate more positively than nonsenior managers overall and across 7 discrete safety climate domains. Patterns of variation by management level differed by professional discipline. Continuing efforts to improve patient safety should address perceptual differences, both among and within groups by management level.

Objective. To contrast the safety-related concerns raised by front-line staff about hospital work systems (operational failures) with national patient safety initiatives. Data Sources. Data Collection. Hospitals submitted data on the operational failures identified through managers' interactions with front-line workers. Data were analyzed for type of failure and frequency of occurrence. Recommendations from staff were compared with recommendations from national initiatives. Principal Findings. The two most frequent categories of operational failures, equipment/supplies and facility issues, posed safety risks and diminished staff efficiency, but have not been priorities in national initiatives. Conclusions. Our study suggests an underutilized strategy for improving patient safety and staff efficiency: leveraging front-line staff experiences with work systems to identify and address operational failures. In contrast to the perceived tradeoff between safety and efficiency, fixing operational failures can yield benefits for both. Thus, prioritizing improvement of work systems in general, rather than focusing more narrowly on specific clinical conditions, can increase safety and efficiency of hospitals.