Patient Safety Climate in 92 US Hospitals

Singer, Sara J.; Gaba, David M.; Falwell, Alyson; Lin, Shoutzu; Hayes, Jennifer; Baker, Laurence C.

doi:10.1097/mlr.0b013e31817e189d

Cited by 189 publications

(76 citation statements)

References 36 publications

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“…Importantly, the survey findings show significant differences between the hospital departments in almost all safety culture dimensions and independent items (Appendix 5 and Appendix 6), as also found in other similar studies 1,18,19,41. The findings confirm that culture is created locally,3,40 and thus, efforts to improve safety culture are most likely to have impact if implemented on a departmental, rather than organizational, level 36,41,47.…”

Section: Discussionsupporting

confidence: 84%

“…The findings can be used as a basis to tailor, adopt, and develop interventions that are likely to make an impact in the respective areas. Importantly, safety culture assessment is crucial because different cultural underlying issues of health care workers in different countries, organizations, and units18,19 are strong determinants of successful implementation of an intervention. As an example, a study found that health care workers of public hospitals in China were mostly concerned with blame and shame if and when they make an error during care delivery, which was the opposite to the findings in the USA where fear of shame was the least problematic concern of health care workers 14.…”

Section: Introductionmentioning

confidence: 99%

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A safety culture assessment by mixed methods at a public maternity and infant hospital in China

Listyowardojo¹,

Yan²,

Leyshon³

et al. 2017

JMDH

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ObjectiveTo assess safety culture at a public maternity hospital in Shanghai, China, using a sequential mixed methods approach. The study was part of a bigger study looking at the application of the mixed methods approach to assess safety culture in health care in different organizations and countries.MethodologyA mixed methods approach was utilized by first distributing the Safety Attitudes Questionnaire measuring six safety culture dimensions and five independent items to all hospital staff (n=1482) working in 18 departments at a single hospital. Afterward, semistructured interviews were conducted using convenience sampling, where 48 hospital staff from nine departments at the same hospital were individually interviewed.ResultsThe survey received a response rate of 96%. The survey findings show significant differences between the hospital departments in almost all safety culture dimensions and independent items. Similarly, the interview findings revealed that there were different, competing priorities between departments perceived to result in a reduced quality of collaboration and bottlenecks in care delivery. Another major finding was that staff who worked more hours per week would perceive working conditions significantly more negatively. Issues related to working conditions were also the most common concerns discussed in the interviews, especially the issue on high workload. High workload was also reflected in the fact that 91.45% of survey respondents reported that they worked 40 hours or longer per week. Finally, interview findings complemented survey findings, thus providing a more complete and accurate picture of safety culture.ConclusionHospital leaders need to prioritize interventions focused on improving the quality of cross-department collaboration and reducing workload. A mixed methods assessment of safety culture provides more meaningful, targeted results, enabling leaders to prioritize and tailor improvement efforts to increase the impact of an intervention.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

A safety culture assessment by mixed methods at a public maternity and infant hospital in China

Listyowardojo¹,

Yan²,

Leyshon³

et al. 2017

JMDH

View full text Add to dashboard Cite

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“…Other studies have shown that safety culture perceptions vary across hospitals, units, and disciplines. 21–23 Although we did not compare results on the basis of clinical training site, we did find perceived differences in safety culture on IM and surgery clerkships. These differences are not surprising given that students also reported that the “team of providers” and “clinical service” are the most influential to their providing safe care.…”

Section: Discussionmentioning

confidence: 87%

Enculturation of Unsafe Attitudes and Behaviors

2013

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Purpose Safety culture may exert an important influence on the adoption and learning of patient safety practices by learners at clinical training sites. This study assessed students’ perceptions of safety culture and identified curricular gaps in patient safety training. Method A total of 170 fourth-year medical students at the University of California, San Francisco, were asked to complete a modified version of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture in 2011. Students responded on the basis of either their third-year internal medicine or surgery clerkship experience. Responses were recorded on a five-point Likert scale. Percent positive responses were compared between the groups using a chi-square test. Results One hundred twenty-one students (71% response rate) rated “teamwork within units” and “organizational learning” highest among the survey domains; “communication openness” and “nonpunitive response to error” were rated lowest. A majority of students reported that they would not speak up when witnessing a possible adverse event (56%) and were afraid to ask questions if things did not seem right (55%). In addition, 48% of students reported feeling that mistakes were held against them. Overall, students reported a desire for additional patient safety training to enhance their educational experience. Conclusions Assessing student perceptions of safety culture highlighted important observations from their clinical experiences and helped identify areas for curricular development to enhance patient safety. This assessment may also be a useful tool for both clerkship directors and clinical service chiefs in their respective efforts to promote safe care.

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“…Notably, leaders are often associated with having more positive perceptions of the safety culture than frontline workers, and managers and physicians generally reported higher levels of positive perceptions of safety as compared to staff nurses [27]. Singer et al [28] found that among nurses, work experience and work position were significantly associated with perceptions of the patient safety culture. There were more positive reports from nurses who worked on a unit or hospital for more than 10 years, while Kim et al [10] also found distinctions in perceptions of patient safety culture between staff nurses and managers among healthcare workers, but we would propose that this does not go far enough to examine potential differences between staff nurses and charge nurses.…”

Section: Introductionmentioning

confidence: 99%

Differences in Perceptions of Patient Safety Culture between Charge and Noncharge Nurses: Implications for Effectiveness Outcomes Research

Wilson

Redman

Talsma

et al. 2012

Nursing Research and Practice

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The implementation of evidence-based practice guidelines can be influenced by nurses' perceptions of the organizational safety culture. Shift-by-shift management of each nursing unit is designated to a subset of staff nurses (charge nurses), whom are often recruited as champions for change. The findings indicate that compared to charge nurses, noncharge nurses were more positive about overall perceptions of safety ( P = .05) and teamwork ( P < .05). Among charge nurses, significant differences were observed based on the number of years' experience in charge: perception of teamwork within units [ F (3, 365) = 3.52, P < .01]; overall perceptions of safety, [ F (3, 365) = 4.20, P < .05]; safety grade for work area [ F (3, 360) = 2.61, P < .05]; number of events reported within the last month [ F (3, 362) = 3.49, P < .05]. These findings provide important insights to organizational contextual factors that may impact effectiveness outcomes research in the future.

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Patient Safety Climate in 92 US Hospitals

Abstract: Differences among and within hospitals suggest that strategies for improving safety climate and patient safety should be tailored for work areas and disciplines.

Cited by 189 publications

References 36 publications

A safety culture assessment by mixed methods at a public maternity and infant hospital in China

A safety culture assessment by mixed methods at a public maternity and infant hospital in China

Enculturation of Unsafe Attitudes and Behaviors

Differences in Perceptions of Patient Safety Culture between Charge and Noncharge Nurses: Implications for Effectiveness Outcomes Research

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