Patient safety climate strength: a concept that requires more attention

Abstract

BackgroundWhen patient safety climate (PSC) surveys are used in healthcare, reporting typically focuses on PSC level (mean or per cent positive scores). This paper explores how an additional focus on PSC strength can enhance the utility of PSC survey data.Setting and participants442 care providers from 24 emergency departments (EDs) across Canada.MethodsWe use anonymised data from the Can-PSCS PSC instrument collected in 2011 as part of the Qmentum accreditation programme. We examine differences in climate strength across EDs using the Rwg(j) and intraclass correlation coefficients measures of inter-rater agreement.ResultsAcross the six survey dimensions, median Rwg(j) was sufficiently high to support shared climate perceptions (0.64–0.83), but varied widely across the 24 ED units. We provide an illustrative example showing vastly different climate strength (Rwg(j) range=0.17–0.86) for units with an equivalent level of PSC (eg, climate mean score=3).ConclusionsMost PSC survey results focus solely on climate level. To facilitate improvement in PSC, we advocate a simple, holistic safety climate profile including three metrics: climate level (using mean or per cent positive climate scores), climate strength (using the Rwg(j), or SD as a proxy) and the shape of the distribution (using histograms to see the distribution of scores within units). In PSC research, we advocate paying attention to climate strength as an important variable in its own right. Focusing on PSC level and strength can further understanding of the extent to which PSC is a key variable in the domain of patient safety.

Relationships between Army nursing practice environments and patient outcomes

“…A response rate >40% is often used as a criterion for adequacy of the sample for survey research to ensure reliability (Kramer, Schmalenberg, Brewer, Verran, & Keller‐Unger, ). However, intraclass correlation coefficient (2) (ICC [2]) provides a direct measure of the representative nature of the group‐level attribute and supports the reliability of the aggregate measure (Ginsburg & Gilin Oore, ). Consensus among the unit responses were considered satisfactory only when the ICC(2) reached at least .60 (Polit & Yang, ) and five responses were available from that unit.…”

Safety climate strength: a promising construct for safety research and practice

“…Implicit in this depiction is the idea that people are relatively passive recipients of climate and culture. By refocusing us on the fact that a safety climate can be of low strength (ie, not shared), Ginsburg's and Oore's5 findings suggest that culture and climate may be more mutable, shaped by processes of mutual interaction and influence among organisational members carrying out their everyday work 19. Ginsburg's and Oore's methodological critique of safety climate is also fundamentally a conceptual critique echoed in many disciplines including political science and sociology that climate in general and safety climate in particular are rarely harmonious and integrated and more likely to be fraught with rivalry and conflict 17 20 21.…”

“…Safety climate is closely related to safety culture in that the former represents perceptions of leader actions and organisational practices reflective of the underlying basic assumptions and beliefs comprising culture 4. Ginsburg and Oore,5 like much of the research in healthcare, focus on safety climate and its measurement through surveys.…”

“…The study from Ginsburg and Oore5 presents evocative findings suggesting that despite the importance of safety climate, our approach to assessing it is incomplete at best and misguided at worst. They helpfully illustrate that how we conceptualise and measure safety climate shapes our understanding of it and the resulting interventions we deploy often in ways that might be inimical to actually producing a strong safety climate.…”

“…The authors offer the SD as a simple measure of strength and the more sophisticated rWG(J) that they expertly detail in their technical appendix as an alternative 5. Strong climates are seen to enhance performance by energising employees around a meaningful, unified goal and shaping and coordinating employees’ behaviour 15.…”