The Enabling, Enacting, and Elaborating Factors of Safety Culture Associated With Patient Safety: A Multilevel Analysis

Abstract

Purpose Worldwide, 1 in 10 hospital patients is harmed while receiving care. Despite evidence that a culture of safety is associated with greater patient safety, these effects and the processes by which safety culture impacts patient safety are not yet clearly understood. Therefore, the purpose of this study was to examine the effects of various safety culture factors on nurses’ perceptions of patient safety using an innovative theoretical model. Design This descriptive, correlational study drew on deidentified, publicly available data from the 2018 Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. The study sample included 34,514 nurses who provided direct care to patients in medical and surgical units in 535 hospitals in the United States. Methods Multilevel linear regression was used to examine the effects of 11 safety culture factors on nurses’ overall perceptions of patient safety. The 11 safety culture factors were grouped as enabling, enacting, and elaborating processes, and entered in separate blocks. Findings All 11 safety culture factors were associated with nurse‐perceived patient safety, and all but two of the 11 factors uniquely predicted nurse‐perceived patient safety. Staffing adequacy was the strongest predictor of nurse‐perceived patient safety, followed by hospital management support for patient safety (both enabling processes), and continuous organizational learning and improvement (an elaborating process). Conclusions Hospital administrators and managers play a key role in promoting a safety culture and patient safety in healthcare organizations through enabling and elaborating processes. Clinical Relevance Organizational efforts should be made to provide sufficient staffing and hospital‐wide support for patient safety. However, all staff, administrators, and managers have a role to play in patient safety.

Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea

“…In this regard, the significance of achieving a positive patient safety culture and patient safety has been continuously emphasized [ 5 , 6 ]. Patient safety culture is a crucial part of organizational culture in which healthcare providers recognize patient safety performance as the highest priority measure to prevent patient harm [ 3 , 7 ]. Furthermore, patient safety culture includes the manner in which healthcare providers are expected to behave, what attitudes and activities are appropriate, and what patient safety procedures are rewarded or prohibited [ 8 , 9 , 10 ].…”

Using Dominance Analysis to Identify the Most Important Dimensions of Safety Culture for Predicting Patient Safety

“…Healthcare professionals' perceptions of safety culture and their association with patient safety have been examined in hospitals around the world, for example, in Canada [5], the United States [6], the Netherlands [7], Jordan [8], Taiwan [9], China [10,11], and Saudi Arabia [12]. Although safety culture has been linked with patient safety outcomes, a recent literature review revealed that research findings regarding these relationships have been inconsistent [13].…”

Fatores contextuais e sua interface com as práticas seguras no ambiente hospitalar / Contextual factors and their interface with safe practices in the hospital environment

“…Para a análise dos dados, seguiu-se a proposta da Análise de conteúdo na modalidade temática, a qual "consiste em descobrir os núcleos de sentido que compõem uma comunicação, cuja presença ou frequência signifiquem alguma coisa para o objeto analítico visado" 15 . Assim, desta análise, emergiram três categorias, tomando por referência o modelo teórico (Figura 1) que foi elaborado a partir da tríade de Donabedian 16 e do modelo "Capacitando, Colocando em prática e Elaborando a CSP" [12][13]17 Nesta categoria, tem-se comportamento, práticas organizacionais e ações da liderança para um cuidado seguro. Estes são considerados como "aspectos capacitantes da CSP" que levam a redução dos erros, priorizando a segurança e criando um ambiente onde os profissionais podem colocar em prática a SP através da adoção de práticas mais seguras 13 .…”

“…Sabe-se que o apoio da gestão hospitalar e da média gerência são fundamentais para que as melhorias ocorram, pois são os líderes que devem apontar os caminhos, direcionar as ações, bem como prover os meios para que isso seja alcançado. O apoio da liderança serve de base para a criação e manutenção da CSP [12][13]17 . Uma liderança engajada e consciente da importância da SP consegue criar um contexto acolhedor para melhorias em sua instituição, ao mesmo tempo que busca corrigir aspectos inadequados do contexto de forma mais abrangente.…”