Alyson Falwell

Relationship of Safety Climate and Safety Performance in Hospitals

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 Associations 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 personnels 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 personnels 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.

Patient safety climate in 92 US hospitals: differences by work area and discipline.

Background:Concern about patient safety has promoted efforts to improve safety climate. A better understanding of how patient safety climate differs among distinct work areas and disciplines in hospitals would facilitate the design and implementation of interventions. Objectives:To understand workers’ perceptions of safety climate and ways in which climate varies among hospitals and by work area and discipline. Research Design:We administered the Patient Safety Climate in Healthcare Organizations survey in 2004–2005 to personnel in a stratified random sample of 92 US hospitals. Subjects:We sampled 100% of senior managers and physicians and 10% of all other workers. We received 18,361 completed surveys (52% response). Measures:The survey measured safety climate perceptions and worker and job characteristics of hospital personnel. We calculated and compared the percent of responses inconsistent with a climate of safety among hospitals, work areas, and disciplines. Results:Overall, 17% of responses were inconsistent with a safety climate. Patient safety climate differed by hospital and among and within work areas and disciplines. Emergency department personnel perceived worse safety climate and personnel in nonclinical areas perceived better safety climate than workers in other areas. Nurses were more negative than physicians regarding their work units support and recognition of safety efforts, and physicians showed marginally more fear of shame than nurses. For other dimensions of safety climate, physician-nurse differences depended on their work area. Conclusions:Differences among and within hospitals suggest that strategies for improving safety climate and patient safety should be tailored for work areas and disciplines.

An overview of patient safety climate in the VA.

OBJECTIVE To assess variation in safety climate across VA hospitals nationally. STUDY SETTING Data were collected from employees at 30 VA hospitals over a 6-month period using the Patient Safety Climate in Healthcare Organizations survey. STUDY DESIGN We sampled 100 percent of senior managers and physicians and a random 10 percent of other employees. At 10 randomly selected hospitals, we sampled an additional 100 percent of employees working in units with intrinsically higher hazards (high-hazard units [HHUs]). DATA COLLECTION Data were collected using an anonymous survey design. PRINCIPAL FINDINGS We received 4,547 responses (49 percent response rate). The percent problematic response--lower percent reflecting higher levels of patient safety climate--ranged from 12.0-23.7 percent across hospitals (mean=17.5 percent). Differences in safety climate emerged by management level, clinician status, and workgroup. Supervisors and front-line staff reported lower levels of safety climate than senior managers; clinician responses reflected lower levels of safety climate than those of nonclinicians; and responses of employees in HHUs reflected lower levels of safety climate than those of workers in other areas. CONCLUSIONS This is the first systematic study of patient safety climate in VA hospitals. Findings indicate an overall positive safety climate across the VA, but there is room for improvement.