Comparing safety climate between two populations of hospitals in the United States

The Safety Climate and Patient Safety Activities in Mental Health Nurses: The Mediating Effect of Safety Control

This study aimed to investigate the mediating effect of safety control on the relationship between safety climate and patient safety management activities for mental health nurses. A survey was conducted on 177 nurses working at mental hospitals in G-do from 28 July 2023 to 15 August 2023. Data were analyzed using the SPSS/WIN 27.0 and Sobel test. Significant relationships were found between safety climate and safety control (r = 0.40, p < 0.001), safety climate and patient safety management activities(r = 0.40, p < 0.001), and safety control and patient safety management activities (r = 0.43, p < 0.001). Additionally, safety control partially mediated the safety climate and the patient safety management activities (Z = 3.63, p < 0.001). Therefore, programs that increase safety control and create a safety climate need to be developed to promote patient safety activities of mental health nurses.

The Safer Culture Framework: An Application to Healthcare Based on a Multi-Industry Review of Safety Culture Literature

BACKGROUND

Errors and preventable harm to patients remain regrettably common and expensive in healthcare. Improvement requires transforming the culture of the healthcare industry to put a greater emphasis on safety. Safety culture involves holding collective attitudes, values, and behaviors that prioritize safety. The Safer Culture framework, previously established through a narrative review of literature in multiple industries, provides a consensus on what impacts safety culture, how it manifests in behavior, and how it influences safety-related outcomes.

METHODS

Through a theoretical review, we validate, refine, and provide nuance to this framework for the development of safety culture in healthcare contexts. To accomplish this, we conceptually map existing dimensions pulled through the literature onto our Safer Culture framework.

RESULTS

A total of 360 articles were reviewed. We present specific elements for each dimension in our framework and apply the dimension to healthcare contexts.

CONCLUSION

We provide an evidence-based and comprehensive framework that can be used by patient safety leaders and researchers to guide the evaluation of safety culture and develop interventions to foster patient safety culture and improve patient safety outcomes.

Patient Safety Climate in General Public Hospitals in China: A Multiregion Study

OBJECTIVE

This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China.

METHODS

Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of "problematic responses" (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis.

RESULTS

In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. "Fear of blame and punishment" and "fear of shame" had the highest PPRs and were prevalent in various types of hospitals. "Provision of safe care" and "organizational resources for safety" also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey.

CONCLUSIONS

Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.

Exploring the Association Between Organizational Culture and Large-Scale Adverse Events: Evidence from the Veterans Health Administration

BACKGROUND

Large-scale adverse events (LSAEs) involve unsafe clinical practices stemming from system issues that may affect multiple patients. Although literature suggests a supportive organizational culture may protect against system-related adverse events, no study has explored such a relationship within the context of LSAEs. This study aimed to identify whether staff perceptions of organizational culture were associated with LSAE incidence.

METHODS

The team conducted an exploratory analysis using the 2008-2010 data from the US Department of Veterans Affairs (VA) All Employee Survey (AES). LSAE incidence was the outcome variable in two facilities where similar infection control practice issues occurred, leading to LSAEs. For comparison, four facilities where LSAEs had not occurred were selected, matched on VA-assigned facility complexity and geography. The AES explanatory factors included workgroup-level (civility, employee engagement, leadership, psychological safety, resources, rewards) and hospital-level Likert-type scales for four cultural factors (group, rational, entrepreneurial, bureaucratic). Bivariate analyses and logistic regressions were performed, with individual staff as the unit of analysis from the anonymous AES data.

RESULTS

Responses from 209 AES participants across the six facilities in the sample indicated that the four comparison facilities had significantly higher mean scores compared to the two LSAE facilities for 9 of 10 explanatory factors. The adjusted analyses identified that employee engagement significantly predicted LSAE incidence (odds ratio = 0.58, 95% confidence interval = 0.37-0.90).

CONCLUSION

Staff at the two exposure facilities in this study described their organizational culture to be less supportive. Lower scores in employee engagement may be a contributing factor for LSAEs.

Incorporating work experience of medical staff into patient safety climate management: a multi-group analysis

Background

This study aims to provide insights on how to incorporate the work experience of medical staff into safety climate management based on the relationships among several safety-related constructs such as teamwork climate, working condition, and job satisfaction.

Methods

A cross-sectional study was conducted in a regional hospital in Taichung City, Taiwan using a Safety Attitude Questionnaire (SAQ)-based questionnaire. The relationships among the constructs were modeled by a structural equation model, and a multi-group analysis was performed. Among the employees participating in the survey, only physicians and nurses were considered in the analysis, accounting for 1596 out of 2277 responses. The key measures were the difference between the unconstrained and fully constrained structural models, the statistically different coefficients, and their strengths across the high and low-experience groups.

Results

Our multi-group analysis showed that the effects of management leadership on job satisfaction and of teamwork climate on safety climate were statistically stronger for low-experience medical staff, whereas the effect of working conditions on safety climate was statistically stronger for high-experience medical staff.

Conclusions

The findings demonstrate how to incorporate the work experience of medical staff into safety climate management. In summary, by focusing on different safety constructs for the less and more experienced staff—job satisfaction and teamwork climate for the less experienced, working conditions for the more experienced—management may be able to improve the organizational safety climate. Our suggestions in this study can be leveraged, should management implement the initiatives and action plans for safety climate improvement.

Patient safety climate in general public hospitals in China: differences associated with department and job type based on a cross-sectional survey

OBJECTIVE

This study analysed differences in the perceived patient safety climate among different working departments and job types in public general hospitals in China.

DESIGN

Cross-sectional survey.

SETTING

Eighteen tertiary hospitals and 36 secondary hospitals from 10 areas in Shanghai, Hubei Province and Gansu Province, China.

PARTICIPANTS

Overall, 4753 staff, including physicians, nurses, medical technicians and managers, were recruited from March to June 2015.

MAIN OUTCOME MEASURE

The Patient Safety Climate in Healthcare Organisations (PSCHO) tool and the percentages of 'problematic responses' (PPRs) were used as outcome measures. Multivariable two-level random intercept models were applied in the analysis.

RESULTS

A total of 4121 valid questionnaires were collected. Perceptions regarding the patient safety climate varied among departments and job types. Physicians responded with relatively more negative evaluations of 'organisational resources for safety', 'unit recognition and support for safety efforts', 'psychological safety', 'problem responsiveness' and overall safety climate. Paediatrics departments, intensive care units, emergency departments and clinical auxiliary departments require more attention. The PPRs for 'fear of blame and punishment' were universally significantly high, and the PPRs for 'fear of shame' and 'provision of safe care' were remarkably high, especially in some departments. Departmental differences across all dimensions and the overall safety climate primarily depended on job type.

CONCLUSIONS

The differences suggest that strategies and measures for improving the patient safety climate should be tailored by working department and job type.

The patient safety climate in healthcare organizations (PSCHO) survey: Short-form development

RATIONALE, AIMS, AND OBJECTIVES

Measures of safety climate are increasingly used to guide safety improvement initiatives. However, cost and respondent burden may limit the use of safety climate surveys. The purpose of this study was to develop a 15- to 20-item safety climate survey based on the Patient Safety Climate in Healthcare Organizations survey, a well-validated 38-item measure of safety climate.

METHODS

The Patient Safety Climate in Healthcare Organizations was administered to all senior managers, all physicians, and a 10% random sample of all other hospital personnel in 69 private sector hospitals and 30 Veterans Health Administration hospitals. Both samples were randomly divided into a derivation sample to identify a short-form subset and a confirmation sample to assess the psychometric properties of the proposed short form.

RESULTS

The short form consists of 15 items represented 3 overarching domains in the long-form scale-organization, work unit, and interpersonal.

CONCLUSION

The proposed short form efficiently captures 3 important sources of variance in safety climate: organizational, work-unit, and interpersonal. The short-form development process was a practical method that can be applied to other safety climate surveys. This safety climate short form may increase response rates in studies that involve busy clinicians or repeated measures.

Patient safety climate profiles across time: Strength and level of safety climate associated with a quality improvement program in Switzerland-A cross-sectional survey study

Safety Climate has been acknowledged as an unspecific factor influencing patient safety. However, studies rarely provide in-depth analysis of climate data. As a helpful approach, the concept of “climate strength” has been proposed. In the present study we tested the hypotheses that even if safety climate remains stable on mean-level across time, differences might be evident in strength or shape. The data of two hospitals participating in a large national quality improvement program were analysed for differences in climate profiles at two measurement occasions. We analysed differences on mean-level, differences in percent problematic response, agreement within groups, and frequency histograms in two large hospitals in Switzerland at two measurement occasions (2013 and 2015) applying the Safety Climate Survey. In total, survey responses of 1193 individuals were included in the analyses. Overall, small but significant differences on mean-level of safety climate emerged for some subgroups. Also, although agreement was strong at both time-points within groups, tendencies of divergence or consensus were present in both hospitals. Depending on subgroup and analyses chosen, differences were more or less pronounced. The present study illustrated that taking several measures into account and describing safety climate from different perspectives is necessary in order to fully understand differences and trends within groups and to develop interventions addressing the needs of different groups more precisely.

Survey on patient safety climate in public hospitals in China

Background

Patient safety climate has been recognized as a core determinant for improving safety in hospitals. Describing workforce perceptions of patient safety climate is an important part of safety climate management. This study aimed to describe staff’s perceptions of patient safety climate in public hospitals in Shanghai, China and to determine how perceptions of patient safety climate differ between different types of workers in the U.S. and China.

Methods

Survey of employees of 6 secondary, general public hospitals in Shanghai conducted during 2013 using a modified version of the U.S. Patient Safety Climate in Health Care Organizations (PSCHO) tool. The percentage of “problematic responses” (PPRs) was used to measure safety climate, and the PPRs were compared among employees with different job types, using χ² tests and multivariate regression models.

Results

Perceptions of patient safety climate were relatively positive among hospital employees and similar to those of employees in U.S. hospitals along most dimensions. For workers in Chinese hospitals, the scales of “fear of blame” and “fear of shame” had the highest PPRs, whereas in the United States the scale of “fear of shame” had among the lowest PPRs. As in the United States, hospital managers in China perceived a more positive patient safety climate overall than other types of personnel.

Conclusions

“Fear of shame” and “fear of blame” may be important barriers to improvement of patient safety in Chinese hospitals. Research on the effect of patient safety climate on outcomes is necessary to implement effective polices to improve patient safety and quality outcomes in China.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-0710-x) contains supplementary material, which is available to authorized users.

Co-worker characteristics and nurses' safety-climate perceptions

PURPOSE

Previous research indicates that nurses' safety-climate perceptions are influenced by individual nurse characteristics, leadership, staffing levels and workplace structure. No literature was identified that explored the relationship between nurses' safety climate perceptions and staffing composition in a particular hospital unit. This paper aims to fill some of the gaps in the research in this area.

DESIGN/METHODOLOGY/APPROACH

Data supplied by 430 registered nurses working in two Midwestern US hospitals were analyzed to co-worker characteristics such as education, licensure, experience and full- or part-time status.

FINDINGS

Registered nurses working in hospitals with proportionally more-experienced nurses perceived their workplaces to be significantly safer for patients. Surprisingly, co-worker licensure, education and full- or part-time status did not significantly influence nurses' safety climate perceptions.

PRACTICAL IMPLICATIONS

Findings indicate that safety-climate perceptions vary significantly between hospital units and experienced nurses may act as a resource that promotes a positive safety climate. Hospitals retaining experienced nurses may potentially reduce errors.

ORIGINALITY/VALUE

The paper illustrates that the results highlight the importance of providing nurses with an environment that encourages retention and creates a workplace where experienced nurses' skills are best utilized.

Parent perceptions of children's hospital safety climate

BACKGROUND

Because patients are at the frontline of care where safety climate is closely tied to safety events, understanding patient perceptions of safety climate is crucial. We sought to develop and evaluate a parent-reported version of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and to relate parent-reported responses to parental need to watch over their child's care to ensure mistakes are not made.

METHODS

Parents (n=172) were surveyed about perceptions of hospital safety climate (14 items representing four domains-overall perceptions of safety, openness of staff and parent communication, and handoffs and transitions) and perceived need to watch over their child's care. Confirmatory factor analysis (CFA) was used to validate safety climate domain measures. Logistic regression was used to relate need to watch over care to safety climate domains.

RESULTS

CFA indices suggested good model fit for safety climate domains. Thirty-nine per cent of parents agreed or strongly agreed they needed to watch over care. In adjusted models, need to watch over care was significantly related to overall perceptions of safety (OR 0.20, 95% CI 0.11 to 0.37) and to handoffs and transitions (0.25, 0.14 to 0.46), but not to openness of staff (0.67, 0.40 to 1.12) or parent (0.83, 0.48 to 1.45) communication.

CONCLUSIONS

Findings suggest parents can provide valuable data on specific safety climate domains. Opportunities exist to improve our safety climate's impact on parent burden to watch over their child's care, such as targeting overall perceptions of safety as well as handoffs and transitions.

Impact of individual and team features of patient safety climate: a survey in family practices

PURPOSE

Knowledge about safety climate is fundamental to improving patient safety in health care organizations. Because individual and organizational factors influence the safety climate, we conducted a health care survey of German family practices so we could analyze the impact of the professional group, the professional experience of practice staff, and practice characteristics on perceptions of the safety climate.

METHODS

We wrote to health care assistants and doctors in 1,800 randomly selected family practices in Germany and asked them to complete a newly developed and validated Frankfurt Patient Safety Climate Questionnaire. We conducted a descriptive analyses of items and climate factors, as well as regression analysis, to identify potential predictors of the safety climate in family practice.

RESULTS

The response rate from the participating practices was 36.1%. Safety climate was perceived to be generally positive with the exception of the factors of error management and perception of the causes of errors. We discovered that whether or not the entire team had taken part in the survey had a positive influence on most factors. Doctors had more positive perceptions of 4 of 7 factors addressed to both professions. Male participants and doctors showed the most willingness to admit they had made an error.

CONCLUSIONS

Though the safety climate in German family practices was positive overall, health care professionals' use of incident reporting and a system's approach to errors was fairly rare. When evaluating the safety climate in primary health care practices, respondents' individual characteristics, as well as organizational features, should be taken into account.

Validation of a novel safety climate instrument in VHA nursing homes

Improvements in nursing home safety climate could lead to enhanced resident safety. Yet safety climate has been little studied in the nursing home setting, and existing safety climate instruments have significant limitations. To investigate safety climate in Veterans Health Affairs nursing homes (Community Living Centers [CLCs]), this study had two objectives: (a) to develop a resident safety climate instrument for use in CLCs and (b) to assess this instrument's psychometric properties by administering it in a sample of CLCs. Using a standard conceptual framework, the CLC Employee Survey of Attitudes about Resident Safety was developed with the aid of an expert panel and multiple rounds of cognitive interviews. It was subsequently pilot tested in a sample of CLC employees. After refinement based on the pilot results, it was administered in a sample of five CLCs, where it was found to have adequate reliability and validity.

Literature review regarding patient safety culture

BACKGROUND

Quite a number of articles on patient safety culture have been published in recent 10 years to assess the safety culture in hospitals using the Hospital Survey on Patient Safety Culture in many countries. However, until now there have been no relevant studies to investigate the quality of these, and their contribution to present-day thinking.

OBJECTIVES

The aim of this study was to explore the areas of theme, and the study design of published research on patient safety culture in literature published in English and Chinese language journals.

METHODS

We searched the major databases, including MEDLINE, EMbase, Chinese Biomedical Literature Database, Chinese Journals Full-text Database, and to analyze the publication years, research themes, authors' affiliations and methodologies of articles published from January 2001 to December 2011. Quality and statistical method were only appraised by classification of study designs.

RESULTS

The annual number of published articles on patient safety culture was increasing in the last decade, and the number of articles published in 2010 and 2011 reached its peak with 86 articles accounting for 44.6% of the decade's publication; patient safety culture scale dominated the included literature, accounting for 67.8% of all studies. Cross-sectional studies and commentary reviews were the most popular study designs which took up approximately 95.9% of the included studies with 66.9% (129 articles) and 29.0% (56 articles), respectively. All the included studies on patient safety culture were conducted in the following four institutions: hospitals, geracomium, Veterans Health Administration hospitals, and medical schools.

CONCLUSIONS

There is a growing change trend in the number of articles on patient safety culture research in recent 10 years, most of which are non-comparative studies. More methodologically rigorous designs are needed to improve research quality on patient safety culture.

State of science: human factors and ergonomics in healthcare

The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs.

PRACTITIONER SUMMARY

There has been an increase in the application of HFE techniques to healthcare delivery in the past 10 years. This paper provides a state of science commentary using four illustrative examples (occupational ergonomics, design for patient safety, surgical safety and organisational and socio-technical systems) to review and discuss analytical and implementation challenges and identify future issues for HFE.

Development of a short-form Learning Organization Survey: the LOS-27

Despite urgent need for innovation, adaptation, and change in health care, few tools enable researchers or practitioners to assess the extent to which health care facilities perform as learning organizations or the effects of initiatives that require learning. This study's objective was to develop and test a short-form Learning Organization Survey to fill this gap. The authors applied exploratory factor analysis and confirmatory factor analysis to data from Veterans Health Administration personnel to derive a short-form survey and then conducted further confirmatory factor analysis and factor invariance testing on additional Veterans Health Administration data to evaluate the short form. Results suggest that a 27-item, 7-factor survey (2 environmental factors, 1 on leadership, and 4 on concrete learning processes and practices) reliably measures key features of organizational learning, allowing researchers to evaluate theoretical propositions about organizational learning, its antecedents, and outcomes and enabling managers to assess and enhance organizations' learning capabilities and performance.

Survey-assessed quality and organizational factors related to quality in Pursuing Perfection hospitals

BACKGROUND

The goal of the Pursuing Perfection (P2) program was to encourage organizations to push quality improvement to new levels of excellence. As part of an evaluation of P2, we surveyed employees at the 7 participating P2 organizations to (1) assess their perceptions of patient care quality and improvement progress and (2) examine perceived performance on organizational and workgroup characteristics associated with quality.

METHODS

Many survey questions were drawn from existing conceptual models and survey instruments. We used factor analysis to create new scales from questions that were not part of established scales. We used correlation coefficients and multivariable models to examine relationships among variables.

RESULTS AND CONCLUSIONS

Variables most strongly associated with perceived quality included standardized and simplified care processes resulting in coordinated care and smooth handoffs, a clear sense of organizational direction and clear action plans, and communication with staff about reasons for change and improvement progress made. Of those variables with a strong relationship to quality, ones with relatively low mean ratings included workgroup coordination; sufficient resources and support for improvement; training; and efficient use of people, time, and energy. These are important areas on which management should focus to improve employee ratings of quality.

Perceptions of hospital safety climate and incidence of readmission

OBJECTIVE

To define the relationship between hospital patient safety climate (a measure of hospitals' organizational culture as related to patient safety) and hospitals' rates of rehospitalization within 30 days of discharge.

DATA SOURCES

A safety climate survey administered to a random sample of hospital employees (n=36,375) in 2006-2007 and risk-standardized hospital readmission rates from 2008.

STUDY DESIGN

Cross-sectional study of 67 hospitals.

DATA COLLECTION

Robust multiple regressions used 30-day risk-standardized readmission rates as dependent variables in separate disease-specific models (acute myocardial infarction [AMI], heart failure [HF], pneumonia), and measures of safety climate as independent variables. We estimated separate models for all hospital staff as well as physicians, nurses, hospital senior managers, and frontline staff.

PRINCIPAL FINDINGS

There was a significant positive association between lower safety climate and higher readmission rates for AMI and HF (p ≤ .05 for both models). Frontline staff perceptions of safety climate were associated with readmission rates (p ≤ .01), but senior management perceptions were not. Physician and nurse perceptions related to AMI and HF readmissions, respectively.

CONCLUSIONS

Our findings indicate that hospital patient safety climate is associated with readmission outcomes for AMI and HF and those associations were management level and discipline specific.

Hospital Safety Climate and Safety Outcomes: Is There a Relationship in the VA?

Strengthening safety climate is recognized as a necessary strategy for improving patient safety. Yet there is little empirical evidence linking hospitals’ safety climate with safety outcomes.The authors explored the potential relationship between safety climate and Veterans Health Administration hospital safety performance using the Patient Safety Indicator (PSI) rates. Safety climate survey data were merged with hospital discharge data to calculate PSIs. Linear regressions examined the relationship between hospitals’ safety climate and dimensions of safety climate with individual PSIs and a PSI composite measure, controlling for organizational-level variables. Safety climate overall was not related to the PSIs or to the PSI composite, although a few individual dimensions of safety climate were associated with specific PSIs. Perceptions of frontline staff were more closely aligned with PSIs than those of senior managers.