The Relationship Between Safety Climate and Performance in Intensive Care Units: The Mediating Role of Managerial Safety Practices and Priority of Safety

Measuring Safety Culture Using an Integrative Approach: The Development of a Comprehensive Conceptual Framework and an Applied Safety Culture Assessment Instrument

An exponential amount of academic research has been dedicated to the safety culture concept, but still, no consensus has been reached on its definition and content. In general, safety culture research lacks an interdisciplinary approach. Furthermore, although the concept of safety culture is characterised by complexity and multifacetedness, the safety culture concept has been characterised by reductionism, where models and theories simplify the concept in order to better grasp it, leading to confined approaches. In this article, the multifacetedness of safety culture is acknowledged, and the topic is addressed from a safety science perspective, combining insights from multiple academic disciplines. An integrative and comprehensive conceptual framework to assess safety culture in organisations is developed, taking into account the limitations of existing models, as well as the needs of the work field. This conceptual framework is called the 'Integrated Safety Culture Assessment' (ISCA), where the 'assessment' refers to its practical usability. The practical rendition of ISCA can be used to map the safety culture of an organisation and to formulate recommendations in this regard, with the ultimate goal of bringing about a change towards a positive safety culture. The comprehensiveness of ISCA lies in the inclusion of technological factors, organisational or contextual factors and human factors interacting and interrelating with each other, and in considering both observable or objective safety-related aspects in an organisation, and non-observable or subjective safety-related aspects. When using ISCA, organisational safety culture is assessed in an integrative way by using a variety of research methods involving the entire organisation, and by taking into account the specific context of the organisation.

Determinants of safety climate at primary care level in Ghana, Malawi and Uganda: a cross-sectional study across 138 selected primary healthcare facilities

BACKGROUND

Safety climate is an essential component of achieving Universal Health Coverage, with several organisational, unit or team-level, and individual health worker factors identified as influencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda.

METHODS

A cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisational-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country.

RESULTS

Our model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.34, p < 0.001), and district managerial support (β = 0.29, p < 0.001). In Ghana, safety climate was positively associated with job satisfaction (β = 0.30, p < 0.05), teamwork (β = 0.46, p < 0.001), and supportive supervision (β = 0.21, p < 0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.43, p < 0.001), and perceived district managerial support (β = 0.35, p < 0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (β = 0.39, p = 0.005) and supportive supervision (β = 0.27, p = 0.023) significantly and positively associated with safety climate.

DISCUSSION/CONCLUSIONS

Our findings highlight the importance of unit-level factors-and in specific, teamwork and supportive supervision-as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed.