Background: Despite the emphasis on patient safety in health care, few organizations have evaluated the extent to which safety is a strategic priority or their culture supports patient safety. In response to the Institute of Medicine's report and to an organizational commitment to patient safety, we conducted a systematic assessment of safety at the Johns Hopkins Hospital (JHH) and, from this, developed a strategic plan to improve safety. The specific aims of this study were to evaluate the extent to which the culture supports patient safety at JHH and the extent to which safety is a strategic priority. Methods: During July and August 2001 we implemented two surveys in disparate populations to assess patient safety. The Safety Climate Scale (SCS) was administered to a sample of physicians, nurses, pharmacists, and other ICU staff. SCS assesses perceptions of a strong and proactive organizational commitment to patient safety. The second survey instrument, called Strategies for Leadership (SLS), evaluated the extent to which safety was a strategic priority for the organization. This survey was administered to clinical and administrative leaders. Results: We received 395 completed SCS surveys from 82% of the departments and 86% of the nursing units. Staff perceived that supervisors had a greater commitment to safety than senior leaders. Nurses had higher scores than physicians for perceptions of safety. Twenty three completed SLS surveys were received from 77% of the JHH Patient Safety Committee members and 50% of the JHH Management Committee members. Management Committee responses were more positive than Patient Safety Committee, indicating that management perceived safety efforts to be further developed. Strategic planning received the lowest scores from both committees. Conclusions: We believe this is one of the first large scale efforts to measure institutional culture of safety and then design improvements in health care. The survey results suggest that strategic planning of patient safety needs enhancement. Several efforts to improve our culture of safety were initiated based on these results, which should lead to measurable improvements in patient safety.

IntroductIon "Second victims" are health care providers who are involved with patient adverse events and who subsequently have difficulty coping with their emotions. Growing attention is being paid to making system improvements to create safer health care and to the appropriate handling of patients and families harmed during the provision of medical care. In contrast, there has been little attention to helping health care workers cope with adverse events. objEctIvEs The aim of the study was to emphasize the importance of support structures for second victims in the handling of patient adverse events and in building a culture of safety within hospitals. MEthods A survey was administered to health care workers who participated in a patient safety meeting. The total number of registered participants was 350 individuals from various professions and different institutions within Johns Hopkins Medicine. The first part of the survey was paper-based and the second was administered online. rEsuLts The survey results reflected a need in "second victim" support strategies within health care organizations. Overall, informal emotional support and peer support were among the most requested and most useful strategies. concLusIons When there is a serious patient adverse event, there are always second victims who are health care workers. The Johns Hopkins Hospital has established a "Second Victims" Work Group that will develop support strategies, particularly a peer-support program, for health care professionals within the system.

The adsorption capacity of a shale gas reservoir is mainly determined by the isothermal adsorption experiment. In this study, the building conditions and performances of seven single‐component and five multi‐component adsorption models were compared and analyzed. The results show that most shale gas reservoir adsorption characteristics obey those of type I on the macroscopic scale. The adsorption isotherms of single components can be described by the Langmuir‐Freundlich, Langmuir, and Toth models. The revised Langmuir, extended Langmuir, and the loading ratio correlation (LRC) models can be applied to binary‐component mixtures; and the extended Langmuir and LRC models perform best for shale gas. The obtained results might have an important promoting effect for modeling the shortage of shale gas.

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