An Overview of Patient Safety Climate in the VA

Abstract

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 5 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.Key Words. Patient safety, safety climate, high-reliability organizationThe health care industry attempts to cure patients while avoiding problems and negative outcomes resulting from the processes of care. In many ways, health care strives to be a ''high-reliability'' enterprise. High-reliability organizations (HROs), which include the aviation and nuclear power industries, successfully perform highly complex and repetitive tasks while avoiding disastrous events. The reliability of HROs is attributed in part to having a strong safety climate, and several different formulations of key principles of r Health Research and Educational Trust

A methodological study to compare survey-based and observation-based evaluations of organisational and safety cultures and then compare both approaches with markers of the quality of care.

“…137,143 Our findings broadly support existing research that shows a more positive assessment of safety climate by managers than by clinical staff. 37,102,103,229,230 The teamwork climate 25 results, but not other components of the survey-based safety climate measure, accord with other studies that found nurses' assessments of aspects of safety climate more negative than doctors' assessments. 106,218,228 To what extent might the empirical results be considered predictable?…”

Operating Room Team Members' Views of Workload, Case Difficulty, and Nonroutine Events

“…Operating room (OR) safety has increased but the literature suggests that opportunities for improvement remain (Alfredsdottir & Bjornsdottir, 2008;Christian et al, 2006;Hartmann et al, 2008;Lingard et al, 2008). Three ways that intraoperative safety has been increased are through improvements in equipment (Barnett & Nathoo, 2004;Kaibara, Saunders, & Sutherland, 2000), individual provider training (Awad et al, 2005;Buback, 2004;Makary et al, 2007), and operative team functioning (Einav et al, 2010;Gore et al, 2010;Haynes et al, 2009;Manser, 2009;Mazzocco et al, 2009;Wolf, Way, & Stewart, 2010).…”

Organizational Leaders’ and Staff Members’ Appraisals of Their Work Environment Within a Children’s Social Service System

“…Multiple studies that assessed climate and patient care in hospital environments (Hansen, Williams & Singer, 2011; Hartmann et al, 2008; Rosen et al, 2010; Singer et al, 2009) found that senior management routinely rated the hospital climate higher than frontline staff. However, frontline staff perceptions were more closely associated with patient readmission and compromised patient safety than senior management perceptions.…”

“…Frontline staff members were more accurate than senior management in identifying weaknesses in safety climate associated with worse patient outcomes. Consistently, staff with direct contact with patients had the most exposure to potential safety issues and resultantly had significantly higher levels of problematic response compared to senior managers, whose work is removed from the direct patient care environment (Hartmann et al, 2008). As senior managers are less often exposed to frontline work, they may be less informed about safety performance than frontline workers whose actions directly affect patients; this is true regardless of health care systems or settings (Rosen et al, 2010).…”