Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center

Abstract

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.

Health care staffs’ perception of patient safety culture in hospital settings and factors of importance for this

“…This assumption is supported by earlier findings [58], where the staff with distance to patients and less education scored lowest for patient safety culture. Earlier research on perceptions of patient safety culture also show inconsistencies between RNs and physicians, where RNs scored higher than physicians for most questions [59]. In Haugen et al [58], variations were reported where nurse anesthetists scored higher than surgeon physicians both in outcome variables as well as for unit level dimensions.…”

“…These results show that physicians, administrators and nurses considered patient safety as a nurse responsibility, yet only 8% of the physicians consider nurses as part of the decision-making team [60]. When managers aim at unifying views like the previously mentioned in order to improve patient safety, they need to be visible to front line staff [59] and bridge the professional boundaries [61]. Professionals from different disciplines must also cooperate [62] in order to make patient safety a responsibility for all health care staff, regardless of profession.…”

Evolution of patient safety culture in a medium-stay hospital: monitoring indicators

“…Por otra parte, en todos los estudios consultados, el personal percibe que los supervisores tienen un mayor compromiso con la seguridad que los gestores, lo que pone de manifiesto la necesidad de mostrar una actitud más proactiva por parte de la gerencia en temas relacionados con la seguridad del paciente [19][20][21][22][23][24][25] . En general, la percepción de seguridad de 2015 fue inferior a la obtenida en 2013, aunque el grado de seguridad percibida se mantuvo en 7,5.…”

“…El estilo de liderazgo, la personalidad y las actitudes de los directivos, pueden influir en las percepciones de los profesionales y en sus comportamientos y por tanto, tener importantes consecuencias para la seguridad del paciente 25 . La cultura organizacional es difícil de cambiar.…”

Should patient safety be more patient centred?

“…There is little evidence supporting links between organisational factors, medical errors and patient safety, 31 yet a number of instruments to measure safety culture or climate in health care have been developed. [32][33][34][35][36][37] A typical instrument is the Agency for Healthcare Research and Quality patient safety culture survey. 38 It measures concepts including: communication openness; feedback and communication about error; frequency of events reported; handoffs and transitions; management support for patient safety; non-punitive response to error; organisational learning/continuous improvement; overall perceptions of patient safety; staffing; supervisor/manager expectation and actions promoting safety; teamwork across units and within units.…”