Baker L, Sara S, Gaba D, Geppert J, Sinaiko AD, Howard SK, Park K; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 706.
Stanford University, Dpt. of Health Research and Policy, HRP Redwood Building, Rm 253, Stanford, CA 94305-5405 Tel. (650) 723-4098 Fax (650) 723-3786
RESEARCH OBJECTIVE: The "safety culture" of an institution like a hospital may be a key determinant of its ability to achieve high levels of patient safety. This study examines "safety culture," studying fundamental attitudes toward patient safety, ways in which attitudes vary by hospital, job class, and clinical status, and the extent to which safety culture differs in healthcare from a recognized high reliability organization, naval aviation. STUDY DESIGN: We study survey data on 6312 physicians and hospital employees from 15 California hospitals, including attending physicians, senior executives, nursing staff, and other hospital personnel (survey response rate=47% overall; 62% excluding physicians). Respondents were asked respondents questions covering 16 topics important to a culture of safety in health care plus demographic information. We examine the frequency of responses suggesting an absence of safety culture ("problematic responses" to the survey questions). We also examined the frequency of "neutral" responses, as these might also imply a lack of safety culture. We report responses for each question overall, by hospital, job class and clinician status. We weight where appropriate to allow accurate comparisons across participating hospitals and job types, and to correct for subject non-response. We compare results for hospitals to results from a similar survey of naval aviators containing closely matched questions. The navy sample consisted of 226 squadrons, with 6901 returned surveys and a response rate of approximately 85 POPULATION STUDIED: 6,312 physicians and hospital employees from 15 California hospitals. In some analyses these are compared to data on 6,901 naval aviators in 226 squadrons. PRINCIPAL FINDINGS: Average overall problematic response among hospital employees was 18%, and another 18% of respondents provided neutral responses. Problematic responses varied widely among participating institutions. Clinicians, especially nurses, provided more problematic responses than did non-clinicians. Front-line workers provided more problematic responses than did senior managers. For naval aviators, average overall problematic responses were 5.6%, compared to 18% for hospital personnel overall and 22% among hospital professionals in high-hazard domains (e.g. emergency department) with p<.0001 vs. aviators in all cases. Problematic response among hospital workers was up to 12 times greater than among aviators. CONCLUSIONS: The strength of safety culture in health care appears to be markedly less than in naval aviation units. In health care, culture measures differed significantly among hospitals and also by clinical status and job class within individual institutions. The results provide the most complete available information on the attitudes and experiences of workers about safety culture in hospitals and about ways in which perceptions of safety culture differ among hospitals and their personnel. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Effort should be devoted to improving the safety culture in hospitals, and perhaps other health care organizations. Further analysis of mechanisms by which senior managers can most successfully transmit their commitment to safety to operationally challenging clinical workplaces is needed. Health care institutions may need to make substantial changes to achieve safety cultures consistent with high reliability organizations.
Publication Types:
Keywords:
- Aviation
- California
- Case-Control Studies
- Culture
- Data Collection
- Hospital Administration
- Hospitals
- Humans
- Institutional Management Teams
- Organizational Culture
- Personnel, Hospital
- Safety
- Safety Management
- ethnology
- organization & administration
- therapy
- hsrmtgs
Other ID:
UI: 102275675
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