Measuring and Comparing Safety Climate in Intensive Care Units

ArticleinMedical care 48(3):279-84 · March 2010with15 Reads
DOI: 10.1097/MLR.0b013e3181c162d6 · Source: PubMed
Learning about the factors that influence safety climate and improving the methods for assessing relative performance among hospital or units would improve decision-making for clinical improvement. To measure safety climate in intensive care units (ICU) owned by a large for-profit integrated health delivery systems; identify specific provider, ICU, and hospital factors that influence safety climate; and improve the reporting of safety climate data for comparison and benchmarking. We administered the Safety Attitudes Questionnaire (SAQ) to clinicians, staff, and administrators in 110 ICUs from 61 hospitals. A total of 1502 surveys (43% response) from physicians, nurses, respiratory therapists, pharmacists, mangers, and other ancillary providers. The survey measured safety climate across 6 domains: teamwork climate; safety climate; perceptions of management; job satisfaction; working conditions; and stress recognition. Percentage of positive scores, mean scores, unadjusted random effects, and covariate-adjusted random effect were used to rank ICU performance. The cohort was characterized by a positive safety climate. Respondents scored perceptions of management and working conditions significantly lower than the other domains of safety climate. Respondent job type was significantly associated with safety climate and domain scores. There was modest agreement between ranking methodologies using raw scores and random effects. The relative proportion of job type must be considered before comparing safety climate results across organizational units. Ranking methodologies based on raw scores and random effects are viable for feedback reports. The use of covariate-adjusted random effects is recommended for hospital decision-making.
    • "The missing values analysis revealed a low proportion of missing values (MV). The number of MV was lower than 5% for all the items, except for q25 (MV = 10.4%), which was anyway lower than in other studies [14,31,32]. The high MV at q25 may be due to a difficulty in interpreting the item meaning, so a better translation or wording may be helpful to reduce the MV. "
    [Show abstract] [Hide abstract] ABSTRACT: Rationale, aims and objective: Neonatal intensive care units (NICUs) are a high-risk setting. The Safety Attitude Questionnaire (SAQ) is a widely used tool to measure safety culture. The aims of the study are to verify the psychometric properties of the Italian version of SAQ, to evaluate safety culture in the NICUs and to identify improvement interventions. Method: A cross-sectional study was conducted in 6 level III NICUs. The SAQ was translated into Italian and adapted to the context, a confirmatory factor analysis (CFA) was performed to validate the questionnaire. Results: 193 questionnaires were collected. The mean response rate was 59.7% (range 44.5%-95.7%). The answers were analysed according to six factors: f1 - teamwork climate, f2 - safety climate, f3 - job satisfaction, f4 - stress recognition, f5 - perception of management, f6 - working conditions. The CFA indexes were adequate (McDonald's omega indexes varied from 0.74 to 0.94, the SRMR index was equal to 0.79 and the RMSEA index was 0.070, 95% CI = 0.063-0.078). The mean composite score was 57.6 (SD 17.9), ranging between 42.3 and 69.7 on a standardized 100-point scale. We highlighted significant differences among units and professions (P < 0.05). Conclusions: The Italian version of the SAQ proved to be an effective tool to evaluate and compare the safety culture in the NICUs. The obtained scores significantly varied both within and among the NICUs. The organizational and structural characteristics of the involved hospitals probably affect the safety culture perception by the staff.
    Full-text · Article · Oct 2015
    • "However, patient safety climate studies confirm that RNs in ICUs have positive perceptions of the teamwork within the unit which includes, e.g. supporting others and coordinating activities535455, which may also influence the team's resource utilization skills. A similar picture emerged with the M-ICU teams, with higher scores than the G-ICU teams with regard to communication skills, which may be a result of RN teams from the M-ICU being more familiar with the CPR guidelines. "
    [Show abstract] [Hide abstract] ABSTRACT: Effective teamwork has proven to be crucial for providing safe care. The performance of emergencies in general and cardiac arrest situations in particular, has been criticized for primarily focusing on the individual's technical skills and too little on the teams' performance of non-technical skills. The aim of the study was to explore intensive care nurses' team performance in a simulation-based emergency situation by using expert raters' assessments and nurses' self-assessments in relation to different intensive care specialties. The study used an explorative design based on laboratory high-fidelity simulation. Fifty-three registered nurses, who were allocated into 11 teams representing two intensive care specialties, participated in a videotaped simulation-based cardiac arrest setting. The expert raters used the Ottawa Crisis Resource Management Global Rating Scale and the first part of the Mayo High Performance Teamwork Scale to assess the teams' performance. The registered nurses used the first part of the Mayo High Performance Teamwork Scale for their self-assessments, and the analyses used were Chi-square tests, Mann-Whitney U tests, Spearman's rho and Intraclass Correlation Coefficient Type III. The expert raters assessed the teams' performance as either advanced novice or competent, with significant differences being found between the teams from different specialties. Significant differences were found between the expert raters' assessments and the registered nurses' self-assessments. Teams of registered nurses representing specialties with coronary patients exhibit a higher competence in non-technical skills compared to team performance regarding a simulated cardiac arrest. The use of expert raters' assessments and registered nurses' self-assessments are useful in raising awareness of team performance with regard to patient safety.
    Full-text · Article · Dec 2014
    • "Another shared theme is collaboration. From the literature we identified that safety and learning should be a collaborative task shared by employees across each organisation (Lähteenmäki et al, 2001; France et al, 2010). Collaboration is critical for safety, as safe and productive operation requires effective work practices both within and across teams. "
    [Show abstract] [Hide abstract] ABSTRACT: This article examines the alignment of learning and safety culture in organisations. It tests the hypothesis that factors that indicate a good learning culture might also signify good safety and vice versa. The hypothesis was tested through an intensive literature review. Areas of alignment of learning culture and safety culture were identified. Six components of learning culture and safety culture can be measured by the same instrument. These components form guiding principles for measurement of safety culture and learning culture. Another eight component areas were identified where learning culture and safety culture partially align. Four further components were found to be relevant to either safety culture or learning culture and do not align. Overall, there is a relationship between learning culture and safety culture, but gauging one does not provide a reliable measure of the other.
    Full-text · Article · Nov 2014
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