Hospital Safety Climate and Safety Outcomes: Is There a Relationship in the VA?
VA Boston Healthcare System, MA, Boston University School of Public Health, MA, USA. Medical Care Research and Review
(Impact Factor: 2.62).
02/2010; 67(5):590-608. DOI: 10.1177/1077558709356703
Strengthening safety climate is recognized as a necessary strategy for improving patient safety. Yet there is little empirical evidence linking hospitals' safety climate with safety outcomes.The authors explored the potential relationship between safety climate and Veterans Health Administration hospital safety performance using the Patient Safety Indicator (PSI) rates. Safety climate survey data were merged with hospital discharge data to calculate PSIs. Linear regressions examined the relationship between hospitals' safety climate and dimensions of safety climate with individual PSIs and a PSI composite measure, controlling for organizational-level variables. Safety climate overall was not related to the PSIs or to the PSI composite, although a few individual dimensions of safety climate were associated with specific PSIs. Perceptions of frontline staff were more closely aligned with PSIs than those of senior managers.
Available from: Byron J. Powell
- "Consistently, staff with direct contact with patients had the most exposure to potential safety issues and as a result 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). "
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ABSTRACT: Several studies have demonstrated the effect of an organization's culture and climate on the delivery of services to clients and the success of clinical outcomes. Workers' perceptions are integral components of organizational social context, and in order to create a positive organizational culture and climate, managers and frontline staff need to have a shared understanding of the social context. The existing literature does not adequately address that discrepancies in perceptions of culture and climate between frontline staff and managers impact the implementation of policies and services. The purpose of this study is to compare the workgroup-level culture and climate of a single, large child and family social services organization, based on the reported experiences of front-line workers and senior managers. The results showed that, as a group, senior managers rated the organization as having a culture that was much more proficient and much less rigid and a climate that was more engaged and more functional than the average frontline workgroup. The discrepancies between the perceptions of upper management and workgroup-level staff indicate the need for interventions that can improve communication and cohesiveness between these two groups.
Available from: Swee C. Goh
- "However, as Rosen et al. (2010, p. 591) state: In general, these studies have been limited to small representative samples, self-reported clinical outcomes, or selected dimensions of climate. One study showed a strong link between a strong safety climate and patient safety outcomes at the hospital level (Singer et al., 2009b) and another had more modest and weaker results in a Veterans Health Administration Hospital study (Rosen et al., 2010). Colla et al. (2005) summarized nine published patient-safety climate surveys; five common themes across these surveys included leadership, policies and procedures, staffing, communication and reporting. "
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ABSTRACT: This article aims to encourage healthcare administrators to consider the learning organization concept and foster collaborative learning among teams in their attempt to improve patient safety.
Relevant healthcare, organizational behavior and human resource management literature was reviewed.
A patient safety culture, fostered by healthcare leaders, should include an organizational culture that encourages collaborative learning, replaces the blame culture, prioritizes patient safety and rewards individuals who identify serious mistakes.
As healthcare institution staffs are being asked to deliver more complex medical services with fewer resources, there is a need to understand how hospital staff can learn from other organizational settings, especially the non-healthcare sectors.
The paper provides suggestions for improving patient safety which are drawn from the health and business management literature.
Available from: Sara J Singer
- "Measurement of the effect of safety climate measured at the level of the hospital, management position, or job type is limited. Singer and colleagues demonstrated that significant variation in perceived safety climate does exist by work role (Hartmann , Meterko, and Rosen 2009; Singer et al. 2009b) and that hospitals whose frontline staff perceived a better safety climate were less likely to experience adverse PSI events (Singer et al. 2009d; Rosen et al. 2010). "
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ABSTRACT: To define the relationship between hospital patient safety climate (a measure of hospitals' organizational culture as related to patient safety) and hospitals' rates of rehospitalization within 30 days of discharge.
A safety climate survey administered to a random sample of hospital employees (n=36,375) in 2006-2007 and risk-standardized hospital readmission rates from 2008.
Cross-sectional study of 67 hospitals.
Robust multiple regressions used 30-day risk-standardized readmission rates as dependent variables in separate disease-specific models (acute myocardial infarction [AMI], heart failure [HF], pneumonia), and measures of safety climate as independent variables. We estimated separate models for all hospital staff as well as physicians, nurses, hospital senior managers, and frontline staff.
There was a significant positive association between lower safety climate and higher readmission rates for AMI and HF (p ≤ .05 for both models). Frontline staff perceptions of safety climate were associated with readmission rates (p ≤ .01), but senior management perceptions were not. Physician and nurse perceptions related to AMI and HF readmissions, respectively.
Our findings indicate that hospital patient safety climate is associated with readmission outcomes for AMI and HF and those associations were management level and discipline specific.
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