Patient Safety Culture and Organisational

Patient Safety Culture and Organisational Behaviour Integrating Error, Leadership and the Work Environment... 

Leadership is another important determinant of patient safety culture and patient safety outcomes (Katz-Navon et al. 2009 Wong and Cummings 2007). This is because leaders are often the drivers of safety culture within the organisation. They set the example for employees through their behaviours (Maierhofer et al. 2000). They also shape subordinate behaviour through the provision of rewards or punishments (Hinze 2002). When leaders take time to discuss safety with employees, employees demonstrate less unsafe behaviour (Zohar and Luria 2003). Similarly, if leaders do not make safety a priority among their team, this will be... 

The measurement of safety culture has now become a core component of patient safety and additional patient safety culture assessment instruments will be needed to accommodate organisational sehings that cover the continuum of care in multiple settings. It will also be necessaiy to examine differences, as well as similarities, in staff perceptions of patient safety culture across different settings of care. In addition, it is necessary to examine in these other healthcare settings the relationships between patient safety culture and patient perceptions of care, as well as clinical outcome measures, as has been done in the hospital setting. 

It is therefore essential to develop comprehensive safeguards around any new technological developments to establish a strong safety culture and ensure that our patients always receive the best possible, safe care. These responsibilities fall both to IT suppliers and to the healthcare organisations that implement the solutions. 

What lies behind the result of a patient safety culture assessment In this chapter we have examined the notion of a safety culture from a systems thinking perspective. In doing so, we depict it as the interpretation of the dynamic relationship between goals, priorities and activities within an organisation. Therefore it is not so much a fixed, essential quality as an ongoing achievement between the organisational members (whether management or frontline ) in the context of the broader envirorunent. 

The safety culture criteria depicted in Table 9.1 can be understood as the goals or ideal end states of patient safety management and they can be used as a frame to define monitor indicators. Organisational activities can be viewed from the point of view of how they contribnte to these six ideal states. The control functions in Table 9.2 on the other hand can be used for selecting drive indicators that facilitate change in the right direction. 

One means of gathering data for monitor indicators is patient safety culture questionnaires. We have developed a patient safety culture questionnaire, TUKU, that measures employees perceptions of the organisational functions depicted in Table 9.4 as well as employees psychological states, such as sense of control and worry about patient safety (Reiman et al. 2013). In one hospital, the results of the questionnaire were compared with the ratio of patient safety incidents at the hospital s 40 units 16 months after the safety culture questionnaire was administered. The results, which must be treated with caution due to the small sample size, indicated that perceptions of work process management , work conditions management . 

Table 9.5 depicts possible outcome indicators. These indicators can be seen as the result of the oiganisation s safety culture and the effects of situational and environmental variability, such as the nature of the patient s illness or injury or the fatigue of the clinician. The aggre tion of these outputs into an outcome indicator can provide the organisation with clues about possible changes to their safety potential. 

Summarising the various concepts and definitions proposed, safety culture appears to be the broader, manifest concept behind the fiamewoik of safety climate. Safety cultme is the source for patterns of behaviour which can be observed, described and changed (Goodmaim 2004), whereas safely climate is the sum of behaviours and attitudes based on common assumptions and beliefs toward patient safety. Cox and Flin (1998) describe culture as an organisation s personality while climate is seen as the organisation s mood . 

Based on the literature review, key dimensions of hospital patient safety culture were identified and items drafted to measure those dimensions. Items were written to obtain a staff-level perspeetive of the extent to which a hospital organisation s culture supports patient safety and event reporting. In addition, most of the items were foeused on the respondent s own work area or unit beeause unit-level eulture is more salient and relevant and has the most immediate influenee on staff attitudes and behaviors. Sinee eulture varies aeross units, it was important to foeus respondents on their own unit s eulture by asking them to identify and seleet their unit first and then answer the questions in the survey about that unit. However, some patient safety eulture issues cut across units, so the last part of the survey foeused specifically on hospital-wide patient safety eulture, ineluding handoffs and transitions, pereeptions of management support and teamwork aeross units. 

The AHRQ Surveys on Patient Safety Culture are now used locally, nationally, and internationally. Most users are healthcare organisations and systems, survey vendors that service healthcare organisations, or healthcare researchers. The surveys are used to ... 

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