Patient Safety Culture studies

An early criticism of patient safety culture survey data was that there was not sufficient evidence that culture was related to medical error, patient safety or quality or patient outcomes. There are still very few empirical studies linking the Hospital SOPS to these important outcomes and many more studies are needed. However, there have been a few key studies showing positive relationships between Hospital SOPS scores and outcomes. 

Clearly more empirical studies are needed linking patient safety culture scores to patient safety and quality outcome data Such studies should examine linkages at the hospital level and at the unit level where relationships may be stronger. The difficulty of this research is that large numbers of hospitals with both safety culture and outcome data are needed to detect these relationships. 

Waterson, P.E., Jackson, J., Stride, C., Hutchinson, A., Hammer, A. and Manser, T. in preparation. The Hospital Survey of Patient Safety Culture (HSPSC) A Cross-national Review of Study Characteristics and Psychometric Properties. Unpublished manuscript. 

The objective of risk management and a safety culture should be a proactive treatment of clinical risk and therefore minimisation of adverse incidents arising from HIT. Nevertheless this should not detract from the notion that one can learn a great deal from analysing incidents or near misses. A patient safety incident is an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient [22]. The ongoing study of incident reports can help identify common types of problems [23] and incident reporting has been cited as one of the major steps in improving the safety of HIT [24]. 

Several instruments have been developed to assess hospital staff s perceptions of aspects of workplace safety culture and a number of studies have reported associations between hospital safety culture and safety outcome measures (Jackson et al. 2010). Profiling the hospital safety culture scores is relatively straightforward but finding safety outcome measures for patients or workers is more challenging (Flin 2007). Different types of safety outcome data can be collected, e.g. (i) hospital incident records for staff or patients or clinical data for patients, (ii) self-reports of incidents and injuries by workers or patients and (iii) workers safety behaviours (self-reported or observed). 

A sample of 475 staff from 10 hospitals in Costa Rica, Gimeno et al. (2005) found that safety culture was related to self-reported work-related injuries. Another study of 789 hospital-based healthcare workers in the USA, found that experienced blood and body fluid exposure incidents for workers were lower when senior management support, safety feedback and training were perceived favourably (Gershon et al. 2000). In Japan, reduced needle-stick and sharp injuries to hospital workers were associated with safety culture factors, such as being involved in health and safety matters (Smith et al. 2010). In our Scottish hospital sample, we collected information on self-reports of worker injuries, as well as observed errors affecting patients. 

In order to identify areas of organisational culture that could be targeted to improve patient safety in Scottish hospitals, a safety culture survey was conducted. The aims of the study were first, to obtain a measure of safety culture from a sample of NHS acute hospitals in Scotland and then to test whether these culture scores were associated with clinical workers safety behaviours and patient and worker injuries. This would also provide a measure of safety culture within the Scottish acute hospital sector and contribute an organisational cultural perspective to the... 

In regard to health care, safety culture has even greater importance, as safety applies not only to the workforce but also to the patients who may get injured due to staff actions. Various studies conducted over the years clearly indicate that the existence of a positive safety culture is essential for reducing preventable patient injuries and their cost to society at large [12-14]. 

A Children s executive explained, "We wanted to understand directly from clinicians and families whether this was a safe place to give and receive care, based on their experience and to learn what they perceived to be barriers in patient safety. The goal was to gain a portrait of the actual safety experience within the organization as a starting point to understand the culture. The focus group methodology was used to create a locally relevant view of safety rather than extrapolate from published studies."... 

Unfortunately, it is the atypical executive leader who takes a long, unflinching look at the real work on the front line. Nevertheless, that act is a prerequisite of a culture of safety. The following two case studies demonstrate how leaders can directly access unedited, unprocessed data about the experience of patient safety in their organizations. Leaders visibility and personal engagement make patient safety visible as a value and a priority. The first case study is from health care the second is from industry. 

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