Safety climate dimensions

Bosak, J., Coetsee, W. J., Cullinane, S. (2013). Safety climate dimensions as predictors for risk behavior. Accident Analysis and Prevention, 55, 256-264. 

Kath, L. M., Marks, K. M., Ranney, J. (2010b). Safety climate dimensions, leader-member exchange, and organizational support as predictors of upward safety communication in a sample of rail industry workers. Safety Science, 48, 643-650. 

While the focus of almost all studies included in this chapter was the adaptation of a patient safety cUmate measure from the USAto their own national and healthcare contexts, maity of the questions we will have to answer in future might be better addressed at a cross-national level. At the level of the survey instmment this would require a certain amount of consistency regarding the use of terminology and the addition or removal of items - a minimal shared item set. Taking cross-national similarities and differences into account (especially with regard to internal consistencies of the various safety climate dimensions) might help to improve further the overall quality of the HSPSC and to further our understanding of factors at the level of healthcare systems that may have a considerable impact on safety climate. 

Of conrse, this approach is based on the assumption that safety culture correlates with safety outcomes. Therefore, it is of critical importance to confirm the cnltnre-ontcome link, which is one of the requirements for a safety culture scale, understood as criterion validity - a more comprehensive summary of the required properties can be found in other literature (e.g. Itoh et al. 2012). For this applied purpose of safety culture, this chapter specifically looks at dimensions of safety culture, how to measure safety outcomes, and the safety culture-outcome link through an examination of case studies, primarily drawn from Japanese hospitals. Before stating these issues in detail, we will, in the rest of this section, briefly argue notions of safety culture (and safety climate). 

As pointed out by Lazar et al. (2013) outcome measures need to be harmonised. They must be rehable, valid and consistent Most outcome measures reflect a single dimension but rrltimately they must be developed to reflect the continuum of care. While we might ideally want and even require measures of safety climate and culture to correlate with outcome measures, we have tried to describe in this section the many factors that will tend to cover or weaken such correlations. 

Itoh, K. and Andersen, H.B. 2010. Dimensions of healthcare safety climate and their correlation with safety outcomes in Japanese hospitals. In B.J.M. Ale, LA. Papazoglou and E. Zio (eds). Risk, Reliability and Safety Back to the Future. London CRC Press, 1655-63. 

In a second step, pubUcations were reviewed for resrrlts on discriminant construct validity by searching for calculations of inter-correlations among the safety climate dimensiorts. In addition, internal consistency was reviewed by assessing Cronbach s alpha for each of the 12 dimensions. The results on Cronbach s alpha were compared to the original HSPSC version by Soria and Nieva (2004) as well as across Ettropean cormtries. 

Benn et al. (2009) Safer Patients Initiative Unclear though the Initiative ran for a total of five years Acute care organisations Compared perceptions of safety climate to 18 performance dimensions Safety climate improvement attributed to Safer Patients Initiative... 

Criterion 3—Level of detail adequate for the development of hypotheses on the overall intervention. The level of detail (Mohaghegh and Mosleh, 2009 Cagno et al., 2014) of factors depends on the importance attached to the different dimensions of the factors in terms of their impacts on the model output. For example, there are two possible approaches to make a cause-to-effect interaction between the human resource system and safety climate . The modeller can consider these two factors as global factors. On the other hand, he/she can establish multiple relations between the human resource system and different dimensions of the safety climate (e.g., perception of the reporting system , perception of training , etc.). The latter is modelled with a higher level of details (Cagno et al., 2014). In our... 

Zohar, D. (2002). The effects of leadership dimensions, safety climate, and assigned priorities on minor injuries in work groups. J. Organizational Behav., 23(1), 75-92. 

There is no general agreement on the dimensions that the safety climate is made up of. Examples of dimensions that are mentioned in the research literature are (Zohar, 1980 Brown and Holmes, 1986 Dedobbeleer and Beland, 1991 Niskanen, 1994 Cox and Elin, 1998) ... 

Certain other healthcare-related instruments fall between a true diagnostic instrument and an opinion survey. The Agency for Healthcare Research and Quality s (AHRQ s) Hospital Survey on Patient Safety Culture is an example, It measures some aspects of team functioning and safety climate it does not measure the dimensions of organizational culture known to predict performance, AHRQ maintains a database of other hospitals that have used the survey as a benchmark, but the survey has not been shown to have predictive validity,... 

The sense of responsibility is strongly influenced by perceptions of the safety climate, which also affect the dimensions of upward communication and approaching others. Relations with superiors and other team members as well as the sense of fair treatment by the organization and superiors all affect whether team members are likely to raise their concerns regarding patient safety. 

Safety climate is underwritten by the organizational dimensions. In particular, there is a strong relationship between perceived organizational support and safety climate. Team members who believe the organization cares about them also accept that leadership is committed to safety. Commitment to safety is one specific way in which organizational support can be demonstrated, and such commitment is a means by which a leader can make his or her ethical commitment to safety visible and tangible. This display of commitment represents an important opportunity for a leader who wants to build a strong safety climate. 

The upward communication dimension deals with team members raising safety issues with superiors—often, these concerns consist of systems issues. In a healthy safety climate, treatment team members also speak up to one another about ways to reduce exposure (the upward communication dimension), even about the exposures they see each other creating. The more that team members are involved in hazard identification and willing to speak up about exposures, the safer the working interface becomes. 

The cultural dimension of approaching others is related to both leader-member exchange and safety climate. If the leader is seen as valuing safety, the subordinate can reciprocate by speaking to others on the treatment team about safety. 

As noted earlier (see chapter 2) "safety culture" is a bit of a misnomer. Safety climate is one of the nine dimensions of organizational culture. 

---