Safety climate in healthcare

Flin, R., Burns, C., Mearns, K. et al. (2006) Measuring safety climate in healthcare. Quality and Safety in Health Care, 15(2), 109-115. 

Singer, S., Meterko, M., Baker, L., Gaba, D., Falwell, A. and Rosen, A. 2007. Workforce perceptions of hospital safety culture Development and vahdation of the patient safety climate in healthcare organizations survey. Health Services Research, 42(5), 1999-2021. 

Patient safety researchers have developed several surveys to assess patient safety climate, including the Safety Attitudes Questionnaire (SAQ), AHRQ s Hospital Survey on Patient Safety Culture (SOPS see Chapter 12 for more detailed information), and Patient Safety Climate in Healthcare Organizations. Our chapter provides an in-depth examination of the SAQ in terms of what it measures, key findings and limitations and future areas in need of research. 

Tal Katz-Navon, Eitan Naveh, and Zvi Stern, "Safety Climate in Healthcare Organizations ... 

Olsen, E. 2010. Exploring the possibility of a eommon stmctural model measuring associations between safety climate factors and safety behaviour in healthcare and the petroleum sectors. Accident Analysis Prevention, 42, 1507-16. 

Madsen, M. D., Andersen, H. B., Itoh, K., Assessing Safety Culture and Climate in Healthcare, in Handbook of Human Factors and Ergonomics in Healthcare and Patient Safety, edited by P. Carayon, Lawrence Erlbaum Associates, Mahwah, New Jersey, 2007, pp. 693-713. 

In the next chapter we present a model for understanding healthcare safety that untangles the complexity and arms you with a useful way to think about the issues. It lays the groundwork for understanding exactly what you need to do to lead healthcare safety improvement and build a strong safety climate in your organization. 

There is no doubt that the continuing evaluation of the safety of medicines into the post-marketing period is an expanding and stiU developing area of research. Matters relating to safety spread over into efficacy, which together imply risks and benefits which, in the present international climate of healthcare provision, have consequences for outcomes and costs. A whole new field of research - pharmacoeconomics - is in the process of development and it is to be anticipated that many of the methods used for safety evaluation will be modified and applied in this area. 

The practice of universal precautions is Federal Law in the United States, and it is the responsibility of every employer or institution that healthcare workers have the resources and training necessary to adhere to these safety precautions.Additionally, support for continued practice of universal precautions needs to come from all levels of administration. Observations by Gershon et al. indicate that one of the strongest correlates with compliance is the institutional safety climate.This implies that if healthcare workers perceive their work environment to be conducive to practicing universal precautions, then they will be more likely to do so. 

Safety and risk management research in healthcare has adopted as its dominant trend the systems oriented approach, modelled largely on previous research in safely critical industries such as aviation and nuclear power. The systems view entails that the focus is not primarily on the mechanisms of individual human error but on the factors that shape human performance (Rasmussen 1986 Reason 1993,1997). In an organisational context, such factors are, of course, those that are within the control of the organisation. For instance, it has been suggested that quahty and safety are affected not only by operators professional and technical competence and skills, but also by their attitudes to and perceptions of their job roles, their organisation and management (Helmreich and Merritt 1998). Such employee attitudes and views are important elements which shape safety cirlture - and its related notion safety climate . Indeed, survey studies have shown that staff attitudes are important indices of safety performance not only in human-machine system domains such as railway operations and constmction (e.g. Itoh and Andersen 1999 Itoh et al. 2004 Silva et al. 2004) but also in healthcare (e.g. Colla et al. 2005 Itoh and Andersen 2010). 

Gu, X. and Itoh, K. 2011. A pilot study on healthcare safety climate and error reporting behavior in China. Journal of Patient Safety, 7(4), 204-12. 

Itoh, K. 2011. Does incident reporting rate indicate risk or safety in healthcare Implications from correlations with safety climate scores. Proceedings of the International Conference on Healthcare Systems Ergonomics and Patient Safety, HEPS 2011. Oviedo, Spain, June 2011, 201-4. 

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. 

Safety climate surveys are well embedded as measures of safety culture in industry and have also been translated and applied in healthcare (Abdullah et al. 2009 Cox and Cheyne 2000 Cox and Cox 1991 Coyle et al. 1995 Flin et al. 2006 Helmreich arid Merritt 1998 Meams et al. 1998, 2003 Modak et al. 2007 Nieva and Sorra 2003 Smits et al. 2008 Sorra and Nieva 2004). Safety climate is regarded as the surface features of the underlying safety culture (Flin et al. 2000). Surveys typically assess workforce perceptions of procedures and behaviours in the work environment that indicate the priority given to safety. 

Safety Climate Tools - Applications and Misapplications in Healthcare Settings... 

Research has been carried out to test the psychometric properties of the Safety Attitudes Questionnaire and AHRQ Hospital Safety Culture Survey (Nieva and Sorra 2003 Sexton et al. 2006 Sorra and Nieva 2004). However, there have been important misapplications of survey tools in healthcare. A proliferation of climate surveys now exist, including many where the factor stmcture and construct validity have not been tested. Many hospitals have developed their own bespoke survey tools and these are poorly designed because basic survey design rules have not been followed. One common issue is surveys that do not counter-balance positive and negative statements, thus increasing the risk of response set bias where the... 

The description of how safety climate tools, walk-rounds and the WHO Surgical Safety Checklist have been implemented in healthcare has identhied some of the challenges to measuring and improving culture in healthcare teams and organisations. Other important barriers to improving safety culture exist ... 

Naveh, E., Katz-Navon, T. and Stem, Z. 2005. Treatment errors in healthcare A safety climate dL rodiCh. Management Science, 51, 948-60. 

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. 

Olsen, E. and Aase, K. 2010. A comparative study of safety climate differences in healthcare and the petroleum industry. Quality and Safety in Health Care, 19(Suppl. 3), i75-i79. 

In the newest report, patient safety culture was included as one of the safe practices that were reviewed for its evidence, both as a practice and in terms of the context sensitivity of the practice and its adoption. In reviewing the evidence on patient safety culture as a practice. Weaver et al. (2013) suggest that developing a culture of safety is a core element of many efforts to improve patient safety and healthcare quality. Their systematic review identified and assessed interventions used to promote safety culture or climate in acute care settings. Based on this review the authors indicate that there is evidence suggesting that interventions can improve perceptions of safety culture and potentially reduce patient harm. 

The leader s role is to define the healthcare safety issue for the organization and the terms of the organization s engagement with it. The leader marshals the constituencies that must cooperate to create a strong safety climate and an organizational culture that supports safety. In subsequent chapters we address how this is done well, what it is made up of, and how such efforts are measured. 

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