Is culture associated with patient safety in the emergency department? A study of staff perspectives.

OBJECTIVE To describe the patient safety culture of Dutch emergency departments (EDs), to examine associations between safety culture dimensions and patient safety grades as reported by ED staff and to compare these associations between nurses and physicians. DESIGN Cross-sectional survey conducted in 2007. SETTING Thirty-three non-academic EDs in the Netherlands. PARTICIPANTS Four hundred and eighty nurses, 159 physicians and 91 other professionals. MAIN OUTCOME MEASURE Self-reported level of patient safety. RESULTS In unadjusted analyses, all dimensions of safety culture were positively associated with the reported level of patient safety and six of these associations with patient safety were statistically significant after adjustment ('teamwork across units', 'frequency of event reporting', communication openness', 'feedback about and learning from errors', 'hospital management support for patient safety'). Differences between nurses and physicians were found on two dimensions ('frequency of event reporting' and ' hospital management support for patient safety'). Physicians tended to grade patient safety higher than nurses whilst having equal judgements on these two dimensions. CONCLUSIONS Staff identified several dimensions of safety culture that are associated with staff-reported safety in the ED. Physicians and nurses identified distinct dimensions of safety culture as associated with reported level of patient safety.

[1]  Cordula Wagner,et al.  The role of patient safety culture in the causation of unintended events in hospitals. , 2012, Journal of clinical nursing.

[2]  Addie Johnson,et al.  Variations in hospital worker perceptions of safety culture. , 2012, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[3]  R. Flin,et al.  Hospital survey on patient safety culture: psychometric analysis on a Scottish sample , 2011, Quality and Safety in Health Care.

[4]  F. El-Jardali,et al.  Predictors and outcomes of patient safety culture in hospitals , 2011, BMC health services research.

[5]  Kabir Khanna,et al.  Exploring Relationships Between Hospital Patient Safety Culture and Adverse Events , 2010, Journal of patient safety.

[6]  Tanja Manser,et al.  Development of the German version of the Hospital Survey on Patient Safety Culture: dimensionality and psychometric properties. , 2010 .

[7]  Addie Johnson,et al.  Perceptions of personal health risks by medical and non-medical workers in a university medical center: a survey study , 2010, BMC Public Health.

[8]  Frank W Guldenmund,et al.  (Mis)understanding Safety Culture and Its Relationship to Safety Management , 2010, Risk analysis : an official publication of the Society for Risk Analysis.

[9]  A. Hamersma,et al.  Application of root cause analysis on malpractice claim files related to diagnostic failures , 2010, Quality and Safety in Health Care.

[10]  J. Sorra,et al.  Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture , 2010, BMC health services research.

[11]  J. Twisk,et al.  The relationship between patient safety culture and the implementation of organizational patient safety defences at emergency departments. , 2010, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[12]  S. Hignett,et al.  Psychometric properties of the Hospital Survey on Patient Safety Culture: findings from the UK , 2010, Quality and Safety in Health Care.

[13]  S. Bodur,et al.  Validity and reliability of Turkish version of "Hospital Survey on Patient Safety Culture" and perception of patient safety in public hospitals in Turkey , 2010, BMC health services research.

[14]  Cordula Wagner,et al.  The nature and causes of unintended events reported at ten emergency departments , 2009, BMC emergency medicine.

[15]  Niraj L. Sehgal,et al.  AHRQ's Hospital Survey on Patient Safety Culture: Psychometric Analyses , 2009, Journal of patient safety.

[16]  P. Groenewegen,et al.  Measuring patient safety culture: an assessment of the clustering of responses at unit level and hospital level , 2009, Quality & Safety in Health Care.

[17]  D. Pittet,et al.  Nurses and Physicians’ Perceptions of the Importance and Impact of Healthcare-Associated Infections and Hand Hygiene: a Multi-Center Exploratory Study in Hong Kong , 2009, Infection.

[18]  P. Groenewegen,et al.  The psychometric properties of the 'Hospital Survey on Patient Safety Culture' in Dutch hospitals , 2008, BMC health services research.

[19]  Espen Olsen [Workers' perceptions of safety culture at a hospital]. , 2007, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[20]  Johan Hellings,et al.  Challenging patient safety culture: survey results. , 2007, International journal of health care quality assurance.

[21]  Marlene R. Miller,et al.  How will we know patients are safer? An organization-wide approach to measuring and improving safety , 2006, Critical care medicine.

[22]  Eitan Naveh,et al.  Treatment Errors in Healthcare: A Safety Climate Approach , 2005, Manag. Sci..

[23]  Young Ik Cho,et al.  The Relation Between Culture and Response Styles , 2005 .

[24]  D. Christakis,et al.  Use of Incident Reports by Physicians and Nurses to Document Medical Errors in Pediatric Patients , 2004, Pediatrics.

[25]  Sue M. Evans,et al.  Attitudes of doctors and nurses towards incident reporting: a qualitative analysis , 2004, The Medical journal of Australia.

[26]  A. Edmondson Speaking Up in the Operating Room: How Team Leaders Promote Learning in Interdisciplinary Action Teams , 2003 .

[27]  Martin Marshall,et al.  Does organisational culture influence health care performance? A review of the evidence , 2003, Journal of health services research & policy.

[28]  W. Hersh,et al.  The effect of health care working conditions on patient safety. , 2003, Evidence report/technology assessment.

[29]  John C. Morey,et al.  Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. , 2002, Health services research.

[30]  D Parker,et al.  Barriers to incident reporting in a healthcare system , 2002, Quality & safety in health care.

[31]  Victor J. Friedman,et al.  A Multifacet Model of Organizational Learning , 2002 .

[32]  P. Croskerry,et al.  Emergency medicine: A practice prone to error? , 2001, CJEM.

[33]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[34]  L R Murphy,et al.  Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. , 2000, American journal of infection control.

[35]  Kathryn Mearns,et al.  Measuring safety climate: identifying the common features☆ , 2000 .

[36]  D. Zohar Safety climate in industrial organizations: theoretical and applied implications. , 1980, The Journal of applied psychology.

[37]  J. M. Bevan,et al.  Measurement in Medicine. , 1971 .

[38]  Hui Zhang,et al.  A Synthesis of Safety Culture and Safety Climate Research , 2002 .

[39]  William R. Hendee,et al.  To Err is Human: Building a Safer Health System , 2001 .

[40]  Joop J. Hox,et al.  Applied Multilevel Analysis. , 1995 .

[41]  M. Hamilton,et al.  Measurement in Medicine , 1952, Nature.

[42]  L. Aiken,et al.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. , 2002, JAMA.