Healthcare professionals’ perception of hospital and unit-Level managers’ contribution to improving safety

The Safety Attitudes Questionnaire (SAQ) is a popular instrument to measure safety culture; however, its six domains have not been equally analyzed and used. Perception of management (PM), one of the underutilized domains, consists of two sets of the same items: one set for unit-level managers and the other for hospital-level managers. The SAQ was administered in a large tertiary hospital in Seoul, with 1,381 questionnaires being returned, including approximately 74% from women and 54% from nurses, which reflects Korea’s healthcare professional composition well. Respondents were asked to score management’s behavior in improving quality and safety. To calculate the score difference (unit managers’ score less hospital managers’ score), the generalized estimating equation was used to take the clinical unit’s clustering effects into account. In all subgroups and all PM items, the unit managers’ score was higher than that of hospital managers; most differences were statistically significant. On a scale of 0 to 100, the greatest difference was observed in the pharmacist group (14.5). In most cases, the score difference was around four to six. Various hypothetical explanations were offered. In Korea, many hospital managers are evaluated by hospitals’ financial performance and, quite often, monetary compensation for adverse events costs less than investing in improving safety, although there is no concrete evidence for this yet. In addition, hospital management’s term lasts around two to three years, which is too short of a time for a hospital’s reputation to drop in Korea’s healthcare environment. Consequently, hospital managers naturally put less emphasis on preventing medical errors. Another explanation arises from healthcare professionals’ fear of being reprimanded after giving a low score to unit managers. Although this survey was administered anonymously, respondents could have felt uncomfortable being critical of their unit managers, who will supervise respondents for a long time. These reasons are all conjecture. Further study is needed.

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