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Is There a Relationship Between Hospital Safety Culture and Safety Outcomes in VA Hospitals?

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Title: Is There a Relationship Between Hospital Safety Culture and Safety Author: Marlena Shin Last modified by: Audio Visual One Created Date: 6/3/2008 4:40:22 PM – PowerPoint PPT presentation

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Title: Is There a Relationship Between Hospital Safety Culture and Safety Outcomes in VA Hospitals?


1
Is There a Relationship Between Hospital Safety
Culture and Safety Outcomes in VA Hospitals?
  • Amy K. Rosen, Ph.D.1,2,

    Sara Singer, Ph.D.3,Christine Hartmann,
    Ph.D.1,2,
    Priti Shokeen, M.S.1, Shibei Zhao,
    M.P.H.1,
    Alyson Falwell, M.P.H.4, David Gaba,
    M.D.4,5

1Center for Health Quality, Outcomes, and
Economic Research (VA Center of Excellence),
2Boston University School of Public Health,
Health Policy and Management, 3Harvard University
School of Public Health, Health Policy and
Management, 4Center for Health Policy and the
Center for Primary Care and Outcomes Research,
Stanford University, 5Patient Safety Culture
Institute, VA Palo Alto Healthcare System.
AcademyHealth ? June 2008
Financial support for this study provided by the
VA HSRD IIR-03-303-1 and
the Agency for Healthcare Research and
Quality RO1 HSO13920
2
Background
  • Reducing adverse events and improving patient
    safety is a national priority
  • High reliability organizations (HROs) attribute
    their strong safety performance to their strong
    safety culture
  • Strong safety culture is critical to improving
    safety and reducing adverse events
  • Little empirical research exists on the
    relationship between safety culture and safety
    outcomes

3
Organizational Safety Culture and Safety
Performance
Dimensions
Organizational Safety Performance

Organizational
Work Unit
Interpersonal
AHRQ Patient Safety Indicators (PSIs)
4
Objective and Hypotheses
  • Objective To examine the relationship between
    safety culture and hospital safety performance in
    VA hospitals
  • Hypotheses
  • (1) Higher levels of hospital safety culture will
    be associated with lower levels of hospital PSIs
  • (2) Individual/interpersonal dimensions of safety
    culture will more strongly influence the
    relationship between safety culture and hospital
    performance than other dimensions
  • (3) Perceptions of safety culture will be more
    strongly associated with PSIs for frontline
    workers than for senior managers
  • (4) Perceptions of safety culture will be more
    strongly associated with PSIs for workers in
    surgical units than in non-surgical units

5
Safety Culture vs. Safety Climate
  • Safety Culture
  • Shared values and beliefs of individuals, and
    structures and systems of work areas and
    organizations, that interact to shape behavioral
    norms (Singer, 2007)
  • Safety Climate
  • The surface features of the safety culture
    discerned from the workforces attitudes and
    perceptions at a given point in time (Flin et
    al., 2000)

Individual Values Beliefs
Structures Work Systems
Behavioral Norms

6
Safety Climate Measurement
  • The Patient Safety Climate in Healthcare
    Organizations (PSCHO) survey used to measure
    perceptions of safety climate among personnel in
    VA hospitals
  • Survey contains 6 demographic questions and 42
    safety items that are based on a 5-point Likert
    scale
  • Responses range from strongly agree to strongly
    disagree
  • High PPR suggests a poor safety climate lack of
    uniform safety climate (Roberts, 1990)

7
Survey Subscales
  • Survey includes 11 subscales determined by
    psychometric analyses

Examples of Dimensions
Organizational Work unit Interpersonal
Subscales Senior leadership Unit leadership Fear of blame
Subscales Resources for safety Unit norms Psychological safety
Subscales Facility characteristics Unit recognition Problem responsiveness
8
Survey Design and Methodology
  • Mailed survey conducted in 30 VA hospitals
    between December 2005 - June 2006
  • Sample (n9,309)
  • 100 of senior managers
  • 100 hospital-based physicians
  • 10 random sample of other personnel
  • At 10 hospitals, 100 of employees working in
    high hazard units
  • 50 response rate (n4,629)
  • Survey was anonymous

9
Data Sources
  • Hospital safety climate
  • PSCHO survey collected from sample of employees
  • Hospital safety performance
  • 13 of the AHRQ PSIs calculated from 2006 VA
    hospital discharge data (AHRQ PSI software
    version 3.1a)
  • Hospital characteristics
  • AHA Annual Hospital Survey, VA Decision Support
    System data (nurse staffing), Area Resource File
    (location)

10
Analysis
  • Reported strength of safety climate by hospital
    (average percent problematic response, PPR), job
    category, and work area
  • PSIs were risk adjusted, using AHRQ comorbidity
    software
  • Linear regression models examined the
    relationship between safety climate overall and
    11 dimensions of safety climate with individual
    PSIs, controlling for hospital teaching status,
    location, and nurse staffing ratios

11
Safety Climate in 29 Hospitals Responses
weighted for sample size and non-response
Low response stronger safety climate
Hospital report statistically significantly
lower problematic response than the VA average
Hospital report statistically significantly
higher problematic response than the VA average
12
Relationship between PSIs and Safety Climate by
Dimensions
Note Observations range from 25 to 28. Any
hospitals with PSI denominator less than 2 were
excluded from models.
13
Relationship between PSIs and Safety Climate
Dimensions by Job Categories
Note Observations range from 25 to 28. Any
hospitals with PSI denominator less than 2 were
excluded from models.
14
Relationship between PSIs and Safety Climate
Dimensions by Work Areas
Note Observations range from 25 to 28. Any
hospitals with PSI denominator less than 2 were
excluded from models.
15
Conclusions and Implications
  • VA results similar to those from the AHRQ-funded
    safety culture study
  • Individual/interpersonal dimensions of safety
    climate most strongly related to individual PSIs
  • Frontline workers perceptions related more to
    safety performance than senior managers
  • Surgical unit employees perceptions related more
    to safety performance than non-surgical employees
  • Suggests interventions to improve safety climate

16
Thank you!
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