A Comprehensive Obstetrics Patient Safety Program Improves Safety Climate and Culture

Abstract

A number of patient safety programs have been developed to improve safety and the quality of care in a hospital setting. Building a patient safety culture involves integration of safety thinking among hospital staff for changes in the practice that improves patient safety. A quantitative measure of safety culture, the safety climate, can be assessed through examination of adverse event outcomes, adherence to standard practices, or analysis of health care teams' attitudes about safety issues. Although many patient safety programs have achieved significant reductions in adverse outcomes, the impact of such programs on staff safety perceptions and attitudes is unclear. This study was designed to assess the effect of implementing an integrated obstetrics patient safety program on perceptions of staff toward safety culture and quality of care in the workplace. The safety program involved implementation of the following interventions: (1) use of an obstetrics patient safety nurse to coordinate educational efforts for staff team training and fetal monitoring as well as to direct an anonymous event reporting system and review adverse events; (2) protocol development to codify and standardize existing practices; (3) an anonymous, computerized event reporting system for reporting events potentially harmful to a patient/visitor; (4) availability of an obstetrics hospitalist 24 hours a day; (5) a multidisciplinary patient safety committee responsible for evaluation of quality assurance and improvement review; and (6) team training for hospital staff through a series of crew resource management seminars. The Safety Attitude Questionnaire was administered on 4 occasions between 2004 and 2009 to assess changes in perceptions of staff with respect to teamwork culture (collaboration), safety culture (organizational commitment to safety), job satisfaction (workplace positivity), working conditions (quality of the work environment), stress recognition (effect of stressors on performance), and approval of managerial action. There were significant improvements from 2004 to 2009 in the proportion of staff members with favorable perceptions of teamwork culture (39%–63%), safety culture (33%–63%), job satisfaction (39%–53%), and managerial actions (10%–37%); all comparisons were P < 0.05. Clinically significant improvements occurred in the perception of both safety and teamwork climate among obstetrics providers, residents, and nurses (P < 0.01). These findings show that safety programs in a hospital setting can improve staff perceptions of safety and the safety climate and may enhance patient care. As a secondary benefit, such programs may reduce the cost of care.