A survey of safety culture in two Australian hospital tertiary hospital intensive care units: the SCATH-ICU study

Abstract

Organisations with a strong cultural commitment to safety demonstrate an unexpectedly low rate of harmful error. Despite this, little is understood about the safety culture of Australian intensive care units (ICUs). This study aimed to evaluate the safety culture of ICUs in two tertiary hospitals in metropolitan Queensland. A cross-sectional survey was used. The 36-item Safety Attitudes Questionnaire (SAQ) was administered electronically to 522 ICU medical, nursing and allied health professionals across two sites (A and B) during January and February 2016. Data were collated into six domains of teamwork climate, safety climate, job satisfaction, stress recognition, working conditions and perceptions of management. Data were analysed using t-tests and between groups using generalising estimating equations. In total, 206 surveys were returned (39.5% response rate), with 65.5% (n=135) from Site B. Respondents included nursing (80.6%), medical (12.7%) and allied health staff (5.9%). Respondents from Site B scored all domains of the SAQ higher than those from Site A (all p<0.001). Perceptions of hospital management were poorer than those of unit management (p<0.001). Both sites demonstrated a need to improve perceptions of management and stress recognition, with other improvement priorities at Site A including job satisfaction and working conditions, and Site B being teamwork and safety climate. Variation was also found between professional groups, in the teamwork climate, working conditions and stress recognition domains (p<0.001). Despite similar governance and external structures, significant differences were found in safety culture between the two sites. This emphasises the importance of unit-level assessment and planning of improvement interventions. This study adds to the evidence that these interventions need to be unit focused, supported by management and multidisciplinary in approach.