Abstract
BackgroundSafety climate is an essential component of achieving Universal Health Coverage, with several organisational, unit or team-level, and individual health worker factors identified as influencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda.MethodsA cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisational-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country.ResultsOur model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.34, p < 0.001), and district managerial support (β = 0.29, p < 0.001). In Ghana, safety climate was positively associated with job satisfaction (β = 0.30, p < 0.05), teamwork (β = 0.46, p < 0.001), and supportive supervision (β = 0.21, p < 0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (β = 0.56, p < 0.001), supportive supervision (β = 0.43, p < 0.001), and perceived district managerial support (β = 0.35, p < 0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (β = 0.39, p = 0.005) and supportive supervision (β = 0.27, p = 0.023) significantly and positively associated with safety climate.Discussion/conclusionsOur findings highlight the importance of unit-level factors—and in specific, teamwork and supportive supervision—as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed.
Highlights
Safety climate is an essential component of achieving Universal Health Coverage, with several organisational, unit or team-level, and individual health worker factors identified as influencing safety climate
Safety climate acts as an emergent property; a social construct, characterising groups of individuals based on their shared perceptions of enacted policies and practices that serve as an indicator of the true priority of safety against other organisational goals [4]
Measurement model goodness of fit was assessed using a number of widely recognised fit indices [40, 41] including: a non-significant Chi-square (χ2), Comparative Fit Index (CFI:42) and Tucker–Lewis Index (TLI: 43) values above 0.95 reflect excellent fit, while values above 0.90 reflect acceptable fit; Root-Mean-Square Error of Approximation with 90% confidence intervals (RMSEA 90% CI 44), and Standardised Root-Mean-Square Residual (SRMR: 45) values of 0.06 or less reflect excellent fit Measurement phase Table 2 presents the descriptive statistics for each variable, across the various countries
Summary
Safety climate is an essential component of achieving Universal Health Coverage, with several organisational, unit or team-level, and individual health worker factors identified as influencing safety climate. Sexton et al [3] indicate that when examining group-level perceptions, the most appropriate term to use is climate (e.g., safety climate, or teamwork climate), in reference to the more readily measurable aspects of safety culture, and as opposed to other aspects of culture such as behaviour and values. In this way, safety climate acts as an emergent property; a social construct, characterising groups of individuals based on their shared perceptions of enacted policies and practices that serve as an indicator of the true priority of safety against other organisational goals [4]
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