Safe Surgery Checklist Implementation: Associations of Management Practice and Safety Culture Change.

Safety culture, shared values with regard to safety management, is a key driver of high-quality health care delivery. The Safe Surgery Checklist (SSC) is an innovative tool for improving surgical care safety, but evidence about SSC effectiveness is mixed. While a structured implementation and management commitment are considered important, limited evidence exists about what managerial practices support safety culture, and how SSC implementation can impact the organization’s managerial practices and safety culture. We examined the relationship between management practices and perceived safety culture and the way checklist implementation induces change in both. Using a pre-posttest design and survey methods, we evaluated the implementation of SSC in a national sample of 42 general acute care hospitals affiliated with a leading hospital system. We measured perceived management practices among management (n=99) using the World Management Survey. We administered the Safe Surgical Practice Survey to clinical operating room personnel to measure perception of pre-operative safety and safety culture (N= 2380 in 2016 and N= 1433 in 2017). Data was collected in two consecutive years. Linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following SSC implementation.

In Belgium, the federal government launched a national program to support hospitals for implementing quality and patient safety strategies. One of the main objectives in the federal program is the development of a safety culture. The purpose of this study was to examine to what extent the hospitals’ safety culture evolved after participating in the federal program and to explore predictor variables of safety culture. In a cross-sectional follow-up design, safety culture was measured in the Belgian acute, psychiatric and long-term care hospitals using validated translations of the Hospital Survey on Patient Safety Culture in Flemish and French. For both nationwide measurements, hospitals were invited to participate in a benchmark research organized by an academic institution (in 2008 and 2012). Generalized Estimating Equations models were fitted to examine the effect of predictor variables on safety culture perceptions. The Belgian safety culture database contains data from 115 827 respondents from 176 hospitals. For 111 hospitals that participated in both benchmarks it was possible to calculate changes in safety culture. The response rate for the second measurement (52.2%) was comparable to the response rate in the first measurement (51.0%). Improvements were observed for most safety culture dimensions with a major significant improvement for ‘Management support for patient safety’. Although ‘Handoffs and transitions’ and ‘Frequency of events reported’ were key areas within the federal program, a decline was observed for these dimensions. Work area, staff position, language (regional context of hospital), hospital type and hospital statute were found to have important effects on safety culture perceptions. Hospital size and work experience, showed to have less effect on safety culture scores. Large comparative safety culture databases allow identifying patterns and trends. Our findings on variations in safety culture perceptions between types of hospitals, hospital units and professional groups implicate the need for a tailor-made approach for safety culture improvement. Future research should focus on enriching the evidence of the effectiveness of safety culture strategies and linking of safety culture and outcomes of care in order to assess the practical validity of safety culture surveys.

This article focuses on employee direct participation in occupational health and safety (OHS) management. The article explains what determines employee opportunities to participate in OHS management. The explanatory framework focuses on safety culture and safety management at workplaces. The framework is empirically tested using Estonian cross-sectional, multilevel data of organizations and their employees. The analysis indicates that differences in employee participation in OHS management in the Estonian case could be explained by differences in OHS management practices rather than differences in safety culture. This indicates that throughout the institutional change and shift to the European model of employment relations system, change in management practices has preceded changes in safety culture which according to theoretical argument is supposed to follow culture change.

Changes in patient safety culture after restructuring of intensive care units: Two cross-sectional studies

Management practices as antecedents of safety culture within the trucking industry: similarities and differences by hierarchical level

The Relationship between Hospital-Based Healthcare Personnel Perceptions of Safety Culture and the Occurrence of Sharps Injuries

IntroductionWithin a 5-year federal program on quality and safety (2007–2012), the Belgian government provided a framework for implementing quality and safety strategies in the acute, psychiatric and long-term care hospitals...

To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture. Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control). A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop. Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture. A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554. Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.

The World Health Organization safe surgery checklist as a catalyst for system improvement.

Healthcare systems are becoming increasingly complex which is helping to promote a ‘culture of safety’ within them based on the best scientific evidence available. Indeed, creating a positive institutional culture of patient safety is reflected in health outcomes. The aim of this present study was to describe the perception of culture of safety by nurses in adult inpatient units in a tertiary hospital and to analyze adverse events reporting. It was a cross-sectional study in which 202 nurses from adult hospitalization units of the Hospital Universitario y Politécnico La Fe in Valencia (Spain) participated. The perception of safety culture was measured using the Hospital Survey on Patient Safety questionnaire version 1.0, which consists of 42 items distributed in 12 dimensions that are considered strengths or weaknesses. In addition, adverse events related to nursing care during the study period and those reported in the official hospital registry were collected. Finally, the association between safety culture and sociodemographic and labor variables was explored. A total of 148 responses to the questionnaire were analyzed (Cronbach’s alpha = 0.94), where seven dimensions and 25 items were identified as weaknesses. Two hundred and fourteen events were identified and none were reported in the official registry. Years of experience were significantly (p < 0.05) associated with safety culture. It is necessary to establish strategies to improve the perception of the safety culture of nurses, as well as to make nurses aware of the importance of notifying adverse events derived from health care.

Impact of the World Health Organization's Surgical Safety Checklist on safety culture in the operating theatre: a controlled intervention study

Safety culture, perceived organizational support, and quality of healthcare: the views of nurses and patients in Saudi Arabia

To describe perceptions of workplace safety culture among nurses employed in long-term care (LTC) settings. A cross-sectional survey. Respondents were licensed nurses (N=550) with membership in gerontological nursing professional organizations in the United States (n=296), Canada (n=251), and other (n=3). An anonymous, self-administered, mail-in questionnaire, which included the Hospital Survey on Patient Safety Culture as well as questions about individual and institutional characteristics. The survey included key aspects of safety culture, such as work setting, supervisor support, communication about errors, and frequency of events reported. Nurse-managers reported significantly more positive safety culture perceptions compared with licensed staff nurses. Additionally, licensed nurses employed in government-run facilities had significantly less positive safety culture perceptions compared with those working in nonprofit organizations. Interventions designed to improve safety culture in LTC settings should be focused on the concerns of licensed staff nurses and the improvement of communication between these nurses and their managers. Enhancing safety culture in long-term care settings may facilitate improvements in resident safety. Assessment of workplace safety culture is the first step in identifying barriers that nurses face to provide safe resident care.

Implementation of the surgical safety checklist at a tertiary academic center: Impact on safety culture and patient outcomes

Safety in the construction industry has always been a major issue. Wherever reliable records are available, construction is found to be one of the most dangerous on safety and health criteria, particularly in developing countries. Though much improvement in construction safety has been achieved, the industry still continues to lag behind most other industries with regard to safety. In developing countries, safety rules usually do not exist; if any exist, the regulatory authority is usually very weak in implementing such rules effectively. Further, work hazards at the construction workplace are either not perceived at all, or perceived to be less dangerous than what they actually are. The safety climate of any organisation consists of employees' attitudes towards, and perceptions of, health and safety behaviour. Construction workers' attitudes towards safety are influenced by their perceptions of risk, management, safety rules and procedures. Although research into safety climate has continued for more than two decades, there is still no universally accepted theory of safety climate. Nevertheless, positive correlation exists between workers' safe behaviour and safety climate in construction site environments. Workers' attitudes and behaviours discernible in safety climate, could be regarded as the micro-elements of an organisation, which themselves are determined by macro-elements of safety management systems and practices. Thus, it could be argued that management safety systems and practices permeate down through the organisation to the workforce. Classic construction safety management functions (such as recruitment, training, supervision, etc.) are determined by different conceptions of the role and nature of management effectiveness. These conceptions are underpinned by related cultural values. Therefore, national culture can be a key characteristic that may manifest itself in varying approaches to the safe work behavior. Pakistan is a developing country that is currently enjoying a relatively strong growth in construction activities. Unfortunately, Pakistan's construction industry suffers from poor safety and health conditions. The framework of the existing occupational and health conditions is fragmented and inadequately enforced, making construction sites more hazardous. It may even be argued that relevant regulations are outdated and irrelevant in day-to-day construction operations. This thesis is broadly concerned with national culture and its influence on safety climate in the construction industry in Pakistan. More specifically, it investigates the safety perceptions, attitudes, and behaviour of Pakistani construction workers and management safety practices. It presents the empirical results of a number of questionnaire surveys administrated in Pakistan targeting construction workers, and managers with safety management responsibilities. Based upon the survey analysis results, this study demonstrates that the majority of Pakistani construction workers have a good degree of risk awareness and self-rated competence, and a relatively high degree of safety awareness. Further it was found, empirically, that overall workers' intentional behaviour seems to be best explained by workers' attitudes towards their own and managements' safety responsibilities, as well as their perception of the risk they are generally exposed to in their workplace environment. The study also showed that workers are more collective, feminist, believe in less power distance and opt for higher uncertainty avoidance in their attitudes. The analysis of the interrelationship between workers' behaviour and national culture revealed that the more workers working in a collective, feminist, and higher uncertainty avoidance environments, the more they are going to exhibit safer behaviour. The management safety practices survey analysis showed that managers' safety management preferences are being influenced by their cultural trends. Their safety related decisions, whether being developed in head office or on site, are influenced by their high collectivistic, feministic, power distance and uncertainty avoidance attitude. This study thus establishes a statistically significant positive relationship between the factors of workers' perceptions, attitudes and safe work behaviour, and management practices. Finally, this study gauges empirically the influence of cultural dimensions on workers' perceptions, attitudes, and safe work behaviour and managers' safety practices. The analysis showed that managers' operational practices on site have the most statistically significant relationship with workers' attitudes and perceptions. It was also found that the more collectivistic and higher uncertainty avoidance attitude of workers, the stronger their safety attitudes and perceptions will be.