Safety climate, safety climate strength, and length of stay in the NICU

Daniel S Tawfik,Jessica B Liu,Jochen Profit,Henry C Lee,Paul J Sharek,Timothy J Vogus,J Bryan Sexton,Eric J Thomas,Courtney C Nisbet

doi:10.1186/s12913-019-4592-1

Abstract

BackgroundSafety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs).MethodsObservational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU’s respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality.ResultsNICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes.ConclusionsSafety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals.

Highlights

Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions is poorly understood
Sample and procedure Selection of Neonatal intensive care unit (NICU) A cross-sectional survey of safety climate and workforce engagement was offered to a voluntary sample of NICUs participating in a quality improvement initiative organized by the California Perinatal Quality Care Collaborative (CPQCC). [32] Of the 61 NICUs who participated in the improvement initiative, 44 participated in the survey, which was administered at the beginning of the improvement initiative
Descriptive characteristics Forty-four NICUs participated in this study, with 2073 of 3294 surveys returned for a 62.9% response rate

Summary

Introduction

Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs). Ample research suggests that a more positive safety climate is associated with a host of workforce and patient outcomes. [22] some recent work suggests (albeit with low response rates) that safety climate may not be a key mechanism underpinning safety and is Tawfik et al BMC Health Services Research (2019) 19:738 otherwise difficult to shape. Prior research has focused on the level of safety climate (i.e., how positive it is) and largely assumed consistency

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