Safety Culture Scores Research Articles

Variability of Patient Safety Culture in Belgian Acute Hospitals

The aim of this study was to measure differences in safety culture perceptions within Belgian acute hospitals and to examine variability based on language, work area, staff position, and work experience. The Hospital Survey on Patient Safety Culture was distributed to hospitals participating in the national quality and safety program (2007-2009). Hospitals were invited to participate in a comparative study. Data of 47,136 respondents from 89 acute hospitals were used for quantitative analysis. Percentages of positive response were calculated on 12 dimensions. Generalized estimating equations models were fitted to explore differences in safety culture. Handoffs and transitions, staffing, and management support for patient safety were considered as major problem areas. Dutch-speaking hospitals had higher odds of positive perceptions for most dimensions in comparison with French-speaking hospitals. Safety culture scores were more positive for respondents working in pediatrics, psychiatry, and rehabilitation compared with the emergency department, operating theater, and multiple hospital units. We found an important gap in safety culture perceptions between leaders and assistants within disciplines. Administration and middle management had lower perceptions toward patient safety. Respondents working less than 1 year in the current hospital had more positive safety culture perceptions in comparison with all other respondents. Large comparative databases provide the opportunity to identify distinct high and low scoring groups. In our study, language, work area, and profession were identified as important safety culture predictors. Years of experience in the hospital had only a small effect on safety culture perceptions.

Evolution of patient safety culture in Belgian acute, psychiatric and long-term care hospitals

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.

Safety Culture and Surgical Site Infection Outcomes After Abdominal Hysterectomy [342

INTRODUCTION: Previous studies demonstrate that hospital workplace culture may affect surgical outcomes. We designed a study evaluating the role of culture on surgical site infection after abdominal hysterectomy. METHODS: Data were collected from eight Minnesota community hospitals participating in a quality measurement collaborative from January 1 to December 31, 2012. Safety culture was measured using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture instrument; surgical site infection was measured using National Healthcare Safety Network definitions. RESULTS: Median hospital size was 93 beds (range 57–426 beds) and mean survey response rate of staff was 44%. Rates of surgical site infection after abdominal hysterectomy ranged from 0% to 5.26%; median abdominal hysterectomy performed was 33 (range 10–276). Safety culture scores ranged from 16 to 92 on a scale of 0–100. Eight dimensions of safety culture were inversely associated with abdominal hysterectomy SSI rates: supervisor expectations and actions (r=−0.93; 95% CI [−0.66, −0.99]), teamwork across units (r=−0.87; 95% CI [−0.43, −0.98]), organizational learning (r=−0.87; 95% CI [−0.43, −0.98]), feedback and communication about error (r=−0.87; 95% CI [−0.41, −0.98]), overall perception of safety (r=−0.84; 95% CI [−0.34, −0.97]), management support for patient safety (r=−0.82; 95% CI [−0.27, −0.97]), frequency of event reporting (r=−0.77; 95% CI [−0.15, −0.96]), and teamwork within the unit (r=−0.77; 95% CI [−0.14, −0.96]). CONCLUSION: In a cohort of community hospitals, there was a strong association between safety culture and risk of abdominal hysterectomy surgical site infection. These data suggest a strong role for safety culture, teamwork culture, and engaged hospital management in creating high-quality surgical outcomes.

Safety Culture and Safety-Relevant Behavior in Air Traffic Management

Since 2010, air navigation service providers have been mandated to implement a positive and proactive safety culture based on shared beliefs, assumptions, and values regarding safety. This mandate raised the need to develop and validate a concept and tools to assess the level of safety culture in organizations. An initial set of 40 safety culture questions based on eight themes underwent psychometric validation. Principal component analysis was applied to data from 282 air traffic management staff, producing a five-factor model of informed culture, reporting and learning culture, just culture, and flexible culture, as well as management’s safety attitudes. This five-factor solution was validated across two different occupational groups and assessment dates (construct validity). Criterion validity was partly achieved by predicting safety-relevant behavior on the job through three out of five safety culture scores. Results indicated a nonlinear relationship with safety culture scales. Overall the proposed concept proved reliable and valid with respect to safety culture development, providing a robust foundation for managers, safety experts, and operational and safety researchers to measure and further improve the level of safety culture within the air traffic management context.

Safety sans Frontières: An International Safety Culture Model

The management of safety culture in international and culturally diverse organizations is a concern for many high-risk industries. Yet, research has primarily developed models of safety culture within Western countries, and there is a need to extend investigations of safety culture to global environments. We examined (i) whether safety culture can be reliably measured within a single industry operating across different cultural environments, and (ii) if there is an association between safety culture and national culture. The psychometric properties of a safety culture model developed for the air traffic management (ATM) industry were examined in 17 European countries from four culturally distinct regions of Europe (North, East, South, West). Participants were ATM operational staff (n = 5,176) and management staff (n = 1,230). Through employing multigroup confirmatory factor analysis, good psychometric properties of the model were established. This demonstrates, for the first time, that when safety culture models are tailored to a specific industry, they can operate consistently across national boundaries and occupational groups. Additionally, safety culture scores at both regional and national levels were associated with country-level data on Hofstede's five national culture dimensions (collectivism, power distance, uncertainty avoidance, masculinity, and long-term orientation). MANOVAs indicated safety culture to be most positive in Northern Europe, less so in Western and Eastern Europe, and least positive in Southern Europe. This indicates that national cultural traits may influence the development of organizational safety culture, with significant implications for safety culture theory and practice.

The Iatroref study: medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture.

Staff behaviours to optimise patient safety may be influenced by burnout, depression and strength of the safety culture. We evaluated whether burnout, symptoms of depression and safety culture affected the frequency of medical errors and adverse events (selected using Delphi techniques) in ICUs. Prospective, observational, multicentre (31 ICUs) study from August 2009 to December 2011. Burnout, depression symptoms and safety culture were evaluated using the Maslach Burnout Inventory (MBI), CES-Depression scale and Safety Attitudes Questionnaire, respectively. Of 1,988 staff members, 1,534 (77.2 %) participated. Frequencies of medical errors and adverse events were 804.5/1,000 and 167.4/1,000 patient-days, respectively. Burnout prevalence was 3 or 40 % depending on the definition (severe emotional exhaustion, depersonalisation and low personal accomplishment; or MBI score greater than -9). Depression symptoms were identified in 62/330 (18.8 %) physicians and 188/1,204 (15.6 %) nurses/nursing assistants. Median safety culture score was 60.7/100 [56.8-64.7] in physicians and 57.5/100 [52.4-61.9] in nurses/nursing assistants. Depression symptoms were an independent risk factor for medical errors. Burnout was not associated with medical errors. The safety culture score had a limited influence on medical errors. Other independent risk factors for medical errors or adverse events were related to ICU organisation (40 % of ICU staff off work on the previous day), staff (specific safety training) and patients (workload). One-on-one training of junior physicians during duties and existence of a hospital risk-management unit were associated with lower risks. The frequency of selected medical errors in ICUs was high and was increased when staff members had symptoms of depression.

간호사의 근로환경 개선을 위한 환자안전문화의 체계적 문헌 분석

Purpose: The purpose of this study was to review the articles and theses on the patient safety culture of clinical nurses for identifying overall research trends regarding patient safety culture among hospital nurses, and to suggest strategies for improving nursing work environment related to patient safety culture. Methods: The subjects for this study were 17 articles selected according to inclusion criteria from five databases in Korea. Results: Seven articles were collected from nursing journals and ten from master's theses. The studies on the 17 articles were conducted at 66 hospitals from seven regions of Korea. The tools for patient safety culture were selected among the three tools from AHRQ and two Korean translation tools. The mean score of patient safety culture was 3.43. Conclusion: The findings from the article review indicate that, in order to improve nursing work environment for patient safety culture, the hospital and nursing manager should emphasize the education for patient safety, communication and open-minded reporting, and cooperation among the departments of hospital.

The relationship between patient safety culture and adverse events: A questionnaire survey

BackgroundPatient safety culture is an important factor in the effort to reduce adverse events in the hospital and improve patient safety. A few studies have shown the relationship between patient safety culture and adverse events, yet no such research has been reported in China. ObjectivesThis study aimed to describe nurses’ perception of patient safety culture and frequencies of adverse events, and examine the relationship between them. DesignThis study was a descriptive, correlated study. Setting and participantsWe selected 28 inpatient units and emergency departments in 7 level-3 general hospitals from 5 districts in Guangzhou, China, and we surveyed 463 nurses. MethodsThe Hospital Survey on Patient Safety Culture was used to measure nurses’ perception of patient safety culture, and the frequencies of adverse events which happened frequently in hospital were estimated by nurses. We used multiple logistic regression models to examine the relationship between patient safety culture scores and estimated frequencies of each type of adverse event. ResultsThe Positive Response Rates of 12 dimensions of the Hospital Survey on Patient Safety Culture varied from 23.6% to 89.7%. There were 47.8–75.6% nurses who estimated that these adverse events had happened in the past year. After controlling for all nurse related factors, a higher mean score of “Organizational Learning-Continuous Improvement” was significantly related to lower the occurrence of pressure ulcers (OR=0.249), prolonged physical restraint (OR=0.406), and complaints (OR=0.369); a higher mean score of “Frequency of Event Reporting” was significantly related to lower the occurrence of medicine errors (OR=0.699) and pressure ulcers (OR=0.639). ConclusionsThe results confirmed the hypothesis that an improvement in patient safety culture was related to a decrease in the occurrence of adverse events.

Patient safety culture in China: a case study in an outpatient setting in Beijing

ObjectivesTo investigate the patient safety culture in an outpatient setting in Beijing and explore the meaning and implications of the safety culture from the perspective of health workers and patients.MethodsA...

Patient Satisfaction as a Possible Indicator of Quality Surgical Care—Reply

Importance In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care. Objective To determine whether patient satisfaction is independent from surgical process measures and hospital safety. Design We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire. Setting Thirty-one US hospitals. Participants Patients and hospital employees. Interventions There were no interventions for this study. Main Outcomes and Measures Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey. Results Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = −0.216 [P = .24]; appropriate hair removal, R = −0.012 [P = .95]; Foley catheter removal, R = −0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = −0.462 [P = .008]). Conclusions and Relevance Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.

Assessment of patient safety culture among personnel in the hospitals associated with Islamic Azad University in Tehran in 2013.

Background:Patient safety is an essential element in the quality of healthcare, and a clear knowledge of its culture in healthcare organizations will lead to both improved healthcare and patient safety. The aim of this study was to assess the patient safety culture at Islamic Azad University hospitals in Tehran, Iran, in 2013.Methods:This cross-sectional study was conducted on clinical and diagnostic staff in all Islamic Azad University hospitals in Tehran in June 2013. The international “Hospital Survey on Patient Safety Culture” questionnaire was used as the measurement tool.Results:In these hospitals, the overall positive score of patient safety culture was 35%. “Teamwork within units” (48% positive) was evaluated as reflecting the most knowledge of the aspects of patient safety culture, and “non-punitive response to error” (12% positive) was evaluated as reflecting the least knowledge of the aspects of patient safety culture.Conclusion:The patient safety culture in the hospitals that were studied should be improved. This goal could be achieved by reinforcing the basics of patient safety culture by teaching the staff members about the aspects of a positive patient safety culture and encouraging them to incorporate these aspects in their day-to-day activities.

Patient Satisfaction as a Possible Indicator of Quality Surgical Care

In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care. To determine whether patient satisfaction is independent from surgical process measures and hospital safety. We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire. Thirty-one US hospitals. PARTICIPANTS Patients and hospital employees. There were no interventions for this study. Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey. Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = -0.216 [P = .24]; appropriate hair removal, R = -0.012 [P = .95]; Foley catheter removal, R = -0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = -0.462 [P = .008]). Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.

Evaluation of patient safety culture: Single-center, non-randomized, cross-sectional study, Department of General Surgery, Faculty of Medicine, Trakya University, Turkey experience

This study aims to measure and analyze the patient safety culture in General Surgery Department, Faculty of Medicine, Trakya University, Edirne-Turkey. A cross-sectional study, utilizing the Turkish version of the Hospital Survey on Patient Safety Culture developed by the Agency for Healthcare Research and Quality and a demographic questionnaire was distributed to 125 health professionals including nurses, technicians, managers and medical staff. 125 healthcare staff, including physicians, nurses, and health officers participated in this research. The main outcome measure(s) comprise the patient safety culture score including subscores on 12 dimensions and 42 items; patient safety grade and number of events reported. Results of this study reveals overall patient safety grade was rated as excellent or very good by 40% of respondents, acceptable by 46% and failing or poor by 14%. The percentage of positive responses was highest for ‘staffing’ (52%), ‘management support for patient safety (41%), ‘non-punitive response to error” (40%), lowest for ‘teamwork within units (11%), feedback and communication about error (12%), organizational learning and continuous improvement (15%). Thus, improving patient safety culture, setting national and organizational based patient safety system without fear of punitive action should be a priority among hospital and national administrators.

Better Medical Office Safety Culture Is Not Associated With Better Scores on Quality Measures

A strong safety culture is an essential element of safe medical practice. Few studies, however, have studied the link between safety culture and clinical quality outcomes. In this study, we examined the association between safety culture and quality measures in primary care offices. A total of 24 primary care offices in Cleveland, Ohio. The Medical Office Survey on Patient Safety was administered to clinicians and support staff to rate 12 dimensions of safety culture and a single overall patient safety rating. An average of the 12 safety culture dimension scores was calculated to produce an aggregated patient safety score. Using linear correlation, we calculated the association between the 2 summary safety measures (overall patient safety rating and aggregated patient safety score) and 2 composite quality measures, a chronic disease score, and a prevention score. The survey response rate was 79% (387/492). There was considerable variation in both safety culture scores and quality scores from office to office. There was no association between the chronic disease score and either summary measure of safety culture. There were small but statistically significant negative associations between the prevention score and the overall patient safety rating (β = -0.087, P = 0.002) as well as the aggregated patient safety score (β = -0.004, P = 0.007). Although safety theory predicts a positive association between safety culture and quality, we found no meaningful associations between safety culture and currently accepted measures of primary care clinical quality. Larger studies across several health care organizations are needed to determine whether these findings are reproducible. If so, it may be necessary to reconsider the dimensions of safety culture in primary care as well as the relationship between safety culture and primary care clinical quality.

A Multicenter Collaborative Approach to Reducing Pediatric Codes Outside the ICU

The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points. A multidisciplinary pediatric advisory panel developed a comprehensive change package of process improvement strategies and measures for tracking progress. Learning sessions, conference calls, and data submission facilitated collaborative group learning and implementation. Twenty Child Health Corporation of America hospitals participated in this 12-month improvement project. Each hospital identified at least 1 noncritical care target unit in which to implement selected elements of the change package. Strategies to improve prevention, detection, and correction of the deteriorating patient ranged from relatively simple, foundational changes to more complex, advanced changes. Each hospital selected a broad range of change package elements for implementation using rapid-cycle methodologies. The primary outcome measure was reduction in codes per 1000 patient days. Secondary outcomes were days between codes and change in patient safety culture scores. Code rate for the collaborative did not decrease significantly (3% decrease). Twelve hospitals reported additional data after the collaborative and saw significant improvement in code rates (24% decrease). Patient safety culture scores improved by 4.5% to 8.5%. A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.

The Association between EMS Workplace Safety Culture and Safety Outcomes

Background. Prior studies have highlighted wide variation in emergency medical services (EMS) workplace safety culture across agencies. Objective. To determine the association between EMS workplace safety culture scores and patient or provider safety outcomes. Methods. We administered a cross-sectional survey to EMS workers affiliated with a convenience sample of agencies. We recruited these agencies from a national EMS management organization. We used the EMS Safety Attitudes Questionnaire (EMS-SAQ) to measure workplace safety culture and the EMS Safety Inventory (EMS-SI), a tool developed to capture self-reported safety outcomes from EMS workers. The EMS-SAQ provides reliable and valid measures of six domains: safety climate, teamwork climate, perceptions of management, working conditions, stress recognition, and job satisfaction. A panel of medical directors, emergency medical technicians and paramedics, and occupational epidemiologists developed the EMS-SI to measure self-reported injury, medical errors and adverse events, and safety-compromising behaviors. We used hierarchical linear models to evaluate the association between EMS-SAQ scores and EMS-SI safety outcome measures. Results. Sixteen percent of all respondents reported experiencing an injury in the past three months, four of every 10 respondents reported an error or adverse event (AE), and 89% reported safety-compromising behaviors. Respondents reporting injury scored lower on five of the six domains of safety culture. Respondents reporting an error or AE scored lower for four of the six domains, while respondents reporting safety-compromising behavior had lower safety culture scores for five of the six domains. Conclusions. Individual EMS worker perceptions of workplace safety culture are associated with composite measures of patient and provider safety outcomes. This study is preliminary evidence of the association between safety culture and patient or provider safety outcomes.

Improving Outcomes by Reducing Elective Deliveries Before 39 Weeks of Gestation: A Community Hospital's Journey

Our goal was to improve quality and safety of care to our obstetric and neonatal patients (presenting between 34 0/7 and 36 6/7 weeks) by lowering the overall induction rate, lowering the elective induction rate less than 39 weeks, decreasing the unanticipated admissions of late preterm infants to the special care nursery (SCN), decreasing the number of transports out of our level II SCN to a higher level III neonatal intensive care unit, and increasing safety culture scores of the Family Birth Center staff at Mercy Hospital Anderson, Cincinnati, OH. A retrospective chart review was conducted over a 2-year period. In 2005, after an intense analysis of the Family Birth Center, the overall induction rate and elective induction rate of less than 39 weeks' gestation were at an alarming 26.4% and 12.1%, respectively. Best practice guidelines for scheduling an induction were developed in collaboration with nursing and medical staff. These elective induction guidelines required patients to have completed 39 0/7 weeks of gestation and to have a Bishop score of at least 8 for nulliparas and 6 for multiparas. In 2006, the induction scheduling process and these newly developed guidelines were strictly enforced. In 2007, outcomes including total induction rate, elective induction rate for less than 39 weeks, cesarean birth rate for elective inductions among nulliparas, and SCN unanticipated admissions of infants 34 0/7 to 36 6/7 weeks' gestation (late preterm infants) were compared with these same measures in 2005.

The relationship between management safety commitment and patient safety culture

The study aims to explore the relationship between management safety commitment and patient safety culture using data from a Chinese hospital. Developing a positive patient safety culture has been suggested as an important strategy to improve the quality of health services and patient safety. Management safety commitment has been identified as key to establishing a culture of safety. However, little empirical evidence could be found in the literature to substantiate the relationship between management safety commitment and patient safety culture. Even less is known about the relationship in a Chinese hospital setting. The study used a correlational research methodology with a cross-sectional survey design. A total of 248 registered nurses, including 20 nurse managers and 228 staff nurses, were surveyed using self-administered questionnaires. Both descriptive and inferential statistics were used to explore the relationship between management safety commitment and patient safety culture. The mean score of safety commitment was 8.38 on a 0-10 visual analogue scale. The mean score of patient safety culture was 148.66. Staff nurses scored patient safety culture significantly lower than those of nurse managers (F = 18.88, P < 0.01). In addition, management safety commitment was significantly related to patient safety culture (r = 0.46, P < 0.01) and was an important predictor of patient safety culture (F = 65.29, P < 0.01). The findings provide significant empirical evidence that management safety commitment is associated with the culture of patient safety. Thus, to build a positive safety culture, managers need to visibly commit to patient safety and be a role model to ensure patient safety.

Exploring Relationships Between Hospital Patient Safety Culture and Adverse Events

There has been very limited research linking staff perceptions of hospital patient safety culture with rates of adverse clinical events. This exploratory study examined relationships between the Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey of Patient Safety Culture and rates of in-hospital complications and adverse events as measured by the AHRQ Patient Safety Indicators (PSIs). The general hypothesis was that hospitals with a more positive patient safety culture would have lower PSI rates. We performed multiple regressions to examine the relationships between 15 patient safety culture variables and a composite measure of adverse clinical events based on 8 risk-adjusted PSIs from 179 hospitals, controlling for hospital bed size and ownership. All patient safety culture data were collected in 2005 and 2006 (except 1 late 2004 hospital), and all PSI data were collected in 2005. Nearly all of the relationships tested were in the expected direction (negative), and 7 (47%) of the 15 relationships were statistically significant. All significant relationships were of moderate size, with standardized regression coefficients ranging from -0.15 to -0.41, indicating that hospitals with a more positive patient safety culture scores had lower rates of in-hospital complications or adverse events as measured by PSIs. Our findings support the idea that a more positive patient safety culture is associated with fewer adverse events in hospitals. Further research is needed to determine the generalizability of these results to larger sets of hospitals and to examine the causal relationship between patient safety culture and clinical patient outcomes.

Implementing Best Practice Safety Initiatives to Diminish Patient Harm in a Hospital-based Family Birth Center

After a risk assessment of its obstetrics unit, the Family Birthing Center at Mercy Hospital Anderson, Cincinnati, Ohio, a level II, 24-bed labor, delivery, recovery, postpartum unit, began serious work toward improving patient safety through interdisciplinary team work, through more effective communication, and by implementing evidence-based strategies to reduce harm to mothers and babies. With the support of administration at both the corporate and facility levels, strong medical staff and nursing leadership, and engaged and committed team members, the unit has moved positive safety culture scores from 74% to 91%, increased staff morale, and elevated the levels of professionalism and interdisciplinary collaboration observed within the department.