An Examination of Hospital Safety Climate.

Abstract

Safety Climate (SC) is a point in time measurement of an organization’s culture relative to safety. Safety, both for patients and caregivers, is an important goal for healthcare organizations. SC is a complex phenomenon that is poorly understood. The purpose of this study was to deepen the understanding of SC, identify elements of SC commonly measured by hospitals, and then test relationships between those elements and registered nurses’ perceptions of SC. This was a study conducted in two phases. A modified Delphi method was used in the first phase of the study to gain the insights of 38 healthcare safety experts’ into 1) the key elements of SC as identified by Sammer et al. (2010), and 2) identify data sets commonly collected by acute care hospitals that operationalize these elements. A retrospective, cross-sectional design using hierarchical multivariable linear modeling was used in Phase II of the study to examine the relationships between the SC elements and SC. SC data were derived from the AHRQ’s Hospital Survey of Patient Safety Culture (2012), with other data derived from institutional administrative warehouses. The findings of Phase I resulted in the modification of the Phase II study model, which included the independent variables of Leadership, Communication, Justice, Patient-Centeredness, RN staffing, Falls with Injury, and Serious Reportable Events (SRE). The dependent variable was SC as operationalized by Overall Patient Safety. Hierarchical multivariable linear modelling supported the inclusion of Leadership, Communication, and Justice in the Safety Climate model. These three variables, with the addition of the type of unit, were statistically significant in independently predicting SC. This study is an important addition to the Safety Climate body of knowledge. As the first known testing of Sammer’s (2010) SC model, safety experts affirmed four of the seven elements of the model (Leadership, Communication, Justice, and Patient-Centeredness) and added three new elements (RN staffing, Falls with Injury, and SRE). The Phase II preliminary validations study supported the inclusion of Leadership, Communication and Justice in the SC model.