Navigating the Health Care System

Safety Culture Creates Better Care for Patients

By Carolyn M. Clancy, M.D.

May 3, 2011

The more we know about safety, the better.

That's why a landmark report on medical errors from the Institute of Medicine remains as important today as it did when it came out 10 years ago. Called "To Err is Human," the report urged hospitals to develop a "culture of safety" to reduce risks and improve care for patients.

Today, safety culture plays a big role in health care. Doctors, nurses, and other health care workers are learning that a positive safety culture can improve patient care.

What does safety culture in a hospital look like?

A survey developed by the Agency for Healthcare Research and Quality (AHRQ) allows hospitals and other health care settings to measure safety by asking staff to rate things like teamwork and communication about errors. The survey launched in 2004. Since then, more than 338,000 employees from 855 hospitals have used the survey.

Employees give responses to statements such as "Staff feel like their mistakes are held against them," and "Staff feel free to question the decisions of or actions of others with more authority." They also give feedback on whether they report mistakes that could hurt a patient, even if no harm was done.

These responses help hospitals recognize what works well and where they need to improve. Sixty percent of hospitals that have taken the survey repeat it to see if their safety culture has changed.

When clinicians feel that they can talk openly about conditions that could harm patients, care improves.

As evidence, hospital units that have open communication have fewer medication errors, a new study from the University of North Carolina finds.

In this study, nurses at 148 hospitals were surveyed over a five-month period. They were asked questions about their willingness to report errors, whether their unit talked openly about errors, and how often they thought about whether an error might occur. Nursing units averaged 3.7 medication errors within 6 months. But nursing units with more open communication had fewer such errors.

How can you tell if your hospital has a good patient safety culture? Surveys and training tools that address safety culture are relatively new, so most hospitals are still learning about how they can improve.

But other tools can indicate a hospital's overall quality.

For example, Hospital Compare, an online tool from the Federal government, lets you compare the quality of care at hospitals. Hospital Compare includes results from a survey that asks patients about their recent hospital stay. Patients tell about communication with doctors and nurses, how they rate the hospital, and whether they would recommend the hospital.

Many hospitals are learning how to create a culture of patient safety. Their patients will benefit from this effort.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Surveys on Patient Safety Culture: Hospital Survey on Patient Safety Culture
Available at: http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm#Toolkit

Effects of learning climate and registered nurse staffing on medication errors. [Nurs Res 2011 Jan-Feb].
Available at: http://www.ncbi.nlm.nih.gov/pubmed/21127452

Department of Health and Human Services
Medicare Hospital Compare Information for Consumers—Overview
Available at: http://hospitalcompare.hhs.gov/staticpages/for-consumers/for-consumers.aspx

Medicare Hospital Compare Information for Consumers—Patients' Survey
Available at: http://hospitalcompare.hhs.gov/staticpages/for-consumers/hcahps/patients-hospital-experiences.aspx

Institute of Medicine
To Err is Human: Building a Safer Health System. November 1999.
Available at: http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx

Current as of May 2011

Internet Citation:

Safety Culture Creates Better Care for Patients. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, May 3, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc050311.htm