Patient Safety and Quality

Hospitals with better safety climates have fewer events that can potentially harm patients

Hospitals with a better safety climate—interpersonal, work unit, and organizational safety attitudes and safeguards—have a lower incidence of patient safety problems such as bed sores, postoperative hemorrhage, and health care-associated infections, concludes a new study. The researchers analyzed survey responses from hospital personnel at 91 hospitals in 37 States about the safety climate at their hospitals. Safety climate topics included unit safety norms, senior managers' engagement in safety issues, and staff fear of blame or shame due to errors or safety problems. Higher levels of safety climate were associated with higher safety performance, defined as a lower incidence of patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ). A higher risk of experiencing PSIs was found for hospitals where employees reported feeling shame and blame for mistakes. Better safety climate perceptions of frontline personnel—but not senior managers—were associated with a decreased risk of hospital PSIs.

The researchers also found a strong relationship between a better safety climate in the hospital and lower risk of patients developing decubitus ulcers (bed sores). Despite hospital efforts to create just and fair work environments, feelings of punishment and low self-esteem continue to sabotage efforts at improving patient safety in hospitals, note the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13920).

See "Relationship of safety climate and safety performance in hospitals," by Sara Singer, M.B.A., Ph.D., Shoutzu Lin, Alyson Falwell, David Gaba, M.D., and Laurence Baker, Ph.D., in the April 2009 HSR: Health Services Research 44(2), pp. 399-421.

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