Elsevier

Safety Science

Volume 45, Issue 6, July 2007, Pages 653-667
Safety Science

Measuring safety culture in healthcare: A case for accurate diagnosis

https://doi.org/10.1016/j.ssci.2007.04.003Get rights and content

Abstract

Recent concern regarding the safety of patients in Western healthcare systems has resulted in the adoption of safety management techniques used in high-risk industries. One such method is the use of safety climate questionnaries to survey workforce perceptions and attitudes towards both worker and patient safety in healthcare organizations. Many of the earliest healthcare safety climate measures did not appear to meet accepted psychometric standards. The theoretical foundation of the relationship between perceptions of safety climate and workers’ behaviour is not well specified in this literature and a model derived from industry research is proposed.

Introduction

There is currently a major drive to improve patient safety in many countries – as well as a new global initiative launched by the World Health Organization (www.who.int/patientsafety). This has resulted in healthcare authorities recommending the introduction of safety management methods from the hazardous industries. One concept that has been readily adopted is that of organizational safety culture. Healthcare providers have been encouraged to assess the current state of their safety culture with a view to designing interventions to improve it, in the intention of enhancing the level of safety in their organizations.

In medicine, the accuracy of the initial diagnosis is critical, as problem identification drives the consideration of treatment options. Good diagnostic skills are founded on a proper understanding of the underlying physiology and anatomy, as well as the mechanisms of disease processes. If this medical analogy is applied to safety culture, it raises the following questions. How accurate are the diagnoses of the state of an organization’s safety culture? Are the diagnostic tools used to measure safety culture reliable and valid? Is there a psychological model or process that explains how organizational safety culture actually influences workers’ behaviours? In this article, the current state of patient and worker safety in hospitals is outlined, then research into safety culture in industry will be briefly considered, with particular reference to emerging theory. This is followed by a review of selected research to measure safety culture in healthcare settings.

Section snippets

Safety in healthcare

Most of the safety research that has been carried out in healthcare has concentrated on the hospitals rather than primary care, although studies in pharmacies, family doctor practices and care homes are now emerging (e.g. Castle and Sonon, 2006). As mentioned above, there is considerable international interest, with many countries establishing government agencies to monitor and manage patient safety in their healthcare system (e.g. National Patient Safety Agency in England; Canadian Patient

Safety culture/safety climate in industry

The UK industrial safety regulator, the Health and Safety Executive, recommends that organisations operating in high-risk industries measure their safety culture regularly (HSE, 1999). This is normally achieved by using self-report questionnaires to assess safety climate. The resulting data provide a range of leading indicators about an organisation’s underlying safety culture, which allow managers to monitor and influence workplace safety outcomes (Fleming, 2005, Nieva and Sorra, 2003), and

Measuring safety climate in healthcare

Safety climate surveys are now being used to measure the safety culture of healthcare organisations and a number of research studies have been published. Flin et al. (2006) identified 12 studies that measured safety climate in healthcare (Carrico, 2003, DeJoy et al., 1995, Felknor et al., 2000, Gershon et al., 2000, Itoh et al., 2002, McCoy et al., 2001, Neal et al., 2000, Pronovost et al., 2003, Singer et al., 2003, Sorra and Nieva, 2003, Woods et al., 2003, Vredenburgh, 2002). The studies

Conclusion

Workers’ behaviours are partly influenced by the prevailing cultural norms in their work group and organisation, therefor effective interventions for behavioural change need to be designed to take these cultural factors into account. Measuring safety climate in healthcare can provide additional diagnostic data for managers with regard to the state of the underlying safety culture (Nieva and Sorra, 2003). Safety climate questionnaires need to achieve as high a standard of measurement as possible

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