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Emphasis on safety culture provides boost to hospitals

Monday July 15, 2013
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When hospital senior management supports the creation and maintenance of a strong safety culture, patient outcomes improve, staff productivity increases and clinical employee turnover decreases, according to a study.

Diane Storer Brown, RN, PhD, FNAHQ, FAAN, senior scientist at the Collaborative Alliance for Nursing Outcomes and strategic leader of hospital accreditation programs at Kaiser Permanente Northern California, and colleagues explored linkages between staff perceptions of safety culture and ongoing measures of hospital nursing unit performance, such as structures, processes and adverse patient outcomes.

The researchers analyzed 37 nursing units in nine hospitals for the study, which was published in the July/August issue of the Journal for Healthcare Quality, the peer-reviewed publication of the National Association for Healthcare Quality. They measured safety culture perceptions six months prior to data collection on nursing-unit performance, and determined statistical relationships with correlation and regression analyses.

The Agency for Healthcare Research defines safety culture as the product of individual and group values, attitudes, perceptions, competencies and patterns of behavior that determine the commitment to an organization’s health and safety management. Previous research has shown that hospitals with better safety climates overall have lower adverse events rates.

For this study, the researchers explored the relationship between safety culture and adverse patient outcomes of care as represented by reported falls, falls with injury and hospital-acquired pressure ulcers of stage 2 or greater.

Teamwork within units was inversely or negatively correlated with reported falls. In other words, when teamwork was stronger fewer falls were reported, and when teamwork was weaker more falls were reported. The regression analysis showed that 20% of the variance in reported falls was related to safety culture

Skill mix, staff turnover and workload intensity all demonstrated robust correlations with safety culture. Nursing units with higher workload intensity had higher safety culture perceptions.

"A strong safety culture allows nurses and other staff to function at a high level of productivity because of strong teamwork and management support and an environment that supports organizational learning, which allows staff to deal with time-intense patient-care activities," Brown said in a news release. "When senior leaders prioritize and emphasize a safety culture, the structure and process of care are carried out in a way that patient outcomes may be improved."

In 2002, the Institute of Medicine issued a landmark study of medical errors in hospitals and stated that a major leadership goal for hospitals should be creation of an organizational culture for safety. Further, passage of the Affordable Care Act in 2009 has placed major emphasis on making patients safer, and hospitals can be denied reimbursement from Medicare for care that is required to correct a medical error.

Read the study abstract: http://onlinelibrary.wiley.com/doi/10.1111/jhq.12016/abstract.


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