Abstract
Background: Despite the emphasis on patient safety in health care, few organizations have evaluated the extent to which safety is a strategic priority or their culture supports patient safety. In response to the Institute of Medicine's report and to an organizational commitment to patient safety, we conducted a systematic assessment of safety at the Johns Hopkins Hospital (JHH) and, from this, developed a strategic plan to improve safety. The specific aims of this study were to evaluate the extent to which the culture supports patient safety at JHH and the extent to which safety is a strategic priority.
Methods: During July and August 2001 we implemented two surveys in disparate populations to assess patient safety. The Safety Climate Scale (SCS) was administered to a sample of physicians, nurses, pharmacists, and other ICU staff. SCS assesses perceptions of a strong and proactive organizational commitment to patient safety. The second survey instrument, called Strategies for Leadership (SLS), evaluated the extent to which safety was a strategic priority for the organization. This survey was administered to clinical and administrative leaders.
Results: We received 395 completed SCS surveys from 82% of the departments and 86% of the nursing units. Staff perceived that supervisors had a greater commitment to safety than senior leaders. Nurses had higher scores than physicians for perceptions of safety. Twenty three completed SLS surveys were received from 77% of the JHH Patient Safety Committee members and 50% of the JHH Management Committee members. Management Committee responses were more positive than Patient Safety Committee, indicating that management perceived safety efforts to be further developed. Strategic planning received the lowest scores from both committees.
Conclusions: We believe this is one of the first large scale efforts to measure institutional culture of safety and then design improvements in health care. The survey results suggest that strategic planning of patient safety needs enhancement. Several efforts to improve our culture of safety were initiated based on these results, which should lead to measurable improvements in patient safety.
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Selected References
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- Andrews L. B., Stocking C., Krizek T., Gottlieb L., Krizek C., Vargish T., Siegler M. An alternative strategy for studying adverse events in medical care. Lancet. 1997 Feb 1;349(9048):309–313. doi: 10.1016/S0140-6736(96)08268-2. [DOI] [PubMed] [Google Scholar]
- Bagian J. P., Lee C., Gosbee J., DeRosier J., Stalhandske E., Eldridge N., Williams R., Burkhardt M. Developing and deploying a patient safety program in a large health care delivery system: you can't fix what you don't know about. Jt Comm J Qual Improv. 2001 Oct;27(10):522–532. doi: 10.1016/s1070-3241(01)27046-1. [DOI] [PubMed] [Google Scholar]
- Gregorich S. E., Helmreich R. L., Wilhelm J. A. The structure of cockpit management attitudes. J Appl Psychol. 1990 Dec;75(6):682–690. doi: 10.1037/0021-9010.75.6.682. [DOI] [PubMed] [Google Scholar]
- Helmreich R. L., Foushee H. C., Benson R., Russini W. Cockpit resource management: exploring the attitude-performance linkage. Aviat Space Environ Med. 1986 Dec;57(12 Pt 1):1198–1200. [PubMed] [Google Scholar]
- Helmreich R. L. On error management: lessons from aviation. BMJ. 2000 Mar 18;320(7237):781–785. doi: 10.1136/bmj.320.7237.781. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schneider Benjamin, Salvaggio Amy Nicole, Subirats Montse. Climate strength: a new direction for climate research. J Appl Psychol. 2002 Apr;87(2):220–229. doi: 10.1037/0021-9010.87.2.220. [DOI] [PubMed] [Google Scholar]
- Sexton J. B., Thomas E. J., Helmreich R. L. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000 Mar 18;320(7237):745–749. doi: 10.1136/bmj.320.7237.745. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Steinberg Earl P. Improving the quality of care--can we practice what we preach? N Engl J Med. 2003 Jun 26;348(26):2681–2683. doi: 10.1056/NEJMe030085. [DOI] [PubMed] [Google Scholar]