. 2021 Sep 19;9(1):30–43. doi: 10.1002/nop2.1063

TABLE 2.

Summary table

Citation (Year) Country	Design and sample	Risk of bias	Safety culture measures	Patient outcomes measures	Key findings relating to safety culture
Ausserhofer et al. (2013) Switzerland	Cross‐sectional study in 35 Swiss acute‐care hospitals Registered nurses (RNs) (n = 1,630) Patients (n = 997)	Low	Safety Organizing Scale (9 items).	Nurse perceptions of adverse events: Patient falls. Medication errors. Pressure injury. Urinary tract infection. Bloodstream infection. Pneumonia. Patient satisfaction with care.	‐ Mean level of unit safety culture was 5.11 (0.49), 7‐point scale (higher scores indicate better safety culture). ‐ There was no significant relationship between safety culture and any patient outcomes.
Brown and Wolosin (2013) United States of America	Cross‐sectional study in 9 hospitals Nursing units (n = 37)	Low	Hospital Survey on Patient Safety Culture (42 items).	Incident/risk management data: Patient falls. Falls with injury (Moderate Injury or above). Pressure injury stage2+.	‐ Mean level of unit safety culture was 3.94 (0.44), 5‐point scale (higher scores indicate better safety culture). ‐ Stronger teamwork within units led to fewer reported falls r = –0.32, p <.05. ‐ Stronger overall safety culture led to fewer pressure injuries r = –0.34, p <.05. ‐ More management support led to higher numbers of reported falls r = +0.35, p <.03.
Han et al. (2020) South Korea	Cross‐sectional study in 2 hospitals Nurses (n = 212)	Low	Hospital Survey on Patient Safety Culture (42 items).	Nurse perceptions of adverse events: Patient falls. Medication errors. Pressure injuries. Use of physical restraints for ≥8 hr. Surgical site infection. Urinary tract infection. Central line‐associated bloodstream infections. Ventilator‐associated pneumonia	‐ Mean level of individual safety attitude was 3.49 (0.58), 5‐point scale (higher scores indicate better safety culture). ‐ Negative relationship between stronger safety culture subscale scores and fewer patient outcomes (except central line‐associated bloodstream infections).
Hessels et al. (2019) United States of America	Cross‐sectional study in 5 hospitals Nursing units (n = 29) Registered nurses (n = 311)	Low	Hospital Survey on Patient Safety Culture (44 items).	Incident/risk management data: Patient falls. Medication Variance. Quality‐of‐care concern. Vascular access device (VAD) events.	‐ Mean level of unit safety culture was 3.52 (0 0.30), 5‐point scale (higher scores indicate better safety culture). ‐ The unit safety culture subscale of management support for patient safety was a predictor of VAD events (R² = 15%, p =.01)
Hofmann and Mark (2006) United States of America	Cross‐sectional study in 42 hospitals Nursing units (n = 81) Registered nurses (n = 1,127)	Low	Zohar Safety Climate Scale (9 items) and Error Orientation Scale (13 items).).	Incident/risk management data: Medication errors. Urinary tract infections. Patient satisfaction with care.	‐ Mean level of unit safety culture was 3.62 (0.26), 5‐point scale (higher scores indicate better safety culture). ‐ Negative relationship between stronger overall safety culture and fewer medication errors (r = −1.51, p <.05) and urinary tract infections (r = −1.27, p <.05). ‐ Positive relationship between stronger overall safety culture and higher patient satisfaction (r = 0.27, p <.01).
Lee et al. (2018) Canada	Cross‐sectional study in 63 hospitals Registered nurses (n = 1,053)	Low	Hospital Survey on Patient Safety Culture (7 items).	Nurse perceptions of adverse events: Patient falls with injury. Medication errors. Urinary tract infections . Quality of care.	‐ Negative relationship between stronger hospital safety culture and fewer medication errors (OR =0.36, CI =0.16–0.80), patient falls with injury (OR =0.42, CI =0.18–0.96), and UTIs (OR =0.40, CI =0.18–0.86).
Olds et al. (2017) United States of America	Cross‐sectional study in 600 hospitals Registered nurses (n = 27,009) Patients (n = 852,974)	Low	Hospital Survey on Patient Safety Culture (7 items).	Coded medical record data In‐hospital mortality.	‐ Mean level of hospital safety culture was 55.0%, (8.7%) (higher percentages indicate better safety culture). ‐ Negative relationship between stronger hospital safety culture (in individual model) and lower mortality (OR =0.92, CI=0.89–0.95, p <.001).
Taylor et al. (2012) United States of America	Cross‐sectional study in 1 hospital Nursing units (n = 29) Registered nurses (n = 723) Patients (n = 28,876)	Low	Safety Attitude Questionnaire (27 items).	Incident/risk management data: Patient falls. Coded medical record data. Pressure injuries. Embolism/ deep vein thrombosis (PE/DVT).	‐ Negative relationship between stronger unit subscales of “safety climate” and fewer pressure injuries (OR=0.52, CI =0.29–0.92, p <.05). ‐ Negative relationship between stronger unit subscales of “teamwork climate” and fewer pressure injuries (OR=0.56, CI 0.38–0.82, p <.01).
Wang et al. (2014) China	Cross‐sectional study in 7 hospitals Nursing units (n = 28) Registered nurses (n = 463)	Low	Hospital Survey on Patient Safety Culture (42 items).	Nurse perceptions of adverse events: Patient falls. Medication error. Pressure injuries. Physical restraints (> 8 hr). Surgical wound infection. Infusion or transfusion reaction. Patients or family complaints.	‐ Mean level of individual safety attitude was 3.46 (0.60), 5‐point scale (higher scores indicate better safety culture). ‐ Negative relationship between stronger safety culture subscales and fewer patient outcomes (except patient falls).