Nurse perceptions of safety climate in Australian acute hospitals: a cross-sectional survey
Sze-Ee Soh A B D , Renata Morello A , Sheral Rifat A , Caroline Brand A C and Anna Barker AA Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia. Email: Renata.Morello@monash.edu; Sheral.r@gmail.com; Caroline.Brand@monash.edu; Anna.Barker@monash.edu
B Department of Physiotherapy, School of Primary Health Care, Monash University, McMahons Road, Frankston, Vic. 3199, Australia.
C Melbourne EpiCentre, The University of Melbourne and Melbourne Health, 300 Grattan Street, Parkville, Vic. 3050, Australia.
D Corresponding author. Email: Sze-Ee.Soh@monash.edu
Australian Health Review 42(2) 203-209 https://doi.org/10.1071/AH16172
Submitted: 20 July 2016 Accepted: 15 January 2017 Published: 16 March 2017
Abstract
Objectives The aim of the present study was to explore nurse perceptions of safety climate in acute Australian hospitals.
Methods Participants included 420 nurses who have worked on 24 acute wards from six Australian hospitals. The Safety Attitudes Questionnaire (SAQ) Short Form was used to quantify nurse perceptions of safety climate and benchmarked against international data. Generalised linear mixed models were used to explore factors that may influence safety climate.
Results On average, 53.5% of nurses held positive attitudes towards job satisfaction followed by teamwork climate (50.5%). There was variability in SAQ domain scores across hospitals. The safety climate and perceptions of hospital management domains also varied across wards within a hospital. Nurses who had worked longer at a hospital were more likely to have poorer perceptions of hospital management (β = –5.2; P = 0.014). Overall, nurse perceptions of safety climate appeared higher than international data.
Conclusions The perceptions of nurses working in acute Victorian and New South Wales hospitals varied between hospitals as well as across wards within each hospital. This highlights the importance of surveying all hospital wards and examining the results at the ward level when implementing strategies to improve patient safety and the culture of safety in organisations.
What is known about the topic? Prior studies in American nursing samples have shown that hospitals with higher levels of safety climate have a lower relative incidence of preventable patient complications and adverse events. Developing a culture of safety in hospitals may be useful in targeting efforts to improve patient safety.
What does this paper add? This paper has shown that the perceptions of safety climate among nurses working in acute Australian hospitals varied between hospitals and across wards within a hospital. Only half the nurses also reported positive attitudes towards job satisfaction and teamwork climate.
What are the implications for practitioners? Programs or strategies that aim to enhance teamwork performance and skills may be beneficial to improving the culture of safety in hospitals. Wards may also have their own safety ‘subculture’ that is distinct from the overall hospital safety culture. This highlights the importance of tailoring and targeting quality improvement initiatives at the ward level.
Additional keywords: acute care, hospital safety culture, safety performance.
References
[1] Jackson T, Nghiem HS, Rowell D, Jorm C, Wakefield J. Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research. J Health Serv Res Policy 2011; 16 141| Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research.Crossref | GoogleScholarGoogle Scholar |
[2] Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care 2003; 12 ii17–23.
| Safety culture assessment: a tool for improving patient safety in healthcare organizations.Crossref | GoogleScholarGoogle Scholar |
[3] Morello RT, Lowthian JA, Barker AL, McGinnes R, Dunt D, Brand C. Strategies for improving patient safety culture in hospitals: a systematic review. BMJ Qual Saf 2013; 22 11–18.
| Strategies for improving patient safety culture in hospitals: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[4] Singer S, Lin S, Falwell A, Gaba D, Baker L. Relationship of safety climate and safety performance in hospitals. Health Serv Res 2009; 44 399–421.
| Relationship of safety climate and safety performance in hospitals.Crossref | GoogleScholarGoogle Scholar |
[5] Bennett PN, Ockerby C, Stinson J, Willcocks K, Chalmers C. Measuring hospital falls prevention safety climate. Contemp Nurse 2014; 47 27–35.
| Measuring hospital falls prevention safety climate.Crossref | GoogleScholarGoogle Scholar |
[6] Black AA, Brauer SG, Bell RAR, Economidis AJ, Haines TP. Insights into the climate of safety towards the prevention of falls among hospital staff. J Clin Nurs 2011; 20 2924–30.
| Insights into the climate of safety towards the prevention of falls among hospital staff.Crossref | GoogleScholarGoogle Scholar |
[7] Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, et al Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care 2010; 22 151–61.
| Intensive care unit safety culture and outcomes: a US multicenter study.Crossref | GoogleScholarGoogle Scholar |
[8] Taylor JA, Dominici F, Agnew J, Gerwin D, Morlock L, Miller MR. Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions. BMJ Qual Saf 2012; 21 101
| Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions.Crossref | GoogleScholarGoogle Scholar |
[9] Brown DS, Wolosin R. Safety culture relationships with hospital nursing sensitive metrics. J Healthc Qual 2013; 35 61–74.
| Safety culture relationships with hospital nursing sensitive metrics.Crossref | GoogleScholarGoogle Scholar |
[10] Sexton JB, Berenholtz SM, Goeschel CA, Watson SR, Holzmueller CG, Thompson DA, et al Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Med 2011; 39 934
| Assessing and improving safety climate in a large cohort of intensive care units.Crossref | GoogleScholarGoogle Scholar |
[11] Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, et al The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 2006; 6 44
| The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research.Crossref | GoogleScholarGoogle Scholar |
[12] Hofmann DA, Mark B. An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. Person Psychol 2006; 59 847–69.
| An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes.Crossref | GoogleScholarGoogle Scholar |
[13] Stone WP, Gershon RMR. Nurse work environments and occupational safety in intensive care units. J Nurs Administ 2009; 39 S27–34.
| Nurse work environments and occupational safety in intensive care units.Crossref | GoogleScholarGoogle Scholar |
[14] Barker AL, Morello RT, Ayton DR, Hill KD, Landgren FS, Brand CA. Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies. Inj Prev 2015; 21 e1–7.
| Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2cfltFyhsg%3D%3D&md5=5d0b4976abf1faa34f4895a5d47454efCAS |
[15] Barker A, Brand C, Haines T, Hill K, Brauer S, Jolley D, et al The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial. Inj Prev 2011; 17 e5
| The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[16] Devriendt E, Van den Heede K, Coussement J, Dejaeger E, Surmont K, Heylen D, et al Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: an observational study. Int J Nurs Stud 2012; 49 327–37.
| Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: an observational study.Crossref | GoogleScholarGoogle Scholar |
[17] Gabrani A, Hoxha A, Simaku A, Gabrani J. Application of the Safety Attitudes Questionnaire (SAQ) in Albanian hospitals: a cross-sectional study. BMJ Open 2015; 5 4
[18] Relihan E, Glynn S, Daly D, Silke B, Ryder S. Measuring and benchmarking safety culture: application of the safety attitudes questionnaire to an acute medical admissions unit. Ir J Med Sci 2009; 178 433–9.
| Measuring and benchmarking safety culture: application of the safety attitudes questionnaire to an acute medical admissions unit.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MvgvFyhsQ%3D%3D&md5=c47c67599da43edccda75e066ce3681eCAS |
[19] Soh S-E, Barker A, Morello R, Dalton M, Brand C. Measuring safety climate in acute hospitals: Rasch analysis of the Safety Attitudes Questionnaire. BMC Health Serv Res 2016; 16 497
| Measuring safety climate in acute hospitals: Rasch analysis of the Safety Attitudes Questionnaire.Crossref | GoogleScholarGoogle Scholar |
[20] Gallego B, Westbrook MT, Dunn AG, Braithwaite J. Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. Int J Qual Health Care 2012; 24 311–20.
| Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics.Crossref | GoogleScholarGoogle Scholar |
[21] Allison PA. Logistic regression using the SAS system: theory and application. Cary, NC: SAS Institute Inc; 2012.
[22] Sawyer T, Laubach VA, Hudak J, Yamamura K, Pocrnich A. Improvements in teamwork during neonatal resuscitation after interprofessional TeamSTEPPS training. Neonatal Netw 2013; 32 26
| Improvements in teamwork during neonatal resuscitation after interprofessional TeamSTEPPS training.Crossref | GoogleScholarGoogle Scholar |
[23] Weaver SJ, Rosen MA, DiazGranados D, Lazzara EH, Lyons R, Salas E, et al Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf 2010; 36 133–42.
| Does teamwork improve performance in the operating room? A multilevel evaluation.Crossref | GoogleScholarGoogle Scholar |
[24] Speroff T, Nwosu S, Greevy R, Weinger MB, Talbot TR, Wall RJ, et al Organisational culture: variation across hospitals and connection to patient safety climate. Qual Saf Health Care 2010; 19 592–6.
| 1:STN:280:DC%2BC3M%2FhslKmtA%3D%3D&md5=76cba6f42d9db64b670553c78037e996CAS |
[25] Adams A, Bond S. Hospital nurses’ job satisfaction, individual and organizational characteristics. J Adv Nurs 2000; 32 536
| Hospital nurses’ job satisfaction, individual and organizational characteristics.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvmsVClsw%3D%3D&md5=1a48a7b3a345de0bb8b1de12ed7a588dCAS |
[26] Kline TJB, Willness C, Ghali WA. Determinants of adverse events in hospitals – the potential role of patient safety culture. J Healthc Qual 2008; 30 11–17.
| Determinants of adverse events in hospitals – the potential role of patient safety culture.Crossref | GoogleScholarGoogle Scholar |
[27] Duffield C, Roche M, O’Brien-Pallas L, Catling-Paull C, King M. Staff satisfaction and retention and the role of the nursing unit manager. Collegian 2009; 16 11–7.
| Staff satisfaction and retention and the role of the nursing unit manager.Crossref | GoogleScholarGoogle Scholar |
[28] Mark BA, Hughes LC, Belyea M, Bacon CT, Chang Y, Jones CA. Exploring organizational context and structure as predictors of medication errors and patient falls. J Patient Saf 2008; 4 66–77.
| Exploring organizational context and structure as predictors of medication errors and patient falls.Crossref | GoogleScholarGoogle Scholar |
