Safety Culture as a Contemporary Healthcare Construct: Theoretical Review and Research Assessment

TITLE. Safety Culture as a Contemporary Healthcare Construct: Theoretical Review and Research Assessment AUTHORS. Patrick A. Palmieri, consultor de salud, Division de Negocios de Salud, Pacifico Peruano Suiza and professor, Center for American Education, Universidad San Ignacio de Loyola, Lima, Peru; and Lori T. Peterson, assistant professor of Health Care Administration, Department of Management and Labor Relations, Nance College of Business, Cleveland State University, Cleveland, Ohio. GOAL. To analyze the theoretical underpinnings of safety culture and to provide an assessment about the state of safety culture research in healthcare. METHODS. First, we reviewed the concept of safety culture, including its origination, disciplinary influences, and associated theoretical tenets. By describing the literature and discussing the interchangeable use of the terms “safety attitude,” “safety climate,” and “safety culture,” we are able to present the conceptual attributes associated with safety culture and present a definition of safety culture. Then, we discuss the psychometric properties for the most widely used instruments in healthcare. The article concludes with a discussion of the current state of safety culture research in healthcare and future opportunities for research. PRINCIPAL FINDINGS. Over time, theoretical development has been limited, which has restricted safety culture research. Reviews of measurement instruments indicate a significant degree of inconsistency in the conceptual and thematic basis. Although a number of instruments are available for research, these instruments vary considerably with regard to general characteristics, the dimensions covered, the availability of psychometrics, and the applicability in studies. The instrument debacle may be responsible for contradictory findings within and between studies. We found that conceptual fragmentation and incomplete theoretical grounding has impeded safety culture research and will continue to hamper further advancement. APPLICATIONS TO PRACTICE. Poor safety management practices represent the root cause of most adverse events. Safety culture is an organizational concept important to the future of the healthcare industry. Yet to date, there are no expert panel recommendations, such as Institute of Medicine reports, to guide healthcare organizations in selecting a valid and reliable safety culture instrument. Researchers have an opportunity to establish a clear conceptual framework, develop valid and reliable measurement instruments, conduct intervention studies, and recommend robust monitoring systems. Safety culture is an important tenet to improve patient safety. By better understanding how to implement organizational changes that impact safety, healthcare administrators, clinical professionals, and ancillary staff can collectively contribute to a better-functioning healthcare system. Photocopying and distributing this PDF of the Journal of Healthcare Management is prohibited without the permission of Health Administration Press, Chicago, Illinois. For permission or reprint, please contact the Copyright Clearance Center at www.copyright. com. 430 Journal of Healthcare Management 55:6 November/December 2010 CONTACT. Patrick A. Palmieri at palmieripa@gmail.com This article was nominated as one of best presented to the Health Care Management Division of the Academy of Management at its 2009 Annual Meeting. For more information about the Academy of Management, visit www.aomonline. org. Photocopying and distributing this PDF of the Journal of Healthcare Management is prohibited without the permission of Health Administration Press, Chicago, Illinois. For permission or reprint, please contact the Copyright Clearance Center at www.copyright. com.