Relationship of safety climate and safety performance in hospitals.

Despite substantial efforts by many health care organizations, medical errors remain too common and continue to generate significant personal and financial burdens (Institute of Medicine 2006). Researchers who study organizations that face hazardous and turbulent task conditions, yet demonstrate sustained superior safety performance, attribute their achievement in large part to their culture of safety (Roberts 1990; Weick and Sutcliffe 2001). These organizations, often termed high-reliability organizations (HROs), are “systems operating in hazardous conditions that have fewer than their share of adverse events” (Reason 2000) and include aircraft carriers, air traffic control systems, and nuclear power plants. The main distinguishing feature of HROs is their ability to perform demanding activities with low incident rates and an almost complete absence of catastrophic failures over several years. Based on evidence from HROs, policy makers interested in improving health care delivery have called upon health care organizations to strengthen their safety culture to reduce adverse events (Institute of Medicine 2001). In this study, the safety culture of an organization is viewed as the values shared among organization members about what is important, their beliefs about how things operate in the organization, and the interaction of these with work unit and organizational structures and systems, which together produce behavioral norms in the organization that promote safety. Although this definition is similar to definitions of organizational culture more generally (Schein 1992), it is specific to the safety culture of an organization and highlights the role of interpersonal, work unit, and organizational contributions in forming shared basic assumptions that individuals working in organizations develop over time. Like others, we adopt the view that culture is difficult to measure, and that it is more feasible to track a related construct called safety climate (Zohar 1980; Griffin and Neal 2000), the perceptions and attitudes of the organization's workforce about surface features of the culture of safety in hospitals at a given point in time (Flin 2007). While most presume that better safety climate in hospitals will be associated with fewer errors and better outcomes, quantitative evidence establishing this link is limited. Anticipated benefits would stem from the ability of organizations with strong safety climates to cultivate behaviors that enhance collective learning by addressing unproductive beliefs and attitudes about errors, their cause and cure. Obtaining better information about the relationship between hospital safety climate and safety performance would be beneficial. By highlighting the importance of safety climate, such information would facilitate the development of benchmarks and initiatives to improve it. Further recognition of safety climate's importance would promote collaboration within and among organizations to compare the measures of safety climate and share useful approaches. Such information would also help hospital managers and clinicians target approaches to safety improvement of greatest potential value. In this study, we examined the relationship between hospital safety climate and measures of hospital performance on selected indicators of patient safety. We combined data from a survey that measured safety climate among personnel in a national sample of hospitals, with indicators of potential safety events from the Agency for Healthcare Research and Quality's Patient Safety Indicators (AHRQ PSIs).