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Survey Targets Key Elements of a Culture of Safety -- by Robin Walters, R.N., B.S.N.

As part of our guest contributor program, we thank Robin Walters R.N., B.S.N, for her article below that explores progress among hospitals toward building a culture of safety. Be sure to also read Robin's other contributions on bloodstream infections and hand washing compliance.

Studies link a "culture of safety" with reducing hospital-acquired infections and harmful medical errors.  But what qualities define a culture of safety and how do hospitals measure up?

In a culture of safety, an atmosphere of trust exists in which people are free to report mistakes (and close calls) without fear of retribution.  Knowing that errors will occur, the focus is on the system which allowed the error, not the person making the error.  In an institution with a strong culture of safety, personnel learn from their mistakes and seek solutions.  Teamwork is a hallmark ingredient.

Hospitals can both evaluate and learn how to strengthen their safety scores by using the Hospital Survey on Patient Safety Culture.  Funded by the Agency for Healthcare Research and Quality (AHRQ), this confidential survey takes about 10 minutes to complete and is designed to assess staff attitudes and actions in 12 aspects of patient safety culture.

To give hospital administrators a reference for their results, AHRQ sponsored a database. The first Comparative Database Report was released in 2007.  For the 2008 Report, 98 of the 519 hospitals submitting results did so for the second time, allowing the Report to identify trends.  The following are highlights from this latest Report:

  • A strength among hospitals is "Teamwork Within Units" -- staff work together and support each other in an atmosphere of respect.
  • An area for growth is "Nonpunitive Response to Error," as it appears staff do not have faith that event reports will not be used against them and mistakes will not stay in their personnel file.  But those hospitals that improved in this area did tend to show an increase in the number of events reported.
  • Smaller hospitals had the highest average positive scores and improved more between reports.
  • Comparing work units, Rehabilitation scored the highest while ICU and Medicine scored the lowest in "Overall Perceptions of Patient Safety."  Pediatrics and Pharmacy made the most patient safety progress.
  • Hospital Administration/Management viewed conditions more positively than other staff in 11 of the 12 areas measured.
  • Of the trending hospitals, 27% showed a 5% or more decrease in the area of "Staffing," which indicates a decline in confidence that workloads and hours are appropriate.

About the author: Robin Walters, R.N., B.S.N., has been privileged to provide care in hospitals, clinics, schools and physician offices, at sites ranging from large urban to remote rural.

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