National Meeting 2007

1062 — Safety Culture in VA Hospitals

Shokeen P (Bedford VA, HSR&D Field Program) , Rosen A (Bedford VA, HSR&D Field Program and Boston University School of Public Health), Zhao S (Bedford VA, HSR&D Field Program), Meterko M (HSR&D Center for Organization, Leadership & Management Research (COLMR), VA Boston Health Care System), Falwell A (Stanford University), Gaba D (VA Palo Alto Health Care System, HSR&D Field Program)

Objectives:
A culture of safety is recognized as a key to reducing adverse events in hospitals. Safety culture represents shared values, beliefs, and norms of behavior as articulated by senior management and translated consistently into effective work practices. This study explores the strength and uniformity of safety culture in 29 VA hospitals, representing four regions of the US.

Methods:
We administered the Patient Safety Climate in Healthcare Organizations (PSCHO) survey, a valid instrument for assessing perceptions and attitudes of safety culture at a point in time, to 100% of hospital-based physicians, 100% of senior managers (defined as department heads and above) and a 10% random sample of all other hospital personnel between December 2005 and June 2006. The PSCHO consists of 42 Likert-scale questions and six demographic questions. For each question, a "problematic response" (PR) suggested a weak safety climate. We calculated average PR rates and 95% confidence intervals (CIs), accounting for sample proportion and patterns of non-response for each question and job-type across all participating hospitals.

Results:
Total deliverable surveys were 9,240, representing a response rate of 49% (4,504 respondents). The average overall PR rate across all hospitals and personnel was 18.1%; rates of PR varied widely between institutions, ranging from 4.4% to 49.6%. The questions eliciting the highest and lowest PR rate were “My unit recognizes individual safety achievement through rewards and incentives” and “If I make a mistake that has significant consequences and nobody notices, I do not tell anyone about it,” respectively. Physicians and hospital employees had statistically significantly higher PR rates than senior managers (PRs = 17.1, 17.3, and 9.8%, respectively); nurses had the highest PR rates of any job-type (PR=20.8%; CI=17.0%-24.7%).

Implications:
Both strength and uniformity of safety culture are important in assessing hospitals’ commitment to patient safety. Perceptions of culture differed among hospitals and by job-type. Our study results are similar to a companion project that examined the safety culture in non-VA hospitals. Next steps are to explore the relationship between safety culture and outcomes.

Impacts:
Despite the positive overall perception of culture among VA employees, variation in problematic response by question and job type warrants further investigation.