2017 HSR&D/QUERI National Conference

4016 — The Impact of Organizational Climate on Patient Safety: Evidence from Large-Scale Adverse Events

Lead/Presenter: Judy George, COIN - Bedford/Boston
All Authors: George J (VA HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA; Boston University School of Public Health) Baker E (CHOIR, Boston, MA) Burgess JF (CHOIR, Boston, MA; Boston University School of Public Health) Maguire E (CHOIR, Bedford, MA) Elwy RE (CHOIR, Bedford, MA;Boston University School of Public Health) Charns MP (CHOIR, Boston, MA; Boston University School of Public Health) Meterko M (Performance Measurement, VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID – 10EA), Bedford, MA)

Safety literature suggests adverse events are less likely to occur in facilities with a supportive organizational climate. Large-scale adverse events (LSAEs) involve unsafe clinical practices stemming from a systems issue that affects multiple patients. This study aimed to identify staff-perceived organizational climate factors associated with LSAEs.

We conducted a cross-sectional matched cohort observational study using the 2008-2010 VA All Employee Survey (AES) data. Hospitals with LSAEs were identified based on participation in a previous study. We matched each LSAE hospital (n = 2) with two non-LSAE hospitals (n = 4) based on VA-assigned facility complexity and geography. LSAE incidence (yes/no) was our outcome variable. Our explanatory variables included workgroup-level (psychological safety, resources, rewards, civility, engagement, leadership) and hospital-level (bureaucratic, entrepreneurial, group, and rational) Likert-type scales for organizational climate factors. We restricted our sample to staff from the hospital units closely related to the LSAE event for the timeframe prior to the hospitals' LSAE detection. We used staff age, gender, and supervisory level as demographic covariates. Bivariate analyses and logistic regressions were performed with staff as the unit of analysis.

Responses from 209 participants across six facilities indicated significant differences (p < .05) between groups for 90% of the explanatory factors. Relative to LSAE sites, the non-LSAE sites had higher mean scores for: civility (+0.75), group (+0.70), resources (+0.64), engagement (+0.63), leadership (+0.61), psychological safety (+0.60), rational (+0.59), entrepreneurial (+0.52), and bureaucratic (+0.39). The final logistic regression yielded a single engagement scale item as a significant predictor of LSAE incidence (OR = 0.55, 95% C.I. 0.35-0.87).

Staff at LSAE facilities described their organizational climate to be less supportive of a safety focus. Lower scores in engagement (particularly, "VA cares about my general satisfaction at work.") may be associated with a greater risk for LSAEs. Additional research is required to validate this study using a larger/different sample.

Hospital leaders may benefit from reviewing organizational climate data, particularly lower levels of staff engagement, as a potential marker of higher LSAE risk. This exploratory study supports the positive association between employee engagement and veteran experience, based on the risk for a LSAE.