Objectives To describe the authors' hospital-wide efforts to improve safety climate at a large academic medical centre.
Design and setting A prospective cohort study used multiple interventions to improve hospital-wide safety climate. 144 clinical units in an urban academic medical centre are included in this analysis.
Interventions The comprehensive unit-based safety programme included steps to identify hazards, partner units with a senior executive to fix hazards, learn from defects, and implement communication and teamwork tools. Hospital-level interventions were also implemented.
Main outcome measures Safety climate was assessed annually using the safety attitudes questionnaire. The safety culture goal was to meet or exceed the 60% minimum positive score or improve the score by ≥10 points.
Results Response rates were 77% (2006) and 79% (2008). For safety climate, 55% of units in 2006 and 82% in 2008 achieved the culture goal. For teamwork climate, 61% of units in 2006 and 83% in 2008 achieved the culture goal. The mean safety climate improvement (difference score) for 79 units at or above 60% in 2006 was 0.201 in 2008; the mean improvement for the 65 units below the threshold was 18.278. The mean teamwork climate improvement (difference score) for the 89 units at or above 60% in 2006 was 0.452 in 2008; the mean improvement for the 55 units below the threshold was 16.176. Climate scores improved significantly from 2006 to 2008 in every domain except stress recognition.
Conclusions Hospital-wide interventions were associated with improvements in safety climate at a large academic medical centre.
- Continuous quality improvement
- healthcare quality
- patient safety
- safety culture
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This is a reprint of a paper that first appeared in Qual Saf Health Care, December 2010, Volume 19, pages 547–554.
Competing interests PJP reports receiving grant support from the Agency for Healthcare Research and Quality for patient safety and culture research, and receives honoraria from various hospitals and hospital associations to speak about patient safety and culture. JBS has a non-financial interest with Pascal Metrics in that he created the Safety Attitudes Questionnaire, but licensed the rights of the SAQ to them. JBS does not receive royalties from the SAQ, but does have permission to act as a paid consultant with Pascal Metrics but has not done so as yet.
Provenance and peer review Not commissioned; externally peer reviewed.