This project aims to improve researchers' understanding of the organizational characteristics that affect safety culture in hospitals, by expanding the implementation of the Patient Safety Climate in Healthcare Organizations survey to a nationwide sample of 100 hospitals. Researchers will examine the relationship between safety climate and hospital characteristics such as size, tax status, region and teaching status. Participating hospitals will benefit substantially from the project, as they will gain insight into the patterns of patient safety climate in their facility, and they will also have the opportunity to implement a unique intervention program that encourages senior hospital managers to view safety issues from the perspective of front-line hospital workers.
In "Improving Safety Culture and Outcomes in Healthcare," researchers will analyze data from two implementations of the Patient Safety Climate survey. Investigators will examine changes in safety climate for the survey population overall, over time for each hospital, and for groups of hospitals with similar characteristics. Investigators will also compare climate data to statewide Patient Safety Indicator (PSI) rates, to examine the predicted relationship between patient safety outcomes and hospital culture/climate. Sampling for the research began in December 2003; hospitals were selected based on a random sample by size and region, with the assumption that this strategy will produce a sample that is diverse in terms of hospitals' tax status, level of teaching activity, and JCAHO accreditation status.
Investigators will select a representative sample of the surveyed hospitals to participate in "Inward Bound," an intervention program that encourages hospital senior managers to experience patient safety from the perspective of the front-line hospital workers. The goal of this program is to reduce the gap in opinion about hospital safety culture between managers and non-managers -- a problem that CHP/PCOR researchers identified in previous patient safety research.
Intervention hospitals will be randomly selected. CHP/PCOR will carry out the intervention in the selected hospitals between the first and second implementation of the Patient Safety Climate survey. Investigators hypothesize that the intervention hospitals will show improvement in their survey responses and a decrease in the size of the gap between managers and non-managers in the second year due to the interventions.
Hospitals not included in the intervention group will act as controls, but are also likely to show improvement in safety climate over time due to their participation in the project, which includes feedback on survey results and an inside look at the best practices of other hospitals.
"Improving Safety Culture and Outcomes" will also include comparisons of safety climate in hospitals to that of other industries known for their high reliability. These industries include the U.S. Marine Corps, commercial aviation, and naval battle groups.
Sponsor
Funding for "Improving Safety Culture and Outcomes in Healthcare" and "Preparing Rural and Urban Hospitals to Improve Safety Culture through Simulation" is provided by grants from the Agency for Healthcare Research and Quality (AHRQ).
AHRQ, a part of the U.S. Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of healthcare, reduce its cost, improve patient safety, decrease medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on healthcare outcomes; quality; and cost, use, and access. The information helps health care decisionmakers--patients and clinicians, health system leaders, purchasers, and policymakers--make more informed decisions and improve the quality of health care services. The agency was created in 1989 as the Agency for Health Care Policy and Research (AHCPR) and reauthorized as the Agency for Healthcare Research and Quality in 1999. Sister agencies include the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration, the Health Care Financing Administration, and the Health Resources and Services Administration. Nearly 80 percent of AHRQ's $269.9 million budget is awarded as grants and contracts to researchers at universities and other research institutions across the country. (http://www.ahrq.gov/about/profile.htm; http://www.ahrq.gov/about/ahrqfact.htm)
For more information about quality and patient safety at AHRQ, visit: http://www.ahrq.gov/qual/index.html.
