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Does improving safety culture affect patient outcomes? - Health ...

Does improving safety culture affect patient outcomes? - Health ...

2.4 Ongoing researchMany

2.4 Ongoing researchMany national and international organisations havespecific research programmes about patient safetyunderway. Researchers state that it is a real priorityto investigate the link between safety culture andoutcomes, but we identified no publicly availablerecords of studies currently underway with thisfocus. This does not indicate that no such studiesare underway, just that records are not readilyavailable. Given the considerable and growinginterest in safety culture in recent years, it is likelythat researchers are currently investigating thistopic to some degree.Most of the research available is published but thereis a notable exception. A PhD thesis in the USA hasexplicitly examined the link between safety cultureand clinical outcomes. The author concluded thatcertain aspects of safety culture are more likely tohave an impact than others. Hospital managementand supervisor support was found to lead toimproved perceptions of safety, but the link withincidents and incident reporting was more difficultto determine. There was some indication thatpositive safety culture may be associated with anincreased rate of medication incidents, but this maybe because a positive safety culture means that staffare more likely to report incidents and thereforeerror rates appear to rise. 612.5 Media attentionAnalysis of public news archives suggests thatmedia attention regarding ‘safety culture’ inhealthcare has grown since 2005. The term ‘safetyculture’ is used explicitly in the press in both theUK and North America. The term ‘safety climate’is not commonly used in the media with regards tohealth.There have been stories postulating a link betweensafety culture and healthcare processes, 62–64errors, 65–69 morbidity 70 and fatalities. 71 As justone example to provide a flavour, there havebeen reports in The Times about how one in tenprescriptions written in hospital may contain anerror, and this has been linked to a general lack ofsafety culture in the NHS. 72Stories about maternity units have also mentionedthe concept of safety culture as one aspect in needof improvement. 73–75But most of the media reports available are opinionpieces or describe the outcomes of specific researchreports. 76In the health press, there have been storiescomparing the safety culture in healthcare to theculture and outcomes of other industries such asaviation, 77–79 and stories about ways to measure 80,81or build safety culture. 82–88 Like many researchreports, these media stories assume a link betweensafety culture and patient outcomes, but do nottend to question or explore this in any detail.THE HEALTH FOUNDATION Research scan: Does improving safety culture affect patient outcomes? 12

3 Impact on staff outcomesOur search strategy focused on the relationshipbetween safety culture and patient outcomes.However, during the literature search it becameevident that there is a growing evidence base aboutthe link between safety culture and outcomesfor healthcare staff. Here we briefly summarise27 relevant studies to give a flavour of emergingfindings.Research suggests that improving safety culturemay directly impact on two specific staff outcomes:staff injury rates and safety behaviours among staffwhich may in turn have follow-on impacts for staffand patient safety.3.1 Staff behaviourBehaviours to improve safetyA number of studies have found a positive linkbetween safety culture and the safety behavioursof staff. For instance, an organisation in the USAfound that strengthening safety culture improvedhow healthcare workers handle hazardous drugsand substances. 89Researchers in Taiwan examined howorganisational culture may influence patient safetybehaviour in hospital. 788 staff from 42 hospitalswere surveyed. Patient safety culture had a positiveimpact on patient safety behaviour among staff.The authors concluded that the safety behaviours ofhospital staff are partly influenced by the prevailingcultural norms in their organisations and workgroups. 90Other researchers in China examined therelationship between safety climate, perceivedcolleagues’ safety knowledge and behaviour,and an individual’s own safety behaviours andperformance. Safety climate and perceivedknowledge and behaviour of colleagues bothimpacted on safety behaviour. The more positivethe safety climate, the stronger the effect ofperceptions about colleagues was on people’s ownsafety behaviour. 91In Norway, almost 2,000 safety climate surveyswere completed by hospital workers and a similarnumber were completed at a large petroleumcompany. There were common safety climatefactors across the industries. The most significantvariables involved organisational managementsupport for safety and manager expectationsand actions promoting safety. These attributesindirectly enhanced safety behaviour and teamworkwithin units as well as learning, feedback andimprovement. 92Specific components of safety culture such asinformation and awareness may also have links tostaff outcomes and behaviours. Researchers in theUSA found that teaching medical students aboutpatient safety makes them more likely to intervenein clinical encounters to avoid patient errors. 93Investigators in Australia examined the factorsthat influence patient safety behaviours by nurses,doctors and allied health professionals. 5,294clinical and managerial staff were surveyed. Abelief that engaging in behaviours will lead toimproved patient safety and perceptions about thepatient safety-related behaviours of one’s colleaguesinfluenced safety behaviour across all professionalgroups. 94THE HEALTH FOUNDATION Research scan: Does improving safety culture affect patient outcomes? 13

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