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

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

However, there are an

However, there are an increasing number of studieswhich suggest that safety climate has improvedsimultaneously with patient outcomes or processmeasures following an intervention. These studiesdo not mean there is a causal relations hip. In fact,some argue that changes in processes and outcomesneed to come first and will then be followed bychanges in culture.Whatever the case, the current evidence does notsuggest that a change in safety culture is a necessaryprecursor for changes in outcomes. It is more likelythat there is a complex interrelationship, withchanges to processes and patient outcomes havingan impact on the way staff think about safety. Thusthere is likely to be a two-way relationship betweensafety culture and patient and staff outcomes, ratherthan a linear or one-way causal link (see Figure 2).Figure 2: Reciprocal relationshipbetween culture and outcomesSafety cultureSafety climateInitiativesStaff outcomesAll influence each otherPatient outcomesTHE HEALTH FOUNDATION Research scan: Does improving safety culture affect patient outcomes? 18

Table 1: Link between safety culture and climate and patient outcomesOutcome Studies Key findings RelationshipSafety cultureAdverse eventsand medicationerrors• 3 cross-sectionalcorrelation studies fromthe USA, Canada andIsrael• 1 before and after studyfrom the USABetter safety culture was associated withfewer adverse events. Safety initiatives alsosimultaneously improved safety culture andpatient outcomesPositive linkSafety climateReadmissions• 1 cross-sectionalcorrelation study fromthe USAPoor safety climate was associated with increasedreadmissions for heart attacks and heart failurePositive linkLength of stay• 1 cross-sectionalcorrelation study fromthe USAReductions in safety climate were associated withincreased length of stayPositive linkMortality• 1 cross-sectionalcorrelation study fromthe USASafety climate was not associated with mortality insurgery patientsNo linkComplications• 3 before and after studiesfrom the USA• 1 cross-sectionalcorrelation study fromthe NetherlandsImproved safety climate was associated withreduced surgical complications in one study butnot another. There was no link between safetyclimate and pressure ulcer ratesMixed findingsMedicationerrors• 2 cross-sectionalcorrelation studies fromthe USASafety climate influenced medication errors andthe impact of safety initiatives on medicationerrorsPositive indirect linkCompositeadverse events• 3 cross-sectionalcorrelation studies fromthe USA and Canada• 4 before and after studiesfrom the USABetter safety climate was associated with feweradverse events or less serious adverse events, butthere were conflicting findings. Safety initiativessimultaneously improved safety climate andpatient outcomesMixed findingsImprovedprocesses andgeneric outcomes• 1 before and after studyfrom the UK• 2 cross-sectionalcorrelation studies fromthe UK and USASafety improvement initiatives were associatedwith enhanced processes, outcomes and safetyclimate, but safety climate improvementshappened simultaneously rather than necessarilycausing positive changeIndirect linkTHE HEALTH FOUNDATION Research scan: Does improving safety culture affect patient outcomes? 19

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