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

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

ContentsKey messages 31

ContentsKey messages 31 Scope 42 Impact on patient outcomes 73 Impact on staff outcomes 134 Summary 17References 22Health Foundation evidence scans provide information to help those involved in improving the qualityof healthcare understand what research is available on particular topics.Evidence scans provide a rapid collation of empirical research about a topic relevant to the HealthFoundation's work. Although all of the evidence is sourced and compiled systematically, they are notsystematic reviews. They do not seek to summarise theoretical literature or to explore in any depth theconcepts covered by the scan or those arising from it.This evidence scan was prepared by The Evidence Centre on behalf of the Health Foundation.© 2011 The Health FoundationOriginally published as Research scan: Does improving safety culture affect patient outcomes?

Key messagesThere is an increasing focus on ways to measure and improvesafety culture in healthcare. This research scan examines whetherimproving safety culture has an impact on patient and staffoutcomes.Safety culture and climateSafety culture refers to the way patient safety isthought about, structured and implemented inan organisation. Safety climate is a subset of this,focused on staff attitudes about patient safety.In recent years, a great deal of research has exploredways to measure safety culture and safety climatein healthcare. There is a growing emphasis oninterventions to improve organisational safetyculture and staff attitudes towards safety. It isassumed that improving safety culture will directlyor indirectly affect patient outcomes. This researchscan examines whether there is any empiricalevidence to support this assumption.The scan describes studies examining the linkbetween safety culture or climate and patientoutcomes. Nine bibliographic databases andnumerous websites were searched for publishedand unpublished material available in early August2011. More than 100 articles were included, 50 ofwhich explicitly examined links between safetyculture or climate and outcomes.Impact on outcomesMany studies and descriptive articles postulate alink between safety culture and patient outcomesor suggest that there is a need for research in thisarea. However, little empirical research has actuallysought to test this relationship in detail.The evidence that does exist has mixed findings andis of variable quality. Most research focuses on thehospital context and examines a single time period,sometimes at single institutions.A small number of studies have found arelationship between safety culture or climate andhospital morbidity, adverse events and readmissionrates. But other studies have found that safetyculture has no impact on patient outcomes.There is more evidence that improving safetyculture impacts on staff safety behaviours andinjury rates among staff.Some studies have found simultaneous improvedsafety culture and patient outcomes followingimprovement initiatives. Therefore rather thana one-way causal relationship, with cultureinfluencing behaviours and clinical outcomes,there may be a circular relationship, with changesin behaviours and outcomes also improving safetyculture.THE HEALTH FOUNDATION Research scan: Does improving safety culture affect patient outcomes? 3

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