Patient safety continues to be a serious health concern in acute-care hospitals. Safety culture has been a frequent target for patient safety improvement over the past decade, based on recommendations from the Institute of Medicine and its use in industry. However, the relationship between safety culture and patient safety in acute-care hospitals has yet to be systematically examined. Thus, a meta-analysis was devised to examine the relationship between patient safety outcomes and safety culture in that setting. Due to the limited empirical research reports available, five small pilot meta-analyses were conducted, examining the relationship between safety culture and each of the following: pressure ulcers, falls, medication errors, nurse-sensitive outcomes, and post-operative outcomes. No significant relationships of any size were identified. An assessment of the relevant literature is presented, offering potential explanations for this surprising finding and an agenda for future research.
Agency for Healthcare Research and Quality. (2005). Advances in patient safety: From research to implementation (AHRQ Publication Nos. 050021 [1-4]). Rockville, MD: Author.
BorensteinM.HedgesL. V.HigginsJ. P. T.RothsteinH. R. (2009). Introduction to meta-analysis. West Sussex, UK: Wiley.
4.
ClarkeS. (2010). An integrative model of safety climate: Linking psychological climate and work attitudes to individual safety outcomes using meta-analysis. Journal of Occupational and Organizational Psychology, 83, 553-578. doi:10.1348/096317909X452122
5.
ClassenD. C.ResarR.GriffinF.FedericoF.FrankelT.KimmelN.JamesB. C. (2011). “Global trigger tool” shows that adverse events in hospitalsmaybe ten times greater than previously measured. Health Affairs, 30, 581-589. doi:10.1377/hlthaff.2011.0190
6.
CollaJ. B.BrackenA. C.KinneyL. M.WeeksW. B. (2005). Measuring patient safety climate: A review of surveys. Quality & Safety in Healthcare, 14, 364-366. doi:10.1136/qshc.2005.014217
7.
Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century (pp. 39-60). Washington, DC: National Academies Press.
CooperH. (2010). Research synthesis and meta-analysis: A step-by-step approach (4th ed.). Thousand Oaks, CA: Sage.
10.
*DavenportD. L.HendersonW. G.MoscaC. L.KhuriS. F.MentzerR. M.Jr. (2007). Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. Journal of the American College of Surgeons, 205, 778-784. doi:10.1016/j.jamcollsurg.2007.07.039
11.
de VriesE. N.RamrattanM. A.SmorenburgS. M.GoumaD. J.BoermeesterM. A. (2008). The incidence and nature of in-hospital adverse events: A systematic review. Quality & Safety in Health Care, 17, 216-233. doi:10.1136/qshc.2007.023622
12.
DowneyJ. R.Hernandez-BoussardT.BankaG.MortonJ. M. (2012). Is patient safety improving? National trends in patient safety indicators: 1998–2007. Health Services Research, 47, 414-430. doi:10.1111/j.1475-6773.2011.01361.x
13.
GreenbergM. D.HavilandA. M.YuH.FarleyD. O. (2009). Safety outcomes in the United States: Trends and challenges in measurement. Health Services Research, 44, 739-755. doi:10.1111/j.1475-6773.2008.00926.x
14.
GrovesP. S.MeisenbachR.Scott-CawiezellJ. (2011). Keeping patients safe in healthcare organizations: A structuration theory of safety culture. Journal of Advanced Nursing, 67, 1846-1855. doi:10.1111/j.1365-2648.2011.05619x
15.
HalliganM.ZecevicA. (2011). Safety culture in healthcare: A review of concepts, dimensions, measures and progress. BMJ Quality & Safety, 20, 338-343. doi:10.1136/bmjqs.2010.040964
16.
HansenL. O.WilliamsM. V.SingerS. J. (2011). Perceptions of hospital safety climate and incidence of readmission. Health Services Research, 46, 596-616. doi:10.1111/j.1475-6773.2010.01204.x
HofmannD. A.MarkB. (2006). An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. Personnel Psychology, 59, 847-869. doi:10.1111/j.1744-6570.2006.00056.x
19.
HuangD. T.ClermontG.KongL.WeissfeldL. A.SextonJ. B.RowanK. M.AngusD. C. (2010). Intensive care unit safety culture and outcomes: A US multicenter study. International Journal for Quality in Health Care, 22, 151-161. doi:10.1093/intqhc/mzq017
20.
JacksonJ.SaracC.FlinR. (2010). Hospital safety climate surveys: Measurement issues. Current Opinion in Critical Care, 16, 632-638. doi:10.1097/MCC.0b013e32833f0ee6
21.
KohnL. T.CorriganJ. M.DonaldsonL. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academies Press.
22.
*LyonJ. S. (2007). The missing link: An examination of safety climate and patient clinical outcomes in a national sample of hospitals (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3260406)
23.
MacDavittK.ChouS. S.StoneP. W. (2007). Organizational climate and health care outcomes. Joint Commission Journal on Quality and Patient Safety, 33(Suppl. 11), 45-56.
24.
MardonR. E.KhannaK.SorraJ.DyerN.FamolaroT. (2010). Exploring relationships between hospital patient safety culture and adverse events. Journal of Patient Safety, 6, 226-232.
25.
*MarkB. A.HughesL. C.BelyeaM.BaconC. T.ChangY.JonesC. A. (2008). Exploring organizational context and structure as predictors of medication errors and patient falls. Journal of Patient Safety, 4, 66-77.
26.
*MerrillK. C. (2011). The relationship among nurse manager leadership style, span of control, staff nurse practice environment, safety climate, and nurse-sensitive patient outcomes (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 884793003)
27.
MorelloR. T.LowthianJ. A.BarkerA. L.McGinnesR.DuntD.BrandC. (2013). Strategies for improving patient safety culture in hospitals: A systematic review. BMJ Quality & Safety, 22, 11-18. doi:10.1136/bmjqs-2011-000582
NobleD. J.PronovostP. J. (2010). Underreporting of patient safety incidents reduces health care's ability to quantify and accurately measure harm reduction. Journal of Patient Safety, 6, 247-250. doi:10.1097/PTS.0b013e3181fd1697
30.
O’BrienR. L. (2009). Keeping patients safe: The relationship between patient safety climate and patient outcomes (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3378501)
31.
PronovostP.GoeschelC. A.MarstellerJ. A.SextonJ. B.PhamJ. C.BerenholtzS. M. (2009). Framework for patient safety research and improvement. Circulation, 119, 330-337. doi:10.1161/CIRCULATIONAHA.107.729848
32.
*RivardP. E. (2006). Change agency and a culture of patient safety at Veterans Administration hospitals (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3238836)
33.
RivardP. E.RosenA. K.CarrollJ. S. (2006). Enhancing patient safety through organizational learning: Are patient safety indicators a step in the right direction?Health Services Research, 41, 1633-1653. doi:10.1111/j.1475-6773.2006.00569.x
34.
RomanoP. S.MullH. J.RivardP. E.ZhaoS.HendersonW. G.LovelandS.RosenA. K. (2009). Validity of selected AHRQ patient safety indicators based on VA national surgical quality improvement program data. Health Services Research, 44, 182-204. doi:10.1111/j.1475-6773.2008.00905.x
35.
ScottT.MannionR.DaviesH.MarshallM. (2003). The quantitative measurement of organizational culture in health care: A review of the available instruments. Health Services Research, 38, 923-945. doi:10.1111/1475-6773.00154
36.
SextonB. J. (2002). A matter of life or death: Social psychological and organizational factors related to patient outcomes in the intensive care unit (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3085063)
37.
*SingerS. J. (2007). Safety climate in United States hospitals: Its measurement, variation, and relationship to organizational safety performance (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3265094)
38.
SingerS.LinS.FalwellA.GabaD.BakerL. (2009). Relationship of safety climate and safety performance in hospitals. Health Services Research, 44, 399-421. doi:10.1111/j.1475-6773.2008.00918.x
39.
SinglaA. K.KitchB. T.WeissmanJ. S.CampbellE. G. (2006). Assessing patient safety culture: A review and synthesis of the measurement tools. Journal of Patient Safety, 2, 105-115.
40.
*TaylorJ. A. (2008). Utility of patient safety case finding methods and associations among organizational safety climate, nurse injuries, and errors (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses database. (UMI No. 3288543)
41.
TwiggD.DuffieldC.BremnerA.RapleyP.FinnJ. (2012). Impact of skill mix variations on patient outcomes following implementation of nursing hours per patient day staffing: A retrospective study. Journal of Advanced Nursing, 68, 2710-2718. doi:10.1111/j.1365-2648.2012.05971.x
42.
*VogusT. J.SutcliffeK. M. (2007a). The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Medical Care, 45, 997-1002. doi:10.1097/MLR.0b013e318053674f
43.
VogusT. J.SutcliffeK. M. (2007b). The safety organizing scale: Development and validation of a behavioral measure of safety culture in hospital nursing units. Medical Care, 45, 46-54.
44.
WeickK. E.SutcliffeK. M. (2007). Managing the unexpected: Resilient performance in an age of uncertainty (2nd ed.). San Francisco, CA: Jossey-Bass.
45.
WilsonR. M.MichelP.OlsenS.GibberdR. W.VincentC.El-AssadyR.LarizgoitiaI. (2012). Patient safety in developing countries: Retrospective estimation of scale and nature of harm to patients in hospital. British Medical Journal, 344, e832. doi:10.1136/bmj.e832
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
