Physicians’ Perception of Patient Safety Culture: Physician Determinants

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Primary Author:</td>
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Geoffroy Fauchet, MD/MPH Candidate  </td>
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Co-Principal Investigators/Collaborators:</td>
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Patrick Kneeland, MD, Matthew Mulvahill, MS, Heidi Wald, MD, MPH</td>
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Organization:</td>
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University of Colorado at Anschutz</td>
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Abstract</h2>
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Purpose</h3>
<p>To identify determinants of individual physicians’ overall perceptions of patient safety culture as measured by the Agency for Healthcare Research and Quality’s (AHRQ) Hospital Survey on Patient Safety Culture (HSPOSC) in order to improve the effectiveness of safety culture interventions.</p>
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Background</h3>
<p align="left">Evidence has linked poor hospital safety culture with negative patient outcomes. As a result, safety culture measurement has become a focal point of improvement efforts and has become regularly monitored in US hospitals. However, physicians’ perception of safety culture is poorly understood because physicians are often under-represented in safety culture surveys.</p>
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Materials & Methods</h3>
<p>A cross-sectional study was performed using the 2012 AHRQ HSOPSC database from January 2008 to June 2011. This amounted to 10,756 respondents from 512 unique hospitals. Predictors were physician specialty, staff position, years worked in current hospital work area/unit and the HSOPSC domains at the unit level. The primary outcome was the average percent positive responses for the overall perceptions of patient safety outcome domain. Linear mixed models were used to assess the relationship between the predictor variables and the primary outcome adjusted for confounding variables.</p>
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Results</h3>
<p>Intensivists had the highest perception of patient safety with 66% positive responses (95%CI: 61.12, 70.13) while emergency medicine specialists had the lowest perceptions of patient safety with 52% positive responses (95%CI: 48.62, 55.97). Resident physicians were not significantly different from attending physicians (p=0.8834). The shortest and longest times worked in the current unit were associated with the highest perception of patient safety and a quadratic trend was significant (p<0.0001). At the unit-level, attending physicians’ percent positive responses in the organizational (p<0.0001), communication (p<0.0001), staffing (p<0.0001), hospital management (p<0.0001), teamwork across units (p=0.0035), and hospital handoffs dimensions (p<0.0001) were significantly associated to the overall perceptions of patient safety domain.</p>
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Conclusion</h3>
<p>These findings suggest that safety culture improvement efforts for physicians need to be tailored based on physician specialty and career stage and focus on significant HSOPSC domains.</p>
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Bibliography</h3>
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Hudson, D., Berenholtz, S., Thomas, E., & Sexton, B. (2009, October). A Safety Culture Primer for the Critical Care Clinician. Contemporary Critical Care, 7(5), 1-12.</li>
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Institute of Medicine. (2000). To Err Is Human: Building A Safer Health System. Washington DC: National Academy Press.</li>
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Nieva, V. F., & Sorra, J. (2003). Safety culture assessment: a tool for improving patient safety in healthcare organizations. BMJ Quality and Safety in Healthcare, 12, ii17–ii23.</li>
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The Health Foundation. (2011). Research scan: Does improving safety culture affect patient outcomes? 25. London: The Health Foundation.</li>
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The Joint Commission. (2012). Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. Oakbrook: The Joint Commission.</li>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>