Strong safety cultures show better patient outcomes in hospitals

When hospital senior management supports the creation and maintenance of a strong safety culture, patient outcomes improve, staff productivity increases and there is less clinical employee turnover, according to research reported in the Journal for Healthcare Quality, the peer-reviewed publication of the National Association for Healthcare Quality (NAHQ).

For the study, lead author Diane Storer Brown, PhD RN FNAHQ FAAN, senior scientist, Collaborative Alliance for Nursing Outcomes and strategic leader, hospital accreditation programs, Kaiser Permanente Northern California, and colleagues examined nine California hospitals to explore linkages between staff perceptions of safety culture and ongoing measures of hospital nursing unit performance, such as structures, processes and adverse patient outcomes. Thirty-seven nursing units in the nine hospitals were analysed. Safety culture perceptions were measured six months prior to data collection on nursing-unit performance and the statistical relationships were determined with correlation and regression analyses.

For this study, Brown explored the relationship between safety culture and adverse patient outcomes of care as represented by reported falls, falls with injury and hospital acquired pressure ulcers (HAPU) of stage 2 or greater. Results from the research showed:

• Teamwork within units was inversely or negatively correlated with reported falls. So when teamwork was stronger fewer falls were reported and when teamwork was weaker more falls were reported. The regression analysis showed that 20% the variance in reported falls was related to safety culture.
• Skill mix, staff turnover and workload intensity all demonstrated robust correlations with safety culture. But the most correlations across all domains were identified with workload intensity. Nursing units with higher workload intensity had higher safety culture perceptions.

“A strong safety culture allows nurses and other staff to function at a high level of productivity because of strong teamwork and management support and an environment that supports organisational learning, which allows staff to deal with time-intense patient-care activities,” said Brown. “When senior leaders prioritise and emphasise a safety culture, the structure and process of care are carried out in a way that patient outcomes may be improved.”