Measuring safety culture in healthcare: A case for accurate diagnosis

Safety Science 45 (2007) 653–667

Rhona Flin, Industrial Psychology Research Centre, University of Aberdeen, Scotland, United Kingdom

Speaker: Jenny2009/01/07

Outline

• Introduction

• Safety in healthcare

• Safety culture/climate in industry

• Measuring safety climate in healthcare

• Conclusion

Introduction

• Improve patient safety with safety management methods & organizational culture

• In medicine, the accuracy of diagnosis is critical.

Introduction

• How accurate are the diagnoses?

• Are the diagnostic tools used to measure safety culture reliable and valid?

• Any model to explain how safety culture influences workers’ behaviors?

Safety in healthcare

• Health worker safety– Minimising accidents to workers– Risk industry: Transportation, nuclear power, food – US: 321,400 nonfatal occupational injuries and

illness– 134,900 resulted in days away from work, job

transfer or restriction– Expensive for employees and healthcare systems– Design interventions to reduce health workers’

injuries and illness (Yassi and Hdancock, 2005)

Safety in healthcare

• Patient safety– retrospective case review– avoidable accident: human factors

&management (Andrews et al., 1997; Bernnan et al., 1991; Vincent et al., 2001) (Flin, 2003)

– Active failures and latent conditions– Heavy workloads, inadequate supervision, lack

of training, stressful environment, inadequate communication (West et al., 2006; Yassi and Hancock, 2005)

– Weak safety culture is a casual factor: Tragedies in UK hospitals (heart surgery in Bristol, Kennedy, 2001)

Safety culture/climate in industry

• Chernobyl disaster• Climate VS culture

– Climate: attitudes, values, and beliefs (surface manifestation of culture) (Schein, 1990)

– Culture: unconscious assumptions (Schein, 1990)

– Quantitative VS Qualitative (Dension, 1996)

• Safety climate: self-report questionnaires• Safety culture: monitor & influence safety

outcomes, benchmark organizational safety performance (Fleming, 2005; Nieva and Sorra, 2003)

Safety culture/climate in industry

• Dimensions of safety climate – Management/ leadership behavior– Safety system– Risk– Work pressure– Competence (knowledge, skills, training)– Procedures/ rules (Flin et al., 2000; Guldenmund, 2000; Zohar, 2003)

Safety culture/climate in industry

• Little research for cross sector/nation comparisons

• Validity of safety climate measures• 5 level: individual, work group, department,

organization, environment (Hofmann and Stetzer, 1996)

• Zohar(2003): group/organization level effects of management

• Safety outcome variables, used to validate safety climate scales, could decide to use which analysis level.

Safety culture/climate in industry

• Explanatory models of safety climate– knowledge, skills and motivation

behavior safety outcome (Griffin and Neal, 2000)

– Expectancy: safety perception & behavior (Zohar, 2003)

– Motivation: expectation to consequences (Vroom, 1964)

– Maximize reward, and reduce punishment

Safety culture/climate in industry

• Explanatory models of safety climate

•Speculative framework•Examine motivational component of behavior

Measuring safety climate in healthcare• Psychometric quality

• Safety climate dimensions: management commitment, supervisor commitment, safety system, and work pressure

• Predicting safety outcomes: self report, and standard precautions

(DeJoy et al., 1995; Felknor et al., 2000)

Conclusions

• Culture affects workers’ behavior

• Measuring safety climate could provide diagnostic data for managers to realize the culture.– Questionnaires– Changing behavior– Safety outcome measures