Medical errors are common and interventions to address vulnerabilities may fail due to a weak organizational safety culture. To transform hospitals and develop a culture of safety and high reliability, an assessment of the perceptions of healthcare professionals to promote organizational learning needs to be done. Though hospitalists and nurses may have different attitudes and views of the hospital culture as it relates to patient safety, little research has examined these differences.
We conducted a cross sectional survey using the AHRQ Hospital Survey on Patient Safety Culture to examine the differences in the perceptions of patient safety culture among registered nurses in a non‐teaching medicine unit and the hospitalists at our institution. The survey consisted of 12 dimensions of safety culture. Responses to questions were recorded on a five‐point Likert response scale. We compared percent positive responses (defined as “Agree” or “Strongly Agree” for agreement or as “Usually” or “Always” for frequency questions) between nurses and hospitalists. Fischer’s Exact test was used to compare proportions.
Thirty nurses (64%) and 17 hospitalists (36%) completed the survey, for a response rate of 96%. For the dimension of non‐punative response to error, nurses were more likely to feel that their mistakes are held against them (64% vs 25%, p< 0.05) and that the person is being written up rather the problem when an event is reported (55% vs 13%, p<0.01). For communication openness, nurses felt less free to question those with more authority (71 % vs 21%, <0.01). Nurses were less likely to be given feedback about changes implemented based on event reports compared to physicians (36% vs 71%, p < 0.05). For the subscale of frequency of event reporting, only 6% of hospitalists submitted more than 2 adverse event reports in the past 12 months compared to 50% of nurses (p<0.01). Mistakes that are caught and corrected were also less likely to be reported by physicians (76% vs 23%, p < 0.01). A similar proportion of hospitalists and nurses reported a problem with exchange of information across hospital units (71% and 63% respectively, p =NS) and that things fall between the cracks when transferring patients from one unit to another (59% and 55 % respectively, p =NS). Both groups gave an overall hospital safety grade in the range of “acceptable” to “very good.”
Perception of patient safety and event reporting behaviors significantly differed between hospitalist and nurses. Nurse responses indicate that there is greater concern over lack of open communication and increased fear of retribution compared to hospitalists. Despite the decreased concern over punative action for reporting safety concerns, hospitalists were less likely to report adverse events and near‐misses compared to nurses. These findings suggest different strategies are needed to promote an environment where nurses and hospitalists identify and report patient safety concerns.
To cite this abstract:Reyna M, Benson A, Brown N, Osio T, Hunt C, Dunn A. Perceptions of Patient Safety Culture Among Hospitalists and Nurses in a Medicine Unit. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 85. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/perceptions-of-patient-safety-culture-among-hospitalists-and-nurses-in-a-medicine-unit/. Accessed March 28, 2020.