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Perceptions of safety culture vary across the intensive care units of a single institution.
Crit Care Med. 2007 Jan; 35(1):165-76.CC

Abstract

OBJECTIVE

To determine whether safety culture factors varied across the intensive care units (ICUs) of a single hospital, between nurses and physicians, and to explore ICU nursing directors' perceptions of their personnel's attitudes.

DESIGN

Cross-sectional surveys using the Safety Attitudes Questionnaire-ICU version, a validated, aviation industry-based safety culture survey instrument. It assesses culture across six factors: teamwork climate, perceptions of management, safety climate, stress recognition, job satisfaction, and work environment.

SETTING

Four ICUs in one tertiary care hospital.

SUBJECTS

All ICU personnel.

MEASUREMENTS AND MAIN RESULTS

We conducted the survey from January 1 to April 1, 2003, and achieved a 70.2% response rate (318 of 453). We calculated safety culture factor mean and percent-positive scores (percentage of respondents with a mean score of > or =75 on a 0-100 scale for which 100 is best) for each ICU. We compared mean ICU scores by ANOVA and percent-positive scores by chi-square. Mean and percent-positive scores by job category were modeled using a generalized estimating equations approach and compared using Wald statistics. We asked ICU nursing directors to estimate their personnel's mean scores and generated ratios of their estimates to the actual scores.Overall, factor scores were low to moderate across all factors (range across ICUs: 43.4-74.9 mean scores, 8.6-69.4 percent positive). Mean and percent-positive scores differed significantly (p < .0083, Bonferroni correction) across ICUs, except for stress recognition, which was uniformly low. Compared with physicians, nurses had significantly lower mean working conditions and perceptions of management scores. ICU nursing directors tended to overestimate their personnel's attitudes. This was greatest for teamwork, for which all director estimates exceeded actual scores, with a mean overestimate of 16%.

CONCLUSIONS

Significant safety culture variation exists across ICUs of a single hospital. ICU nursing directors tend to overestimate their personnel's attitudes, particularly for teamwork. Culture assessments based on institutional level analysis or director opinion may be flawed.

Authors+Show Affiliations

CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17110876

Citation

Huang, David T., et al. "Perceptions of Safety Culture Vary Across the Intensive Care Units of a Single Institution." Critical Care Medicine, vol. 35, no. 1, 2007, pp. 165-76.
Huang DT, Clermont G, Sexton JB, et al. Perceptions of safety culture vary across the intensive care units of a single institution. Crit Care Med. 2007;35(1):165-76.
Huang, D. T., Clermont, G., Sexton, J. B., Karlo, C. A., Miller, R. G., Weissfeld, L. A., Rowan, K. M., & Angus, D. C. (2007). Perceptions of safety culture vary across the intensive care units of a single institution. Critical Care Medicine, 35(1), 165-76.
Huang DT, et al. Perceptions of Safety Culture Vary Across the Intensive Care Units of a Single Institution. Crit Care Med. 2007;35(1):165-76. PubMed PMID: 17110876.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perceptions of safety culture vary across the intensive care units of a single institution. AU - Huang,David T, AU - Clermont,Gilles, AU - Sexton,J Bryan, AU - Karlo,Crystal A, AU - Miller,Rachel G, AU - Weissfeld,Lisa A, AU - Rowan,Kathy M, AU - Angus,Derek C, PY - 2006/11/18/pubmed PY - 2007/1/20/medline PY - 2006/11/18/entrez SP - 165 EP - 76 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 1 N2 - OBJECTIVE: To determine whether safety culture factors varied across the intensive care units (ICUs) of a single hospital, between nurses and physicians, and to explore ICU nursing directors' perceptions of their personnel's attitudes. DESIGN: Cross-sectional surveys using the Safety Attitudes Questionnaire-ICU version, a validated, aviation industry-based safety culture survey instrument. It assesses culture across six factors: teamwork climate, perceptions of management, safety climate, stress recognition, job satisfaction, and work environment. SETTING: Four ICUs in one tertiary care hospital. SUBJECTS: All ICU personnel. MEASUREMENTS AND MAIN RESULTS: We conducted the survey from January 1 to April 1, 2003, and achieved a 70.2% response rate (318 of 453). We calculated safety culture factor mean and percent-positive scores (percentage of respondents with a mean score of > or =75 on a 0-100 scale for which 100 is best) for each ICU. We compared mean ICU scores by ANOVA and percent-positive scores by chi-square. Mean and percent-positive scores by job category were modeled using a generalized estimating equations approach and compared using Wald statistics. We asked ICU nursing directors to estimate their personnel's mean scores and generated ratios of their estimates to the actual scores.Overall, factor scores were low to moderate across all factors (range across ICUs: 43.4-74.9 mean scores, 8.6-69.4 percent positive). Mean and percent-positive scores differed significantly (p < .0083, Bonferroni correction) across ICUs, except for stress recognition, which was uniformly low. Compared with physicians, nurses had significantly lower mean working conditions and perceptions of management scores. ICU nursing directors tended to overestimate their personnel's attitudes. This was greatest for teamwork, for which all director estimates exceeded actual scores, with a mean overestimate of 16%. CONCLUSIONS: Significant safety culture variation exists across ICUs of a single hospital. ICU nursing directors tend to overestimate their personnel's attitudes, particularly for teamwork. Culture assessments based on institutional level analysis or director opinion may be flawed. SN - 0090-3493 UR - https://wwww.unboundmedicine.com/medline/citation/17110876/Perceptions_of_safety_culture_vary_across_the_intensive_care_units_of_a_single_institution_ L2 - https://dx.doi.org/10.1097/01.CCM.0000251505.76026.CF DB - PRIME DP - Unbound Medicine ER -