Lessons learned from measuring safety culture: An Australian case study

Publication Type:
Journal Article
Midwifery, 2010, 26 (5), pp. 497 - 503
Issue Date:
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Background: adverse events in maternity care are relatively common but often avoidable. International patient safety strategies advocate measuring safety culture as a strategy to improve patient safety. Evidence suggests it is necessary to fully understand the safety culture of an organisation to make improvements to patient safety. Aim: this paper reports a case study examining the safety culture in one maternity service in Australia and considers the benefits of using surveys and interviews to understand safety culture as an approach to identify possible strategies to improve patient safety in this setting. Setting: the study took place in one maternity service in two public hospitals in NSW, Australia. Concurrently, both hospitals were undergoing an organisational restructure which was part of a major health reform agenda. The priorities of the reform included improving the quality of care and patient safety; and, creating a more efficient health system by reducing administration inefficiencies and duplication. Design: a descriptive case study using three approaches: • Safety Attitudes Questionnaire and Safety Climate Scale surveys administered to maternity health professionals (59/210, 28% response rate) measured six safety culture domains: Safety climate, Teamwork climate, Job satisfaction, Perceptions of management, Stress recognition and Working conditions. • Semi-structured interviews (15) with key maternity, clinical governance and policy stakeholders augmented the survey data and explored the complex issues associated with safety culture. • A policy audit and chronological mapping of the key policies influencing safety culture identified through the surveys and interviews within the maternity service. Findings: the safety culture was identified to warrant improvement across all six safety culture domains. There was reduced infrastructure and capacity to support incident management activities required to improve safety, which was influenced by instability from the organisational restructure. There was a perceived lack of leadership at all levels to drive safety and quality and improving the safety culture was neither a key priority nor was it valued by the organisation. Conclusion: the safety culture was complex as was undertaking this study. We were unable to achieve a desired 60% response rate highlighting the limitations of using safety culture surveys in isolation as a strategy to improve safety culture. Qualitative interviews provided greater insight into the factors influencing the safety culture. The findings of this study provide evidence of the benefits of including qualitative methods with quantitative surveys when examining safety culture. Undertaking research in this way requires local engagement, commitment and capacity from the study site. The absence of these factors is likely to limit the practicality of this approach in the clinical setting. Significance: the use of safety culture surveys as the only method of assessing safety culture is of limited value in identifying strategies to potentially improve the safety culture. © 2010 Elsevier Ltd.
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