Developing a safety culture : the unintended consequence of a 'one size fits all' policy
- Publication Type:
- Thesis
- Issue Date:
- 2009
Open Access
Copyright Clearance Process
- Recently Added
- In Progress
- Open Access
This item is open access.
Developing a safety culture: The unintended consequence of a ‘one size fits all’ policy.
Background
Adverse events in maternity care are relatively common but often avoidable. Evidence suggests
it is necessary to understand the safety culture of an organisation to make improvements to
patient safety. The safety domains that are thought to influence safety culture in health care
include: Safety Climate; Teamwork; Working Conditions; Perceptions of Management; Job
Satisfaction; and Stress Recognition. Little is known about the safety culture in the Australian
maternity setting, which was the impetus for this Study. This thesis reports an examination of
the safety culture in a maternity service in New South Wales (NSW).
Setting
The Study took place in one maternity service located in two public hospitals in NSW,
Australia. Concurrently, both hospitals were undergoing an organisational restructure.
Design
This mixed method research study used a concurrent triangulation design and included two
Studies. The Policy Study explored the policy context in which the maternity service was
situated; and, the Service Study examined the safety culture within the maternity service.
Data collection included:
• A policy audit and chronological mapping of the key policies influencing safety culture
within the maternity service.
• Safety culture surveys, the Safety Attitudes Questionnaire and Safety Climate Scale
(59/210, 28% response rate) that measured the following six safety culture domains;
Safety climate; Teamwork climate; Job Satisfaction; Perceptions of management; Stress
recognition and Working conditions (Sexton et al., 2004).
• Semi-structured interviews (15) with key maternity, clinical governance and policy
stakeholders.
Results
The safety culture was found to be lacking across all six safety domains. The key finding was
that the overarching policy context created unintended consequences for the maternity service
and adversely influenced their capacity to have a positive safety culture. These unintended
consequences reduced their available infrastructure and capacity to respond to adverse events;
and created a lack of leadership at all levels to drive the safety and quality agenda. The safety
culture was also influenced by inadequate communication during the escalation of care;
inadequate supervision of junior medical staff; difficulty ensuring the right staffing and skill
mix, and low staff morale.
Conclusion
The safety culture in this maternity setting was complex, context-specific but importantly,
influenced by the broader policy context in which it was situated. This Study provides evidence
that the policy context needs to be included as a seventh safety culture domain in health care.
This Study has demonstrated the importance of policy on the capacity to ensure patient safety.
Implications
The policy context has not been previously identified as being important when addressing the
safety culture in health care. Considering the influence of the policy context in relation to safety
culture is an important step to develop strategies to improve patient safety in other settings. This
is an area for future research.
Please use this identifier to cite or link to this item: