Lessons learned from measuring safety culture: An Australian case study

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dc.contributor.author Allen, S
dc.contributor.author Chiarella, M
dc.contributor.author Homer, CSE
dc.date.accessioned 2011-02-07T06:24:30Z
dc.date.issued 2010-10
dc.identifier.citation Midwifery, 2010, 26 (5), pp. 497 - 503
dc.identifier.issn 0266-6138
dc.identifier.other C1 en_US
dc.identifier.uri http://hdl.handle.net/10453/13760
dc.description.abstract 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.
dc.language eng
dc.relation.hasversion Accepted manuscript version
dc.relation.isbasedon 10.1016/j.midw.2010.07.002
dc.rights NOTICE: this is the author’s version of a work that was accepted for publication in Midwifery. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Midwifery, [Volume 26, Issue 5, October 2010, Pages 497–503] DOI# http://dx.doi.org/10.1016/j.midw.2010.07.002
dc.subject Maternity, Patient safety, Safety culture, Safety domains, Humans, Safety Management, Midwifery, Health Promotion, Maternal Health Services, Medical Errors, Obstetrics and Gynecology Department, Hospital, Hospitals, Public, New South Wales, Health Care Surveys, Pregnancy, Organizational Case Studies, Quality Assurance, Health Care, Nurse's Role, Female, Female, Health Care Surveys, Health Promotion, Hospitals, Public, Humans, Maternal Health Services, Medical Errors, Midwifery, New South Wales, Nurse's Role, Obstetrics and Gynecology Department, Hospital, Organizational Case Studies, Pregnancy, Quality Assurance, Health Care, Safety Management, Patient Safety, Health-Care, Climate, Nursing
dc.subject Maternity; Patient safety; Safety culture; Safety domains; Humans; Safety Management; Midwifery; Health Promotion; Maternal Health Services; Medical Errors; Obstetrics and Gynecology Department, Hospital; Hospitals, Public; New South Wales; Health Care Surveys; Pregnancy; Organizational Case Studies; Quality Assurance, Health Care; Nurse's Role; Female; Female; Health Care Surveys; Health Promotion; Hospitals, Public; Humans; Maternal Health Services; Medical Errors; Midwifery; New South Wales; Nurse's Role; Obstetrics and Gynecology Department, Hospital; Organizational Case Studies; Pregnancy; Quality Assurance, Health Care; Safety Management; Patient Safety; Health-Care; Climate; Nursing
dc.title Lessons learned from measuring safety culture: An Australian case study
dc.type Journal Article
dc.description.version Published
dc.parent Midwifery
dc.journal.volume 5
dc.journal.volume 26
dc.journal.number 5 en_US
dc.publocation Oxford en_US
dc.identifier.startpage 497 en_US
dc.identifier.endpage 503 en_US
dc.cauo.name FOH.Faculty of Health en_US
dc.conference Verified OK en_US
dc.conference IEEE/RSJ International Conference on Intelligent Robots and Systems
dc.for 1117 Public Health and Health Services
dc.personcode 996762 en_US
dc.personcode 0000064469 en_US
dc.personcode 995146 en_US
dc.percentage 100 en_US
dc.classification.name Public Health and Health Services en_US
dc.classification.type FOR-08 en_US
dc.edition en_US
dc.custom en_US
dc.date.activity en_US
dc.date.activity 2010-10-18
dc.location.activity ISI:000282156800005 en_US
dc.location.activity Taipei, TAIWAN
dc.description.keywords Patient Safety; Health-Care; Climate en_US
dc.description.keywords Science & Technology
dc.description.keywords Technology
dc.description.keywords Computer Science, Artificial Intelligence
dc.description.keywords Computer Science, Information Systems
dc.description.keywords Robotics
dc.description.keywords Computer Science
dc.description.keywords OPTIMAL PATHS
dc.description.keywords VEHICLES
dc.description.keywords CAR
dc.description.keywords Maternity
dc.description.keywords Patient safety
dc.description.keywords Safety culture
dc.description.keywords Safety domains
dc.description.keywords Maternity
dc.description.keywords Patient safety
dc.description.keywords Safety culture
dc.description.keywords Safety domains
dc.staffid en_US
dc.staffid 995146 en_US
pubs.embargo.period Not known
pubs.organisational-group /University of Technology Sydney
pubs.organisational-group /University of Technology Sydney/Faculty of Arts and Social Sciences
pubs.organisational-group /University of Technology Sydney/Faculty of Arts and Social Sciences/Communication & Learning Group
pubs.organisational-group /University of Technology Sydney/Faculty of Health
pubs.organisational-group /University of Technology Sydney/Strength - Health Services and Practice Research


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