L. R. Putnam1,5,6, Z. M. Alawadi2,5, R. Jain3,6, M. Matuszczak3,6, L. S. Kao2,5, J. M. Etchegaray4, E. J. Thomas4,5, K. P. Lally3,5,6, K. Tsao1,5,6 6Children’s Memorial Hermann Hospital,Houston, TX, USA 1University Of Texas Health Science Center At Houston,Department Of Pediatric Surgery,Houston, TX, USA 2University Of Texas Health Science Center At Houston,Department Of General Surgery,Houston, TX, USA 3University Of Texas Health Science Center At Houston,Department Of Pediatric Anesthesia,Houston, TX, USA 4University Of Texas Health Science Center At Houston,Department Of Internal Medicine,Houston, TX, USA 5Center For Surgical Trials And Evidence-based Practice,Houston, TX, USA
Introduction
A healthcare institution’s commitment to safety practices can be measured through its safety culture. In 2011, we identified and targeted four domains of our perioperative safety culture for implementation of a multifaceted safety program. We hypothesized that ongoing physician-led educational and team-building activities would continue to improve all domains of our perioperative safety culture in our children’s hospital.
Methods
Pediatric perioperative personnel involved in direct patient care (nurses, scrub techs, anesthesiologists, surgeons) were administered the psychometrically validated Safety Attitudes Questionnaire (SAQ) before and after each 18-month interventional period (baseline, phase 1, phase 2). The 26-question SAQ evaluated 4 domains: safety culture, teamwork, speaking up, and safety rounds. Interventions involved administrative reorganization focused on safety and physician-led educational safety workshops throughout the entire study period in response to baseline findings. Based on the ongoing deficiencies noted at phase 1, additional interventions were implemented that targeted leadership safety rounds and real-time variance reporting. Data are presented as the percent of respondents who slightly or strongly agreed; 80% agreement represents high safety culture. Chi-square analysis was performed.
Results
The SAQ was completed by 48 (39%), 97 (79%), and 63 (75%) pediatric perioperative personnel at baseline, phase 1, and phase 2, respectively. All four domains remain improved or sustained from baseline, but only safety rounds improved from phase 1 to phase 2 (Table). The greatest improvement was in safety rounds, which improved to 43% over the study period, yet it was still the lowest scoring domain. Teamwork remained the highest scoring domain throughout. None of the domains reached the 80% threshold for high safety culture.
Conclusion
Institutional safety culture, as measured by a validated tool, varies over time and is difficult to change despite ongoing, multifaceted strategies targeting specific areas for improvement. Repeated measurements and iterative changes are necessary to sustain and improve safety culture. However, multiple interventions and change cycles are likely needed to achieve the desired results.
