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Is Hospital Safety Culture Needed to Improve Patient Safety?

A new study shows that focusing on treatment techniques could be more effective than hospital safety culture in improving patient safety.

By Sara Heath

A focus on hospital safety culture may not be a conclusive indicator of lower rates of adverse patient outcomes and patient safety, shows a recent study published in BMJ Quality and Safety.

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A research team, spearheaded by Dr. Jennifer Meddings of the University of Michigan Medical School, sought to understand the link between hospital safety culture and the rate of adverse patient events. The team specifically looked at two catheter-associated infections – central-line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).

The research team consulted two studies conducted by the Agency for Healthcare Research and Quality (AHRQ), which funded initiatives seeking to reduce the rates of CLABSI and CAUTI using both technical aspects of care and improvements in hospital safety culture.

To understand how either hospital managed success in reducing CLABSI and CAUTI, Meddings and colleagues administered a Hospital Survey on Patient Safety Culture (HSOPS). These surveys, which were independent of the AHRQ study results, measured teamwork, communication, non-punitive response to error, staffing, and management support.

In comparing the results of the AHRQ studies and the results of the HSOPS surveys, Meddings was able to determine whether the hospital’s culture around patient safety had an effect on improving rates of catheter-associated infections.

Ultimately, the research team found that hospital safety culture did not have an effect on catheter-associated infections, showing that such initiatives to improve hospital culture may not be the key to improving quality care and patient safety.

Rather, the key may be implementing better technical standards for caring for patients requiring catheters, ensuring that the insertion, maintenance, and removal processes are done with technical excellence to reduce risk of infection.

“An important implication of this result is that it is possible to reduce CLABSI and CAUTI rates without improving safety culture, through improvements in technical components of care such as standardising procedures involving catheter insertion, maintenance and removal,” Meddings and colleagues reported.

These results are critical, particularly for hospitals with limited resources that may not be able to implement a facility-wide overhaul of their hospital safety culture. By doing several short training sessions with providers, hospitals can potentially make a dent in their rates of catheter-associated infections.

“This interpretation would prompt reconsideration and prioritisation of technical and safety culture components of interventions in future studies, particularly for hospitals or units with limited bandwidth to implement new interventions given competing priorities or limited resources,” the research team said.

However, these results may also indicate a different trend, Meddings and colleagues claimed. The tested hospitals may have seen reductions in catheter-associated infections as a result of improved hospital safety culture, and the HSOPS survey may potentially have been an inadequate measures of that safety culture.

“Another potential explanation of the findings is that safety culture did improve in these collaboratives and was instrumental for reducing CLABSI and CAUTI but the HSOPS tool did not adequately detect or assess important components of safety culture in the participating unit,” the team posited.

The HSOPS survey may not have approached measuring hospital safety culture adequately, or the hospital staff members completing the surveys may not have had enough knowledge regarding the hospital’s safety culture.

These results foremost show the need to revise hospital safety culture efforts, the research team concluded. Going forward, hospitals should reassess their measures of hospital safety culture via the HSOPS survey, as well as look into how they emphasize technical skill in maintaining patient safety.

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