NEW YORK (Reuters Health)—The “safety culture” of a hospital may be just as important in delivering high-quality surgical patient care as more technical issues like surgeon skill and operating room equipment, according to a new study.
“The study supports what many surgeons have known for a long time, and that is that the organizational culture matters,” Dr. Martin Makary, professor of surgery and health policy and management at Johns Hopkins University School of Medicine, Baltimore, says in a news release. “While we have traditionally only studied the incremental patient benefits of different medications and surgical interventions, it turns out that organizational culture has a big impact on patient outcomes.”
In particular, the study points to three characteristics of good safety culture that make a difference: an ability and willingness to learn from past mistakes; a high degree of interest in adopting best practices; and an ability to collaborate to benchmark performance.
Using the Hospital Survey on Patient Safety Culture, developed by the Agency for Healthcare Research and Quality, the researchers measured 12 different safety culture factors that could influence rates of surgical site infection (SSI) after colon surgery at seven Minnesota community hospitals, each with 168 beds on average (range 42–393). Hospital SSI rates after colon surgery ranged from 0% to 30%, with an average rate of 11.3%, and surgical unit safety culture scores ranged from 16 to 92 on a scale of zero to 100.
They calculated Pearson’s r and 95% confidence intervals (CI) for each of the scores of the 12 dimensions of safety culture versus the incidence of SSI after colectomy and found that 10 of the 12 factors made a difference: overall perceptions of patient safety; teamwork across units; organizational learning; feedback and communication about error; management support for patient safety; teamwork within units; communication openness; supervisor/manager expectations of actions promoting safety; non-punitive response to error; and frequency of events reported.
The two safety factors not associated with infection rates were handoffs and transitions and staffing.
“These data suggest an important role for positive safety and teamwork culture and engaged hospital management in producing high-quality surgical outcomes,” the authors conclude in their paper published online on Dec. 9 in the Journal of the American College of Surgeons.
One key shortcoming, they note, is limiting the study only to SSI. “There are hundreds of outcome variables that can be measured with a safety culture,” Dr. Makary says. He told Reuters Health by email that he plans to study the impact of safety culture on other outcome variables. He also says he believes that a hospital’s safety culture likely has a role in variation in outcomes and quality of care among hospitals.
“Variation in organizational culture may be an important factor in understanding the broader endemic issue of variation in medical quality,” he says.
The study had no commercial funding and the authors have no disclosures.