Using a multihospital survey to examine the safety culture

Jt Comm J Qual Saf. 2004 Mar;30(3):125-32. doi: 10.1016/s1549-3741(04)30014-6.


Background: A culture of safety survey was used to study features of the safety culture and their relationship with patient safety indicators.

Study design: Anonymous written surveys were collected from 455 of 1,027 (44%) workers at four Massachusetts hospitals. Respondents characterized their organizations' patient safety, workplace safety, and features of a safety culture, such as leadership commitment, professional salience, presence of a nonpunitive environment, error reporting, and communication.

Results: Employees universally regarded patient safety as an essential part of their job. Two-thirds of workers worried at least once a day about making a mistake that could injure a patient; 43% said that the work load hindered their ability to keep patients safe. Workers' overall assessment of patient safety was associated with their perceptions of workplace safety (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.02-3.43, p = .044) and leadership commitment to patient safety (OR 3.20, 95% CI 1.97-5.19, p < .001). Incident reporting rates correlated with survey results, while adoption of best practices and expert opinion did not.

Discussion: Patient safety is salient to workers, who universally embraced patient safety as an essential part of their job. Independent indicators of patient safety did not line up neatly with safety culture survey results. Incident reporting rates correlated directly, while adoption of best practices and expert opinion varied inversely with survey results. The safety culture is a complex phenomenon that requires further study.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Academic Medical Centers
  • Attitude of Health Personnel*
  • Hospitals, Community
  • Humans
  • Leadership
  • Logistic Models
  • Massachusetts
  • Organizational Culture*
  • Safety Management*
  • Surveys and Questionnaires