Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions

J Am Coll Surg. 2007 Dec;205(6):778-84. doi: 10.1016/j.jamcollsurg.2007.07.039. Epub 2007 Oct 18.


Background: Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality.

Study design: Surveys were administered to staff on general/vascular surgery services during a year. Surveys included multiitem scales measuring OCSFs. Additionally, perceived levels of communication and collaboration with coworkers were assessed. The National Surgical Quality Improvement Program was used to assess risk-adjusted morbidity and mortality. Correlations between outcomes and OCSFs were calculated and between outcomes and communication/collaboration with attending and resident doctors, nurses, and other providers.

Results: Fifty-two sites participated in the survey: 44 Veterans Affairs and 8 academic medical centers. A total of 6,083 surveys were returned, for a response rate of 52%. The OCSF measures of teamwork climate, safety climate, working conditions, recognition of stress effects, job satisfaction, and burnout demonstrated internal validity but did not correlate with risk-adjusted outcomes. Reported levels of communication/collaboration with attending and resident doctors correlated with risk-adjusted morbidity.

Conclusions: Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity. This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.

Publication types

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

MeSH terms

  • Academic Medical Centers / organization & administration
  • Academic Medical Centers / standards
  • Academic Medical Centers / statistics & numerical data
  • Burnout, Professional / epidemiology
  • Communication
  • Cooperative Behavior
  • General Surgery / organization & administration*
  • General Surgery / standards
  • Health Care Surveys
  • Hospital Mortality
  • Hospitals, Teaching / organization & administration*
  • Hospitals, Teaching / standards
  • Hospitals, Veterans / organization & administration
  • Hospitals, Veterans / standards
  • Hospitals, Veterans / statistics & numerical data
  • Humans
  • Interprofessional Relations*
  • Job Satisfaction
  • Organizational Culture
  • Outcome and Process Assessment, Health Care*
  • Patient Care Team / organization & administration*
  • Postoperative Complications / epidemiology*
  • Quality Indicators, Health Care*
  • Risk Adjustment*
  • Safety Management / organization & administration*
  • Surgical Procedures, Operative / mortality*
  • Surveys and Questionnaires
  • United States / epidemiology