Quality and strength of patient safety climate on medical-surgical units

Health Care Manage Rev. 2009 Jan-Mar;34(1):19-28. doi: 10.1097/01.HMR.0000342976.07179.3a.


Background: Describing the safety climate in hospitals is an important first step in creating work environments where safety is a priority. Yet, little is known about the patient safety climate on medical-surgical units.

Purposes: Study purposes were to describe quality and strength of the patient safety climate on medical-surgical units and explore hospital and unit characteristics associated with this climate.

Methodology: Data came from a larger organizational study to investigate hospital and unit characteristics associated with organizational, nurse, and patient outcomes. The sample for this study was 3,689 RNs on 286 medical-surgical units in 146 hospitals.

Findings: Nursing workgroup and managerial commitment to safety were the two most strongly positive attributes of the patient safety climate. However, issues surrounding the balance between job duties and safety compliance and nurses' reluctance to reveal errors continue to be problematic. Nurses in Magnet hospitals were more likely to communicate about errors and participate in error-related problem solving. Nurses on smaller units and units with lower work complexity reported greater safety compliance and were more likely to communicate about and reveal errors. Nurses on smaller units also reported greater commitment to patient safety and participation in error-related problem solving.

Practice implications: Nursing workgroup commitment to safety is a valuable resource that can be leveraged to promote a sense of personal responsibility for and shared ownership of patient safety. Managers can capitalize on this commitment by promoting a work environment in which control over nursing practice and active participation in unit decisions are encouraged and by developing channels of communication that increase staff nurse involvement in identifying patient safety issues, prioritizing unit-level safety goals, and resolving day-to-day operational problems the have the potential to jeopardize patient safety.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Attitude of Health Personnel*
  • Benchmarking
  • Catchment Area, Health
  • Communication
  • Decision Making, Organizational
  • Health Care Surveys
  • Hospital Administrators / psychology*
  • Hospital Units / organization & administration
  • Hospital Units / standards*
  • Hospitals, Teaching / standards
  • Humans
  • Interprofessional Relations*
  • Medical Errors / prevention & control
  • Nursing Service, Hospital / organization & administration
  • Nursing Service, Hospital / standards*
  • Nursing Staff, Hospital / psychology*
  • Organizational Culture
  • Patient Care Team / standards*
  • Problem Solving
  • Safety Management / standards*
  • Social Responsibility
  • United States
  • Workplace / standards