Comparing safety climate between two populations of hospitals in the United States

Health Serv Res. 2009 Oct;44(5 Pt 1):1563-83. doi: 10.1111/j.1475-6773.2009.00994.x. Epub 2009 Jul 3.


Objective: To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting.

Data sources: Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey of Hospitals.

Study design: Cross-sectional study of 69 U.S. and 30 VA hospitals.

Data collection: For each sample, hierarchical linear models used safety-climate scores as the dependent variable and respondent and facility characteristics as independent variables. Regression-based Oaxaca-Blinder decomposition examined differences in effects of model characteristics on safety climate between the U.S. and VA samples.

Principal findings: The range in safety climate among U.S. and VA hospitals overlapped substantially. Characteristics of individuals influenced safety climate consistently across settings. Working in southern and urban facilities corresponded with worse safety climate among VA employees and better safety climate in the U.S. sample. Decomposition results predicted 1.4 percentage points better safety climate in U.S. than in VA hospitals: -0.77 attributable to sample-characteristic differences and 2.2 due to differential effects of sample characteristics.

Conclusions: Results suggest that safety climate is linked more to efforts of individual hospitals than to participation in a nationally integrated system or measured characteristics of workers and facilities.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Health Services Research
  • Hospital Administration*
  • Humans
  • Middle Aged
  • Organizational Culture
  • Residence Characteristics
  • Safety Management / organization & administration*
  • United States
  • United States Department of Veterans Affairs / organization & administration*
  • Young Adult