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Background: The purpose of this study was to explore the variability in safety culture dimensions within and between Swiss and US clinical areas., Methods: Cross-sectional design. The 30-item Safety Attitudes Questionnaire (SAQ) was distributed in 2009 to clinicians involved in direct patient care in medical and surgical units of two Swiss and 10 US hospitals. At the unit level, results were calculated as the percentage of respondents within a unit who reported positive perceptions. MANOVA and ANOVA were used to test for differences between and within US and Swiss hospital units., Results: In total, 1370 clinicians from 54 hospital units responded (response rate 84%), including 1273 nurses and 97 physicians. In Swiss hospital units, three SAQ dimensions were lower (safety climate, p=0.024; stress recognition, p<0.001; and perceptions of management, p<0.001) compared with US hospital units. There was significant variability in four out of six SAQ dimensions (teamwork climate, safety climate, job satisfaction and perceptions of unit management) (p<0.001). Moreover, intraclass correlations indicate that these four dimensions vary more at the unit level than hospital level, whereas stress recognition and working conditions vary more at the hospital level., Conclusions: The authors found differences in SAQ dimensions at the country, hospital and unit levels. The general emphases placed on teamwork and safety climate in quality and safety efforts appear to be highlighting dimensions that vary more at the unit than hospital level. They suggest that patient safety improvement interventions target unit level changes, and they support the emphasis being placed on teamwork and safety climate, as these vary significantly at the unit level across countries.

Background: The Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient safety and clinical outcomes in adult ICUs through a unit-based patient safety program and evidenced-based practices. Few studies have shown how to draw on a strong safety culture to improve clinical outcomes. A study was conducted to (1) examine the impact of a Safety Attitudes Questionnaire Action Plan (SAQAP) on the 2008 Safety Attitudes Questionnaire (SAQ) and (2) determine the impact of an SAQAP on ICU central line-associated blood stream infections (CLABSIs) and ventilator-associated pneumonia (VAP) rates., Methods: The SAQ was administered at 23 ICUs in 11 hospitals in fall 2007 and 2008. Units were surveyed as to whether they completed an SAQAP on the basis of 2007 SAQ results. Annual rates of infection were submitted as unadjusted monthly CLABSI infections per 1,000 line days and VAP infections per 1,000 ventilator days for 2007 and 2008., Results: SAQAPs were completed on 9 (39%) of the 23 units. Units that developed SAQAPs demonstrated higher improvement rates in all domains of the SAQ except working conditions. Improvements were close to statistical significance for teamwork climate (+18.4% in SAQAP units versus -6.4%, p = .07) and job satisfaction (+25.9% increase in SAQAP units versus +7.3%, p = .07). Units with SAQAPs decreased the CLABSI rates by 10.2% in 2008 compared with 2007, while those without SAQAP had a 2.2% decrease in rates (p = .59). Similarly, VAP rates decreased by 15.2% in SAQAP units, while VAP rates increased by 4.8% in units without SAQAP (p = .39)., Conclusions: Teams that developed SAQAPs improved their unit culture and clinical outcomes. An active, targeted intervention in culture can translate into improved outcomes for patients.

Objective: To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds., Data Sources/study Setting: Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas., Study Design: Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas., Results: Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t=2.67, p=.03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t=2.06, p=.06). Main safety issues by category were equipment/facility (A [26 percent] and B [33 percent]) and communication (A [24 percent] and B [18 percent])., Conclusions: WalkRounds implementation requires significant organizational will; sustainability requires outstanding project management and leadership engagement. In the patient care areas that rigorously implemented WalkRounds, frontline caregiver assessments of patient safety increased. SAQ results such as safety climate scores facilitate the triage of quality improvement efforts, and provide consensus assessments of frontline caregivers that identify themes for improvement.

This tool can be used in any setting where physicians, nurses, and other disciplines work as a team to manage patients and admission-to-discharge flow.