NURS 6223 Week 10 Safety Culture Analysis Example

Safety Culture Analysis: Two Units, Nearly Identical Survey Scores, Very Different Reporting

Student Name

College of Nursing, Walden University

NURS 6223: Healthcare Quality Assurance and Risk Management in Healthcare Organizations

Instructor Name

Month Day, Year

Safety Culture Analysis: Two Units, Nearly Identical Survey Scores, Very Different Reporting

Survey Results

Two adult medical units at a composite teaching hospital completed the AHRQ Hospital Survey on Patient Safety Culture in the same cycle. The survey measures staff perceptions across a set of culture dimensions, and its items and composites have shown acceptable psychometric properties at the individual, unit and hospital levels in a large multihospital analysis (Sorra & Dyer, 2010). On the three dimensions most relevant to reporting, response to error, communication openness and reporting of patient safety events, the two units' positive response rates differed by only a few percentage points, well within what normal variation between units would produce. Taken alone, the survey would suggest the two units share a similar culture.

Reporting Data

The reporting systems tell a different story. Unit A files reports often, and most are near misses and good catches: a wrong-patient label caught before a specimen left the unit, a heparin bag hung at the wrong concentration and stopped before starting. Most are filed within the same shift, by nurses, technicians and pharmacists alike. Unit B files seldom. Most of its reports describe events that caused harm, for example an injurious fall or a stage 3 pressure wound, and many are filed days after the event, sometimes only after a family complaint or a chart review brought them to light. Near misses almost never appear.

Interpretation

The reporting pattern is better evidence of culture than the survey, because it records what staff do rather than what they say. A high volume of near-miss reports filed promptly indicates that staff see reporting as useful and safe, that they notice problems before harm occurs, and that they trust something good will come of telling. A low volume dominated by harm events, filed late, indicates the opposite: staff report when they must, because the harm is visible or someone else will report it, and otherwise stay quiet. National data support reading reporting this way; across acute hospitals in England, higher reporting rates correlated with more positive safety culture data from staff surveys and with better risk-management ratings, and high-reporting hospitals had a smaller share of reports in the falls category, suggesting they captured a wider range of events (Hutchinson et al., 2009).

What the survey missed on Unit B is how reports are handled. Staff interviews, described below, revealed that the Unit B manager reviews report outcomes at staff meetings and names the individuals involved, intending accountability. Staff experience it as public blame. Blame is a well-documented barrier to reporting, although not the only one; qualitative work with physicians also found that reporting was discouraged when errors seemed inevitable and reporting pointless (Waring, 2005). On Unit B, both conditions appear to hold.

A Third Source

Brief interviews with six staff on each unit, conducted by a patient safety specialist from outside nursing and kept anonymous, served as a check. Unit A staff described reports leading to visible changes, such as relabeling look-alike bags. Unit B staff described the staff meeting practice and said they report only what cannot be kept off the record. The interviews were small and cannot stand alone, but they explain the reporting data in a way the survey scores could not.

Recommendations

1. Feedback to reporters: every reporter on both units receives a short note within two weeks describing what was learned or changed as a result of the report.

2. An anonymous reporting option on Unit B, promoted by the unit's staff champions, for a period of six months.

3. A change in the Unit B manager's visible response to reports: case reviews at staff meetings will discuss events and system fixes without naming individuals, and the manager will thank reporters publicly for near-miss reports. The director will coach the manager on this change.

4. Monitoring: the ratio of near-miss to harm reports and the median time from event to report on each unit, tracked monthly, as the main indicators of change, with the next survey cycle as a secondary check.

References

Hutchinson, A., Young, T. A., Cooper, K. L., McIntosh, A., Karnon, J. D., Scobie, S., & Thomson, R. G. (2009). Trends in healthcare incident reporting and relationship to safety and quality data in acute hospitals: Results from the National Reporting and Learning System. Quality and Safety in Health Care, 18(1), 5-10. https://doi.org/10.1136/qshc.2007.022400

Sorra, J. S., & Dyer, N. (2010). Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Services Research, 10, Article 199. https://doi.org/10.1186/1472-6963-10-199

Waring, J. J. (2005). Beyond blame: Cultural barriers to medical incident reporting. Social Science & Medicine, 60(9), 1927-1935. https://doi.org/10.1016/j.socscimed.2004.08.055