The article by Singer et al. focuses on the exploration of an organization-wide survey related to patient safety culture. First, the authors identify the problem statement, which is expressed in terms of a need for increased attention on the part of hospital staff toward patient safety. The relevance of the chosen topic lies in the fact that not only physicians, but also senior executives as well as other personnel, were taken into account.
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Two paramount objectives were established: to evaluate attitudes toward the patient safety provision, and to specify the level of safety culture in different hospitals. The principal goal of the research was to determine whether or not the hospital corresponds to the notion of High Reliability Organizations (HROs).
The research was based on 15 California hospitals and 6,312 employees. The age of respondents varied between 40 and 60. In order to conduct a survey, scholars created a list of closed-ended questions that covered 16 topics. Respondents were free to respond either by mail or the Internet. With regard to the survey instrument, it is essential to point out the Pharmaceutical Supply Chain Initiative (PSCI) tool, namely, safety orientation in medical facilities, a management attitudes questionnaire, a naval command assessment tool, an anesthesia work environment survey, and a risk management questionnaire.
The raw data was exposed to sample weighting and non-responsive weighting, applied multiplicatively in order to compare hospitals. Analysis of the data focused on the accurate interpretation of the respondents’ answers. In particular, problematic responses were given greater attention. In structuring the research, Singer et al. identified the five prevalent factors affecting the responses: organization, production, reporting / seeking help, department, and shame / self-awareness (114). By utilizing multivariate regressions, along with disjunctive non-response weighted data, the authors met the first objective specified earlier.
The results of the research were represented in a table format according to the above-mentioned factors to promote visibility of information. It is significant to note that data collected was analyzed from different perspectives. From the demographic point, there were more women respondents, yet sex varied with job position. At that, their response rate constituted 47 (4 percent, or 62 percent excluding physicians).
In the context of safety culture and related attitudes, problematic responses were higher for those that were hypothesized, and lower for personal ones. At the same time, a number of respondents expressed their fear of making a mistake, as well as the lack of compensation. About 52 percent reported that the quality of patient safety had decreased, due to a shortage of qualified personnel. The total problematic responses constituted 18 percent.
The scholars detected a considerable variation between hospitals, from 13 to 22 percent. Variation between hospitals’ personnel attitudes, namely, between job positions, also differed. The clinicians and front-line employees turned out to be more likely to express problematic responses than non-clinicians and senior managers. Nurses were the most pessimistic participants (25 questions out of 30). In general, the majority of the respondents indicated an appropriate culture of safety. Although unsafe incidents were also detected, their percentage remained small.
Based on analyzed data, Singer et al. provided readers with an accurate discussion (117). In particular, they emphasized that safety culture indicators varied, depending on job class, sex, and hospitals. Although hospitals demonstrated different levels of responsiveness, the attitude to the core indicators was clearly revealed. Limitations to the research were stated, in order to make the results more objective and non-biased.
Precisely speaking, physicians comprised the group of least responsive participants. However, the overall subject response rate of this research seemed to be adequate, and sufficient to draw appropriate conclusions. It should be noted that the majority of hospitals were especially interested in enhancing their performance safety. With this in mind, it is possible to suggest that this survey reflects the best scenario. In addition, implications were related to discord detected between senior managers and non-clinicians.
This tendency might cause embellishing of the patients’ problems and inadequate communication. The authors claimed that in the case where further research should prove the above assumptions, it would be crucial to initiate elaborate strategies to eliminate current biases. With that said, attention should be paid both to short-term and long-term interventions.
Furthermore, the authors compare the key findings with previous research conducted by Sexton et al., concluding that a safe attitude, as well as experience, is an indispensable component of safety culture comprehension. Also, Ciavarelli and Roberts consider that a problematic response exceeding 10 percent is alarming. Therefore, the situation requires further research to identify the magnitude that would point to an unsafe culture in hospitals. Enlarging the geographical coverage of the study may achieve more comprehensive results.
That, in turn, will allow embracing more characteristics of medical staff and hospitals. The evaluation of interventions established to ensure safe culture might be beneficial, as well, within a longitudinal research study. As a result of potential research and subsequent in-depth analysis, it will be possible to suggest appropriate interventions to improve the current safety culture performance. It is also noted that one cannot avoid non-response biases. Therefore, it might be useful to follow up with a thorough survey of non-responders.
Singer, S. J., D. M. Gaba, J. J. Geppert, A. D. Sinaiko, S. K. Howard, and K. C. Park. “The Culture of Safety: Results of an Organization-Wide Survey in 15 California Hospitals.” Quality and Safety in Health Care 12.2 (2003): 112-18. Print.