1 Safety Culture/Safety Climate and the Impact on Employee Safety in the Health Care Environment Robyn R.M. Gershon, MT, MHS, DrPH Mailman School of Public Health Columbia University Funding provided by CDC/NIOSH

2 Co-Authors Patricia W. Stone, M.P.H., Ph.D, RNPatricia W. Stone, M.P.H., Ph.D, RN David M. DeJoy, Ph.DDavid M. DeJoy, Ph.D

3 Presentation Outline IntroductionIntroduction –What is safety culture/safety climate? –How are they measured? –Why are these concepts important in healthcare? Research FindingsResearch Findings –Data supporting the significance of safety culture Practical Implications for ImprovementPractical Implications for Improvement

4 Introduction Safety Culture/Safety Climate Definitions OrganizationalCulture Ethical Culture Culture of Diversity Research Culture Safety Culture Patients Staff Visitors Racial Gender Religion Sexual Orientation Applied Basic

5 Introduction How is Culture Formed? Organizational values Organizational Attributes Organizational Culture Exogenous Factors Leadership Vision Goals Objectives Styles Staff Values Perceptions Behaviors Market Factors Type of Service Offered Clientele Variables

6 Introduction How is Culture Measured? Ethnographic InterviewsEthnographic Interviews In-depth InterviewsIn-depth Interviews Focus GroupsFocus Groups Document ReviewsDocument Reviews Site Surveys, Walk-throughsSite Surveys, Walk-throughs Indirectly-by measuring climateIndirectly-by measuring climate

7 Introduction What is Climate? “The personality of an organization”“The personality of an organization” The prevailing norms, feelings, attitudes and perceptions of employees about a workplaceThe prevailing norms, feelings, attitudes and perceptions of employees about a workplace “the psychological atmosphere of an organization”“the psychological atmosphere of an organization”

8 Introduction Organizational Climate Subconstructs Perceptions of ……Perceptions of …… –Leadership Styles –Group behaviors & relationships –Communication channels –Quality of worklife variables

9 Introduction How is Climate Measured? Qualitative Research Quantitative Research In-depth Interviews Focus Groups Observations Surveys Outcomes Research

10 Introduction How do Culture & Climate Relate to each other? Organizational Culture Organizational Climate

11 Introduction Why is Culture/Climate so important? Organizational Culture Values Attributes Organizational Climate Employees Perceptions Organizational Outcomes Patient Outcomes Worker Outcomes Productivity Outcomes

12 Influence of Safety Climate

13 Research What Predicts Bloodborne Pathogen Safety Climate?

14 Research in Safety Climate: Bloodborne Pathogens SubconstructsSubconstructs –Availability of PPE/Engineering Controls –Management Support for BBP safety –Absence of Job hindrances –Feedback & Training –Cleanliness, Orderliness –Communication/Group Conflict

15 Research MethodsMethods Sample 789 Hospital HCWs (60% Response) –Mailed Questionnaire

16 Research Results DemographicsDemographics –75% female –75% RNs –Mean age 37 –8-year Tenure

17 Research Results Management Support O.R. = 2.3 Safe Work Practices Cleanliness & orderliness O.R. = 3.3 Cleanliness & Orderliness O.R. = O.5 Exposure Feedback/training O.R = O.5

18 Research Results Safety Climate only accounts for about 25% of these Other causes are: Safe Work Practices Conflict of interest variablesConflict of interest variables Risk-taking personalityRisk-taking personality Risk-perceptionRisk-perception Influence of co-workersInfluence of co-workers Maladaptive fear responseMaladaptive fear response Exposure Procedure variables Patient variables Availability of engineering controls Safe work practices

19 Practical Implications To Target Safety ClimateTo Target Safety Climate –Change the culture oPower in #’s oPower in power oPower in outcomes data To Target Other Risk FactorsTo Target Other Risk Factors oTraining & Education managers & staff oPeer Support oOpinion leader support oAccountability – managers & staff oEngineer out risk to fullest extent

20 Conclusions & Recommendations Measure safety climateMeasure safety climate Measure outcomesMeasure outcomes Evaluate Interventions (pre/post tests)Evaluate Interventions (pre/post tests) Target “culture” – start at “micro- culture” level if necessary (i.e., at the Department Level)Target “culture” – start at “micro- culture” level if necessary (i.e., at the Department Level)