2. Safety culture = shared beliefs and patterns of behaviour that determine how we work together to achieve quality care. Safety culture affects patient outcomes. Communication breakdown leads to compromise in the point of care, resulting in patient harm. (Maxfield, Grenny et al. 2005)Maxfield, Grenny et al. 2005 Safety culture is also important for its effects on provider experience. There is strong evidence for the connection between culture and items such as staff turnover and job satisfaction. (Huang, Clermont et al. 2007)Huang, Clermont et al. 2007

3. Promotes the work of the BC surgical community. Assesses the impact of culture on patient and provider experience in BC by answering the question 'Does culture matter?' Evaluates the potential improvements in patient and provider experience as a result of culture interventions; in other words, 'Is it worth investing in culture interventions?' Identifies the mechanisms and causal ingredients of successful culture initiatives. Provides an opportunity to make a novel contribution to the academic literature.

4. 1. Is safety culture in surgical departments in BC correlated with clinical outcomes, rates of adverse event reporting, overtime, sick time and/or staff turnover? 2. Can a conscious effort to change safety culture lead to culture change?

5. VariableMeasured byFormatYear Requested Safety CultureSafety Attitudes Questionnaire (SAQ) Average of each domain on SAQ + total culture score 2013 & 2014 Clinical Outcomes NSQIP data (11 variables) Aggregate rates of each post-operative outcome 2013 & 2014 Adverse event reporting rate Patient Safety Learning System Number of adverse events reported at each severity level (0-5) in each unit 2013 & 2014 Staff OvertimeHealth Authority HRTotal overtime hours and total hours worked in each surgical unit 2013 & 2014 Staff Sick timeHealth Authority HR Total sick time hours and total hours worked in each surgical unit 2013 & 2014 Staff TurnoverHealth Authority HRRate of staff turnover in surgical units2013 & 2014 Culture Improvement 10 questions completed by surgical unit leads. Record of culture improvement activity2014

6. We propose to collect existing data at two points in time  Spring 2013 and Spring 2014. Health Authorities and Surgeon Leads are invited to enrol and agree to submit data. Identify one individual to act as a research liaison who will assist with the collection and release of data. Data provision will require less than 5 hours of staff time. Health authorities and physicians that wish to be co- investigators in this research are invited to participate to a greater degree, although this is not required.

7. Friday Feb 22, 2013 09.00 – 10.00 PST To join the online session, click here To join by teleconference only:here 1-877-668-4490 Access Code: 629 430 051 Friday Feb 22, 2013 09.00 – 10.00 PST To join the online session, click here To join by teleconference only:here 1-877-668-4490 Access Code: 629 430 051 Thursday Mar 7, 2013 07.00 – 08.00 PST To join the online session, click here To join by teleconference only:here 1-877-668-4490 Access Code: 624 197 333 Thursday Mar 7, 2013 07.00 – 08.00 PST To join the online session, click here To join by teleconference only:here 1-877-668-4490 Access Code: 624 197 333 We will review the proposed research and answer your questions. We will also go over the next steps and how to enrol. Note: Both sessions will cover the same content. For more information: Visit http://bcpsqc.ca/clinical- improvement/sqan/research/http://bcpsqc.ca/clinical- improvement/sqan/research/ -OR- Contact: Rebecca Brooke Email: rbrooke@bcpsqc.carbrooke@bcpsqc.ca Tel: 604 668 8227

8. Huang, D. T., G. Clermont, J. B. Sexton, C. A. Karlo, R. G. Miller, L. A. Weissfeld, K. M. Rowan and D. C. Angus (2007). "Perceptions of safety culture vary across the intensive care units of a single institution *." Critical Care Medicine 35(1): 165-176 110.1097/1001.CCM.0000251505.0000276026.CF. Makary, M. A., et al. (2006). "Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder." Journal of the American College of Surgeons 202(5): 746-752. Maxfield, D., J. Grenny, R. McMillan, K. Patterson and A. Switzler (2005). Silence Kills: The Seven Crucial Conversations in Healthcare. Provo, Utah, VitalSmarts LC. Mazzocco, K., D. B. Petitti, K. T. Fong, D. Bonacum, J. Brookey, S. Graham, R. E. Lasky, J. B. Sexton and E. J. Thomas (2009). "Surgical team behaviors and patient outcomes." American journal of surgery 197(5): 678-685.