Exploring Relationships Between Hospital Patient Safety Culture and Adverse Events

TLDR

Limited research has linked staff perceptions of hospital patient safety culture to rates of adverse clinical events, and further studies are needed to assess generalizability and causal relationships. This exploratory study aimed to determine whether higher scores on the AHRQ Hospital Survey of Patient Safety Culture are associated with lower rates of in‑hospital complications and adverse events measured by PSIs. Using data from 179 hospitals collected in 2005–2006, the authors performed multiple regressions of 15 safety‑culture variables against a composite PSI measure, controlling for bed size and ownership. Nearly half of the tested relationships were statistically significant and negatively associated with PSI rates, with standardized coefficients ranging from –0.15 to –0.41, indicating that stronger safety culture correlates with fewer adverse events.

Abstract

Objectives: There has been very limited research linking staff perceptions of hospital patient safety culture with rates of adverse clinical events. This exploratory study examined relationships between the Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey of Patient Safety Culture and rates of in-hospital complications and adverse events as measured by the AHRQ Patient Safety Indicators (PSIs). The general hypothesis was that hospitals with a more positive patient safety culture would have lower PSI rates. Methods: We performed multiple regressions to examine the relationships between 15 patient safety culture variables and a composite measure of adverse clinical events based on 8 risk-adjusted PSIs from 179 hospitals, controlling for hospital bed size and ownership. All patient safety culture data were collected in 2005 and 2006 (except 1 late 2004 hospital), and all PSI data were collected in 2005. Results: Nearly all of the relationships tested were in the expected direction (negative), and 7 (47%) of the 15 relationships were statistically significant. All significant relationships were of moderate size, with standardized regression coefficients ranging from −0.15 to −0.41, indicating that hospitals with a more positive patient safety culture scores had lower rates of in-hospital complications or adverse events as measured by PSIs. Conclusions: Our findings support the idea that a more positive patient safety culture is associated with fewer adverse events in hospitals. Further research is needed to determine the generalizability of these results to larger sets of hospitals and to examine the causal relationship between patient safety culture and clinical patient outcomes.