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Comparing NICU teamwork and safety climate across two commonly used survey instruments
  1. Jochen Profit1,2,
  2. Henry C Lee1,2,
  3. Paul J Sharek2,3,4,
  4. Peggy Kan1,2,
  5. Courtney C Nisbet2,
  6. Eric J Thomas5,
  7. Jason M Etchegaray6,
  8. Bryan Sexton7,8
  1. 1Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital; Palo Alto, CA, USA
  2. 2California Perinatal Quality Care Collaborative; Palo Alto, CA, USA
  3. 3Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA
  4. 4Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
  5. 5University of Texas at Houston – Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston, TX, USA
  6. 6The Rand Corporation, Santa Monica, CA, USA
  7. 7Department of Psychiatry, Duke University School of Medicine; Duke University Health System, Durham, NC, USA
  8. 8Duke Patient Safety Center, Duke University Health System, Durham, NC, USA
  1. Correspondence to Dr Jochen Profit, Department of Pediatrics, Stanford University, 1265 Welch Rd, x115, Stanford, CA 94305, USA; profit{at}stanford.edu

Abstract

Background and objectives Measurement and our understanding of safety culture are still evolving. The objectives of this study were to assess variation in safety and teamwork climate and in the neonatal intensive care unit (NICU) setting, and compare measurement of safety culture scales using two different instruments (Safety Attitudes Questionnaire (SAQ) and Hospital Survey on Patient Safety Culture (HSOPSC)).

Methods Cross-sectional survey study of a voluntary sample of 2073 (response rate 62.9%) health professionals in 44 NICUs. To compare survey instruments, we used Spearman's rank correlation coefficients. We also compared similar scales and items across the instruments using t tests and changes in quartile-level performance.

Results We found significant variation across NICUs in safety and teamwork climate scales of SAQ and HSOPSC (p<0.001). Safety scales (safety climate and overall perception of safety) and teamwork scales (teamwork climate and teamwork within units) of the two instruments correlated strongly (safety r=0.72, p<0.001; teamwork r=0.67, p<0.001). However, the means and per cent agreements for all scale scores and even seemingly similar item scores were significantly different. In addition, comparisons of scale score quartiles between the two instruments revealed that half of the NICUs fell into different quartiles when translating between the instruments.

Conclusions Large variation and opportunities for improvement in patient safety culture exist across NICUs. Important systematic differences exist between SAQ and HSOPSC such that these instruments should not be used interchangeably.

  • Safety culture
  • Critical care
  • Surveys

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. JP acquired funding for this study, conceptualised and designed the study, selected data for inclusion in analyses, analysed the data, assisted with interpretation of the results, drafted the initial manuscript, and approved the final manuscript as submitted. PK assisted with designing the analysis and interpretation of the results, revised the manuscript, and approved the final manuscript as submitted. HL helped with conceptualising the paper, designing the analysis and interpreting the results. He revised the manuscript, and approved the final manuscript as submitted. PS helped conceptualise and design the study, was the local lead for CPQCC NICUs, helped select data for inclusion in the survey and analyses, assisted with interpretation of the results, revised the manuscript, and approved the final manuscript as submitted. CN coordinated data collection among CPQCC member NICUs, de-identified data, assisted with interpretation of the results, revised the manuscript, and approved the final manuscript as submitted. EJT helped acquire funding, conceptualised and designed the study, selected data for inclusion in the survey and analyses, assisted with interpretation of the results, revised the manuscript, and approved the final manuscript as submitted. JME helped with conceptualising the paper, designing the analysis and interpreting of the results. He revised the manuscript, and approved the final manuscript as submitted. BS helped acquire funding for this study, conceptualised and designed the study, selected data for inclusion in the survey and analyses, assisted with interpretation of the results. He revised the initial manuscript and approved the final manuscript as submitted.

  • Funding Texas Children's Hospital (33–126); Agency for Healthcare Research and Quality (1UC1HS014246); National Institute of Child Health and Human Development (K23 HD056298-01, K24 HD053771-01).

  • Author note At the time of the research, Dr Profit was on faculty at Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Section of Neonatology. He held a secondary appointment in the Department of Medicine, Section of Health Services Research and conducted his research at the VA Health Services Research and Development Center of Excellence. Dr. Etchegaray held an appointment at the University of Texas at Houston – Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School.

  • Competing interests None declared.

  • Ethics approval Institutional Review Boards at Stanford University and Baylor College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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