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Despite some notable advances in patient safety (eg, an average 17% reduction across a set of hospital-acquired conditions including adverse drug events and urinary tract infections in the USA between 2010 and 20151), substantially reducing or eliminating harm remains elusive for nearly every healthcare organisation. One consistent recommendation for becoming harm-free is developing a strong safety climate or shared employee perceptions that safety is organisationally rewarded, supported, valued and prioritised relative to other organisational goals.2 ,3 Safety climate is closely related to safety culture in that the former represents perceptions of leader actions and organisational practices reflective of the underlying basic assumptions and beliefs comprising culture.4 Ginsburg and Oore,5 like much of the research in healthcare, focus on safety climate and its measurement through surveys.
There is growing empirical evidence in healthcare that safety climate matters to multiple indicators of safety including patient safety indicators,6 ,7 hospital readmissions8 and treatment errors.4 ,9 ,10 More recently, studies suggest that a safety climate can serve as a resource to those delivering care, helping to reduce burnout.11 ,12 Consequently, there have been efforts by accreditors (eg, the Joint Commission in the USA) and advocacy organisations (eg, the Leapfrog Group) to encourage regular efforts to survey their employees regarding safety climate and benchmark those results/learn from the data.13
The study from Ginsburg and Oore5 presents evocative findings suggesting that despite the importance of safety climate, our approach to assessing it is incomplete at best and misguided at worst. They helpfully illustrate that how we conceptualise and measure safety climate shapes our understanding of it and the resulting interventions we deploy often in ways that might be inimical to actually producing a strong safety climate. In other words, current approaches …