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Associations between safety culture and employee engagement over time: a retrospective analysis
  1. Elizabeth Lee Daugherty Biddison1,
  2. Lori Paine2,
  3. Peter Murakami3,
  4. Carrie Herzke1,
  5. Sallie J Weaver4
  1. 1Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Elizabeth Lee Daugherty Biddison, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; edaughe2{at}


With the growth of the patient safety movement and development of methods to measure workforce health and success have come multiple modes of assessing healthcare worker opinions and attitudes about work and the workplace. Safety culture, a group-level measure of patient safety-related norms and behaviours, has been proposed to influence a variety of patient safety outcomes. Employee engagement, conceptualised as a positive, work-related mindset including feelings of vigour, dedication and absorption in one's work, has also demonstrated an association with a number of important worker outcomes in healthcare. To date, the relationship between responses to these two commonly used measures has been poorly characterised. Our study used secondary data analysis to assess the relationship between safety culture and employee engagement over time in a sample of >50 inpatient hospital units in a large US academic health system. With >2000 respondents in each of three time periods assessed, we found moderate to strong positive correlations (r=0.43–0.69) between employee engagement and four Safety Attitudes Questionnaire domains. Independent collection of these two assessments may have limited our analysis in that minimally different inclusion criteria resulted in some differences in the total respondents to the two instruments. Our findings, nevertheless, suggest a key area in which healthcare quality improvement efforts might be streamlined.

  • Patient safety
  • Safety culture
  • Attitudes

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