Research
Obstetrics
A comprehensive obstetrics patient safety program improves safety climate and culture

Presented at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010.
https://doi.org/10.1016/j.ajog.2010.11.004Get rights and content

Objective

The purpose of this study was to determine the effect of an obstetrics patient safety program on staff safety culture.

Study Design

We implemented (1) obstetrics patient safety nurse, (2) protocol-based standardization of practice, (3) crew resource management training, (4) oversight by a patient safety committee, (5) 24-hour obstetrics hospitalist, and (6) an anonymous event reporting system. We administered the Safety Attitude Questionnaire on 4 occasions over 5 years (2004-2009) to all staff members that assessed teamwork and safety cultures, job satisfaction, working conditions, stress recognition, and perceptions of management.

Results

We observed significant improvements in the proportion of staff members with favorable perceptions of teamwork culture (39% in 2004 to 63% in 2009), safety culture (33% to 63%), job satisfaction (39% to 53%), and management (10% to 37%). Individual roles (obstetrics providers, residents, and nurses) also experienced improvements in safety and teamwork, with significantly better congruence between doctors and nurses.

Conclusion

Safety programs can improve workforce perceptions of safety and an improved safety climate.

Section snippets

Materials and Methods

We sequentially introduced multiple patient safety interventions from December 2002 to November 2006 at a university-based obstetrics service at Yale–New Haven Hospital. The details of this program have been previously described.10 Briefly, the effort involved the initiation of the following interventions:

Results

Details of the numbers of surveys that were administered and returned are listed in the Table. The median total number of employees who responded to each survey was 191 (range, 183–198). Overall response rates were 89%, 95%, 94%, and 72% for each period of administration respectively (median, 91.5%). The last survey (2009) added our postpartum staff, which accounted for a larger number of surveys that were administered. Although this administration period showed the lowest response rate, the

Comment

Berenholtz and Pronovost17 have proposed a safety scorecard that consists of 4 domains: outcome measures (How often do we harm patients?), process measures (How often do we use evidence-based medicine?), structural measures (How do we know we learned from our mistakes?), and staff attitudes surveys (How well have we created a culture of safety?).

We describe the overall improvement of safety climate, as measured by workforce surveys, in the setting of a comprehensive patient safety effort. In a

Acknowledgments

We would like to acknowledge MCIC Vermont, Inc, its leadership, and the individual hospitals of MCIC Vermont, Inc, that contributed with similar patient safety initiatives at their own institutions.

References (22)

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    Supported in part by MCIC Vermont, Inc (New York, NY) as a quality assurance activity.

    Reprints not available from the authors.

    Cite this article as: Pettker CM, Thung SF, Raab CA, et al. A comprehensive obstetrics patient safety program improves safety climate and culture. Am J Obstet Gynecol 2011;204:216.e1-6.

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