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Comparing Safety Climate between Two Populations of Hospitals in the United States

Authors

  • Sara J. Singer,

    1. Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115,
    2. Institute for Health Policy, Massachusetts General Hospital, Boston, MA,
    3. Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA,
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    • Address correspondence to Sara J. Singer, M.B.A., Ph.D., Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115; e-mail: ssinger@hsph.harvard.edu. Sara J. Singer, M.B.A., Ph.D., is also with the Institute for Health Policy, Massachusetts General Hospital, Boston, MA. Sara J. Singer, M.B.A., Ph.D., Shoutzu Lin, M.S., and David M. Gaba, M.D., are with the Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA. Christine W. Hartmann, Ph.D., is with the Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, Bedford, MA. Christine W. Hartmann, Ph.D., Mark Meterko, Ph.D., and Amy K. Rosen, Ph.D., are with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Amresh Hanchate, Ph.D., is with the Section of General Internal Medicine, Boston University School of Medicine, Boston, MA. Shibei Zhao, M.P.H., Mark Meterko, Ph.D., Priti Shokeen, M.S., and Amy K. Rosen, Ph.D., are with the Center for Organization, Leadership, and Management Research, Boston VA Medical Center, Boston, MA. Shoutzu Lin, M.S., is with the Chronic Heart Failure (CHF) Quality Enhancement Research Initiative, and David M. Gaba, M.D., is with the Patient Safety Culture Institute, VA Palo Alto Health Care System, Palo Alto, CA.

  • Christine W. Hartmann,

    1. Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, Bedford, MA,
    2. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA,
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  • Amresh Hanchate,

    1. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA,
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  • Shibei Zhao,

    1. Center for Organization, Leadership, and Management Research, Boston VA Medical Center, Boston, MA,
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  • Mark Meterko,

    1. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA,
    2. Center for Organization, Leadership, and Management Research, Boston VA Medical Center, Boston, MA,
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  • Priti Shokeen,

    1. Center for Organization, Leadership, and Management Research, Boston VA Medical Center, Boston, MA,
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  • Shoutzu Lin,

    1. Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA,
    2. Chronic Heart Failure (CHF) Quality Enhancement Research Initiative, Palo Alto, CA,
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  • David M. Gaba,

    1. Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA,
    2. Patient Safety Culture Institute, VA Palo Alto Health Care System, Palo Alto, CA.
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  • Amy K. Rosen

    1. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA,
    2. Center for Organization, Leadership, and Management Research, Boston VA Medical Center, Boston, MA,
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Abstract

Objective. To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting.

Data Sources. Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey of Hospitals.

Study Design. Cross-sectional study of 69 U.S. and 30 VA hospitals.

Data Collection. For each sample, hierarchical linear models used safety-climate scores as the dependent variable and respondent and facility characteristics as independent variables. Regression-based Oaxaca–Blinder decomposition examined differences in effects of model characteristics on safety climate between the U.S. and VA samples.

Principal Findings. The range in safety climate among U.S. and VA hospitals overlapped substantially. Characteristics of individuals influenced safety climate consistently across settings. Working in southern and urban facilities corresponded with worse safety climate among VA employees and better safety climate in the U.S. sample. Decomposition results predicted 1.4 percentage points better safety climate in U.S. than in VA hospitals: −0.77 attributable to sample-characteristic differences and 2.2 due to differential effects of sample characteristics.

Conclusions. Results suggest that safety climate is linked more to efforts of individual hospitals than to participation in a nationally integrated system or measured characteristics of workers and facilities.

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