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Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: A study of intensive care units

Steyrer, Johannes and Schiffinger, Michael and Clemens, Huber and Valentin, Andreas and Strunk, Guido (2013) Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: A study of intensive care units. Health Care Management Review, 38 (4). pp. 306-316. ISSN 1550-5030

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Abstract

Background: Hospitals face an increasing pressure towards efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). Purposes: Based on extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact. Methodology / Approach: A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire. Linear regression was employed to identify the effects of the predictor variables on error rate, as well as interaction effects between safety tools and safety climate. Findings: Higher workload has a detrimental effect on safety while safety climate - unlike the examined safety tools - has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant. Practice Implications: Increased workload and capacity utilization increase the occurrence of medical error; an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies. (authors' abstract)

Item Type: Article
Additional Information: To see the final version of this paper please visit the publisher's website. Access to the published version requires a subscription.
Keywords: patient safety / safety tools / safety climate / workload / medical error / intensive care units
Divisions: Departments > Marketing
Version of the Document: Accepted for Publication
Variance from Published Version: Typographical
Depositing User: ePub Administrator
Date Deposited: 01 Dec 2014 13:26
Last Modified: 13 Feb 2017 12:58
Related URLs:
FIDES Link: https://bach.wu.ac.at/d/research/results/64957/
URI: http://epub.wu.ac.at/id/eprint/4391

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