Safety climate, safety climate strength, and length of stay in the NICU
Abstract Background Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-10-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4592-1 |
| _version_ | 1828832968369504256 |
|---|---|
| author | Daniel S. Tawfik Eric J. Thomas Timothy J. Vogus Jessica B. Liu Paul J. Sharek Courtney C. Nisbet Henry C. Lee J. Bryan Sexton Jochen Profit |
| author_facet | Daniel S. Tawfik Eric J. Thomas Timothy J. Vogus Jessica B. Liu Paul J. Sharek Courtney C. Nisbet Henry C. Lee J. Bryan Sexton Jochen Profit |
| author_sort | Daniel S. Tawfik |
| collection | DOAJ |
| description | Abstract Background Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs). Methods Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU’s respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality. Results NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes. Conclusions Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals. |
| first_indexed | 2024-12-12T17:05:19Z |
| format | Article |
| id | doaj.art-d88b503ff429477bbee1ae94e4ce8b62 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T17:05:19Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-d88b503ff429477bbee1ae94e4ce8b622022-12-22T00:18:01ZengBMCBMC Health Services Research1472-69632019-10-0119111110.1186/s12913-019-4592-1Safety climate, safety climate strength, and length of stay in the NICUDaniel S. Tawfik0Eric J. Thomas1Timothy J. Vogus2Jessica B. Liu3Paul J. Sharek4Courtney C. Nisbet5Henry C. Lee6J. Bryan Sexton7Jochen Profit8Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of MedicineThe McGovern Medical School at The University of Texas Health Science Center at HoustonGraduate School of Management, Vanderbilt UniversityPerinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of MedicineCalifornia Perinatal Quality Care CollaborativeCalifornia Perinatal Quality Care CollaborativePerinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of MedicineDepartment of Psychiatry, Duke University Health System, Duke University School of MedicinePerinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of MedicineAbstract Background Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs). Methods Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU’s respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (< 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality. Results NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes. Conclusions Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals.http://link.springer.com/article/10.1186/s12913-019-4592-1Safety climateSafety climate strengthLength of stayQuality of careNeonatology |
| spellingShingle | Daniel S. Tawfik Eric J. Thomas Timothy J. Vogus Jessica B. Liu Paul J. Sharek Courtney C. Nisbet Henry C. Lee J. Bryan Sexton Jochen Profit Safety climate, safety climate strength, and length of stay in the NICU BMC Health Services Research Safety climate Safety climate strength Length of stay Quality of care Neonatology |
| title | Safety climate, safety climate strength, and length of stay in the NICU |
| title_full | Safety climate, safety climate strength, and length of stay in the NICU |
| title_fullStr | Safety climate, safety climate strength, and length of stay in the NICU |
| title_full_unstemmed | Safety climate, safety climate strength, and length of stay in the NICU |
| title_short | Safety climate, safety climate strength, and length of stay in the NICU |
| title_sort | safety climate safety climate strength and length of stay in the nicu |
| topic | Safety climate Safety climate strength Length of stay Quality of care Neonatology |
| url | http://link.springer.com/article/10.1186/s12913-019-4592-1 |
| work_keys_str_mv | AT danielstawfik safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT ericjthomas safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT timothyjvogus safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT jessicabliu safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT pauljsharek safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT courtneycnisbet safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT henryclee safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT jbryansexton safetyclimatesafetyclimatestrengthandlengthofstayinthenicu AT jochenprofit safetyclimatesafetyclimatestrengthandlengthofstayinthenicu |