The Enabling, Enacting, and Elaborating Factors of Safety Culture Associated With Patient Safety: A Multilevel Analysis

• Published in: Journal of nursing scholarship Vol. 52; no. 5; pp. 544 - 552
• Main Authors: Lee, Seung Eun, Dahinten, V. Susan
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-09-2020
• Subjects: Attitude of Health Personnel; Cross-Sectional Studies; Culture; Health care; Health care industry; Health Care Surveys; Hospital Administration; Hospitals; Humans; Medical errors; Models, Theoretical; Multilevel Analysis; Multilevel modeling; Nurses; Nursing; Nursing Staff, Hospital - psychology; Organizational learning; patient outcomes; Patient Safety; Perceptions; Safety; safety climate; safety culture; Safety Management - organization & administration; Staffing; Supervisor-Subordinate interactions; United States; Urinary tract diseases; Urinary tract infections; Urogenital system; Workforce planning; United States; United States > US; Multilevel modeling; patient safety; patient outcomes; safety climate; safety culture
• ISSN: 1527-6546; 1547-5069
• DOI: 10.1111/jnu.12585

Purpose
Worldwide, 1 in 10 hospital patients is harmed while receiving care. Despite evidence that a culture of safety is associated with greater patient safety, these effects and the processes by which safety culture impacts patient safety are not yet clearly understood. Therefore, the purpose of this study was to examine the effects of various safety culture factors on nurses’ perceptions of patient safety using an innovative theoretical model.
Design
This descriptive, correlational study drew on deidentified, publicly available data from the 2018 Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. The study sample included 34,514 nurses who provided direct care to patients in medical and surgical units in 535 hospitals in the United States.
Methods
Multilevel linear regression was used to examine the effects of 11 safety culture factors on nurses’ overall perceptions of patient safety. The 11 safety culture factors were grouped as enabling, enacting, and elaborating processes, and entered in separate blocks.
Findings
All 11 safety culture factors were associated with nurse‐perceived patient safety, and all but two of the 11 factors uniquely predicted nurse‐perceived patient safety. Staffing adequacy was the strongest predictor of nurse‐perceived patient safety, followed by hospital management support for patient safety (both enabling processes), and continuous organizational learning and improvement (an elaborating process).
Conclusions
Hospital administrators and managers play a key role in promoting a safety culture and patient safety in healthcare organizations through enabling and elaborating processes.
Clinical Relevance
Organizational efforts should be made to provide sufficient staffing and hospital‐wide support for patient safety. However, all staff, administrators, and managers have a role to play in patient safety.