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The Relationship Between Safety Culture and Voluntary Event Reporting in a Large Regional Ambulatory Care Group.

Miller, Nina MD, MPH; Bhowmik, Shelly MD, MPH; Ezinwa, Margarete MD, MPH; Yang, Ting PhD, MHS; Schrock, Susan MD; Bitzel, Daniel MS, LSWA; McGuire, Maura Joyce MD
doi: 10.1097/PTS.0000000000000337
Original Article: PDF Only

Objectives: The safety culture in the workplace may affect event reporting. We evaluated the relationship of safety culture and voluntary event reporting within a large network of ambulatory practices, most of which provided primary care.

Methods: This study was an observational, retrospective cohort study. Patient safety event reporting rates for 35 ambulatory practices were collected using a standard tool (UHC Patient Safety Net [PSN]) and normalized based on the number of patient visits in each practice. The overall and domain-specific safety culture of each practice was measured with a validated instrument (Safety Attitudes Questionnaire [SAQ]), distributed to 828 employees in 2013. We compared safety culture scores and the average event reporting rates during a 4-month window before and after the survey distribution. Poisson regression analyses were performed to determine the relationship between PSN reporting rates and SAQ results.

Results: The SAQ response rate was 87%. Practices varied widely in rates of reporting events, from 0.00 to 6.99 reports per 1000 total patient visits per month. Regression analyses indicated a positive association between PSN reporting rates and SAQ scores for the domains of overall culture (incidence rate ratio [IRR], 1.019; P = 0.004) and 4 safety culture domains: teamwork climate (IRR, 1.016; P = 0.019), safety climate (IRR, 1.018; P = 0.004), working conditions (IRR, 1.017; P = 0.006), and perceptions of local management (IRR, 1.016; P = 0.040).

Conclusions: Our work provides new evidence to show that in the ambulatory setting more events and near misses are reported when there is a strong culture of safety.

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