Association of Safety Culture with Surgical Site Infection Outcomes : Journal of the American College of Surgeons

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Original scientific article

Association of Safety Culture with Surgical Site Infection Outcomes

Fan, Caleb J. BSa; Pawlik, Timothy M. MD, MPH, PhD, FACSb; Daniels, Tania PT, MBAc; Vernon, Nora BA, RN, MSc; Banks, Katie BAc; Westby, Peggyc; Wick, Elizabeth C. MD, FACSb; Sexton, Bryan J. PhDd; Makary, Martin A. MD, MPH, FACSb,*

Author Information

aSchool of Medicine, The Johns Hopkins University, Baltimore, MD

bDepartment of Surgery, The Johns Hopkins University, Baltimore, MD

cDepartment of Quality and Patient Safety, Minnesota Hospital Association, St Paul, MN

dDepartment of Psychiatry, Duke University Health System, Durham, NC

Correspondence address: Martin A Makary, MD, MPH, FACS, Halsted 610, 600 N Wolfe St, Baltimore, MD 21231.

E-mail: [email protected]

Submitted August 26, 2015; revised November 2, 2015; accepted November 3, 2015.

Disclosure Information: This research study at Johns Hopkins was supported by Mr and Mrs John Rodda and The Rodda Family Partnership, LTD. The authors have nothing else to disclose.

Presented at the 12th Annual American Medical Association Research Symposium, Dallas, TX, November 2014.

Journal of the American College of Surgeons 222(2):p 122-128, February 2016. | DOI: 10.1016/j.jamcollsurg.2015.11.008

Abstract

Background 

Hospital workplace culture may have an impact on surgical outcomes; however, this association has not been established. We designed a study to evaluate the association between safety culture and surgical site infection (SSI).

Study Design 

Using the Hospital Survey on Patient Safety Culture and National Healthcare Safety Network definitions, we measured 12 dimensions of safety culture and colon SSI rates, respectively, in the surgical units of Minnesota community hospitals. A Pearson’s r correlation was calculated for each of 12 dimensions of surgical unit safety culture and SSI rate and then adjusted for surgical volume and American Society of Anesthesiologists (ASA) classification.

Results 

Seven hospitals participated in the study, with a mean survey response rate of 43%. The SSI rates ranged from 0% to 30%, and surgical unit safety culture scores ranged from 16 to 92 on a scale of 0 to 100. Ten dimensions of surgical unit safety culture were associated with colon SSI rates: teamwork across units (r = −0.96; 95% CI [−0.76, −0.99]), organizational learning (r = −0.95; 95% CI [−0.71, −0.99]), feedback and communication about error (r = −0.92; 95% CI [−0.56, −0.99]), overall perceptions of safety (r = −0.90; 95% CI [−0.45, −0.99]), management support for patient safety (r = −0.90; 95% CI [−0.44, −0.98]), teamwork within units (r = −0.88; 95% CI [−0.38, −0.98]), communication openness (r = −0.85; 95% CI [−0.26, −0.98]), supervisor/manager expectations and actions promoting safety (r = −0.85; 95% CI [−0.25, −0.98]), non-punitive response to error (r = −0.78; 95% CI [−0.07, −0.97]), and frequency of events reported (r = −0.76; 95% CI [−0.01, −0.96]). After adjusting for surgical volume and ASA classification, 9 of 12 dimensions of surgical unit safety culture were significantly associated with lower colon SSI rates.

Conclusions 

These data suggest an important role for positive safety and teamwork culture and engaged hospital management in producing high-quality surgical outcomes.

© 2016 by Lippincott Williams & Wilkins, Inc.

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