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Does Employee Safety Matter for Patients Too? Employee Safety Climate and Patient Safety Culture in Health Care

Mohr, David C., PhD*†; Eaton, Jennifer Lipkowitz, MD, MPH; McPhaul, Kathleen M., PhD, MPH, COHN-S; Hodgson, Michael J., MD, MPH§

doi: 10.1097/PTS.0000000000000186
Original Articles

Objective We examined relationships between employee safety climate and patient safety culture. Because employee safety may be a precondition for the development of patient safety, we hypothesized that employee safety culture would be strongly and positively related to patient safety culture.

Methods An employee safety climate survey was administered in 2010 and assessed employees' views and experiences of safety for employees. The patient safety survey administered in 2011 assessed the safety culture for patients. We performed Pearson correlations and multiple regression analysis to examine the relationships between a composite measure of employee safety with subdimensions of patient safety culture. The regression models controlled for size, geographic characteristics, and teaching affiliation. Analyses were conducted at the group level using data from 132 medical centers.

Results Higher employee safety climate composite scores were positively associated with all 9 patient safety culture measures examined. Standardized multivariate regression coefficients ranged from 0.44 to 0.64.

Conclusions Medical facilities where staff have more positive perceptions of health care workplace safety climate tended to have more positive assessments of patient safety culture. This suggests that patient safety culture and employee safety climate could be mutually reinforcing, such that investments and improvements in one domain positively impacts the other. Further research is needed to better understand the nexus between health care employee and patient safety to generalize and act upon findings.

From the *Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System; and

School of Public Health, Boston University, Boston, Massachusetts;

Office of Public Health, Occupational Health, Veterans Health Administration; and

§Occupational Safety and Health Administration, Department of Labor, Washington, District of Columbia.

Correspondence: David C. Mohr, PhD, VA Boston Healthcare System, 150 South Huntington Ave, Mailcode 152 M, Boston, MA 02130 (e-mail:

The authors disclose no conflict of interest.

The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (IIR 08–067).

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. This document is not a standard or regulation, and it neither creates new legal obligations nor alters existing obligations created by OSHA standards or the Occupational Safety and Health (OSH) Act.

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