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A Multilevel Analysis of U.S. Hospital Patient Safety Culture Relationships With Perceptions of Voluntary Event Reporting

Burlison, Jonathan, D.*; Quillivan, Rebecca, R.*; Kath, Lisa, M.; Zhou, Yinmei; Courtney, Sam, C.; Cheng, Cheng; Hoffman, James, M.

doi: 10.1097/PTS.0000000000000336
Original Article: PDF Only

Objectives Patient safety events offer opportunities to improve patient care, but, unfortunately, events often go unreported. Although some barriers to event reporting can be reduced with electronic reporting systems, insight on organizational and cultural factors that influence reporting frequency may help hospitals increase reporting rates and improve patient safety. The purpose of this study was to evaluate the associations between dimensions of patient safety culture and perceived reporting practices of safety events of varying severity.

Methods We conducted a cross-sectional survey study using previously collected data from The Agency for Healthcare Research and Quality Hospital Survey of Patient Safety Culture as predictors and outcome variables. The dataset included health-care professionals in U.S. hospitals, and data were analyzed using multilevel modeling techniques.

Results Data from 223,412 individuals, 7816 work areas/units, and 967 hospitals were analyzed. Whether examining near miss, no harm, or potential for harm safety events, the dimension feedback about error accounted for the most unique predictive variance in the outcome frequency of events reported. Other significantly associated variables included organizational learning, nonpunitive response to error, and teamwork within units (all P < 0.001). As the perceived severity of the safety event increased, more culture dimensions became significantly associated with voluntary reporting.

Conclusions To increase the likelihood that a patient safety event will be voluntarily reported, our study suggests placing priority on improving event feedback mechanisms and communication of event-related improvements. Focusing efforts on these aspects may be more efficient than other forms of culture change.

From the *Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee; †Department of Psychology, College of Sciences, San Diego State University, San Diego, California; ‡Department of Biostatistics, St. Jude Children’s Research Hospital; and §Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Sciences Center, Memphis, Tennessee.

Correspondence: James M. Hoffman, PharmD, 262 Danny Thomas Place, MS 150, Memphis, TN (e-mail:

Conflicts of Interest and Sources of Funding: There are no known possible conflicts of interest to declare. This study was supported by the Cancer Center Core Grant NIH CA 21765 and ALSAC.

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