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Improved Safety Culture and Teamwork Climate Are Associated With Decreases in Patient Harm and Hospital Mortality Across a Hospital System

Berry, Janet C. DNP, RN, MBA*†‡; Davis, John Terrance MD‡§; Bartman, Thomas MD, PhD‡∥¶; Hafer, Cindy C. MBA, MHA, CPHQ; Lieb, Lindsay M. BSH; Khan, Nadeem MD**¶; Brilli, Richard J. MD, FAAP, MCCM‡§¶**

doi: 10.1097/PTS.0000000000000251
Original Article: PDF Only

Objectives Improved safety and teamwork culture has been associated with decreased patient harm within specific units in hospitals or hospital groups. Most studies have focused on a specific harm type. This study’s objective was to document such an association across an entire hospital system and across multiple harm types.

Methods The Safety Attitudes Questionnaire (SAQ) was administered to all clinical personnel (including physicians) before, 2 years after, and 4 years after establishing a comprehensive patient safety/high-reliability program at a major children’s hospital. Resultant data were analyzed hospital-wide as well as by individual units, medical sections, and professional groups.

Results Safety attitude scores improved over the 3 surveys (P < 0.05) as did teamwork attitude scores (P = nonsignificant). These increases were accompanied by contemporaneous statistically significant decreases in all-hospital harm (P < 0.01), serious safety events (P < 0.001), and severity-adjusted hospital mortality (P < 0.001). Differences were noted between physicians’ and nurses’ views on specific safety and teamwork items within individual units, with nursing scores often lower. These discipline-specific differences decreased with time.

Conclusions Improved safety and teamwork climate as measured by SAQ are associated with decreased patient harm and severity-adjusted mortality. Discrepancies in SAQ scores exist between different professional groups but decreased over time.

From the *Nursing Administration, †Perioperative Services, ‡Quality Improvement Services, §Hospital Administration, ∥Division of Neonatology, and **Division of Critical Care Medicine, Nationwide Children’s Hospital; and ¶Department of Pediatrics, The Ohio State University College of Medicine Columbus, Ohio.

Correspondence: John Terrance Davis, MD, Nationwide Children’s Hospital, 700 Children’s Dr, A6454 Columbus, OH 43205 (e-mail:

The authors disclose no conflict of interest.

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