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Safety Culture in the Operating Room

Variability Among Perioperative Healthcare Workers

Pimentel, Marc Philip T. MD, MPH*†‡; Choi, Stephanie BA; Fiumara, Karen PharmD, BCPS; Kachalia, Allen MD, JD†‡§; Urman, Richard D. MD, MBA*†

doi: 10.1097/PTS.0000000000000385
Original Article: PDF Only

Introduction Safety culture is defined as the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine an organization's health and safety management. There is a lack of studies assessing patient safety culture in the perioperative setting.

Objectives We examined safety culture at a single tertiary care hospital, across all types of surgery, using previously collected data from a validated survey tool. We aim to understand how safety culture varies among perioperative staff.

Methods The Hospital Survey on Patient Safety Culture was administered at a single tertiary care hospital in 2014. We identified 431 respondents as perioperative healthcare workers: surgery attending physician, surgery trainee physician, anesthesia attending physician, anesthesia trainee physician, nurse, and technician. We calculated percent positive scores for each dimension of safety culture, as well as a composite score. Pairwise comparisons were calculated via analysis of variance.

Results The average response rate was 67%. The dimensions with the highest average percent positive scores were teamwork within hospital units (69%) and organizational learning and continuous improvement (57%). The dimensions with the lowest scores were feedback and communication about error (34%) and hospital handoffs and transitions (30%). Surgery attending physicians perceived the strongest safety climate overall, whereas nurses and surgical technicians perceived significantly worse safety climate.

Conclusions We observed significant variability in perioperative safety culture, across dimensions of safety climate, professional roles, and levels of training. These variations in safety culture should be addressed when implementing culture change programs in the perioperative setting.

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital; †Harvard Medical School; Departments of ‡Quality and Safety and §Medicine, Brigham and Women's Hospital, Boston, MA.

Correspondence: Marc Philip T. Pimentel, MD, MPH, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, CWN-L1, Boston, MA 02115 (e-mail:

The authors disclose no conflict of interest.

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