Nurse-reported patient safety climate in Swiss hospitals: a descriptive-explorative substudy of the Swiss RN4CAST study.

QUESTIONS UNDER STUDY Measuring the patient safety climate in the organisation of healthcare can help to identify problematic issues with a view to improving patient safety. We aimed (1) to describe the nurse-reported engagement in safety behaviours, (2) to describe the prevailing nurse-reported patient safety climate of general medical, surgical and mixed medical-surgical units in Swiss acute-care hospitals and (3) to explore differences between hospital type, unit type and language regions. METHODS This substudy utilised data from the nurse survey (N = 1,633) of the multicentre-cross sectional RN4CAST study. Patient safety climate was measured with the 9-item Safety Organizing Scale (SOS) which captured registered nurses' engagement in safety behaviours and practices at the unit level. RESULTS A total of 35 Swiss hospitals participated in the study. Of the 120 eligible units included in the analysis, only on 33 units (27.5%) did at least 60% of the nurses report a positive patient safety climate. A majority of nurses (51.2-63.4%, n = 1,564) reported that they were "consistently engaged" in only three of the nine measured patient safety behaviours. Our multilevel regression analyses revealed both significant between-unit and between-hospital variability. From our three variables of interest (hospital type, unit type and language regions) only language regions was consistently related to nurse-reported patient safety climate. Nurses in the German-speaking region reported a more positive patient safety climate than nurses in the French- and Italian-speaking language regions. CONCLUSIONS The findings of this study suggest a need to improve the patient safety climate on many units in Swiss hospitals. Leaders in hospitals should strengthen the patient safety climate at unit level by implementing methods, such as root cause analysis or patient safety leadership walk rounds, to improve individual and team skills and redesign work processes. The impact of these efforts should be measured by periodically assessing the patient safety climate with the SOS.