Comparing safety climate for nurses

Objectives The main aim of the study was to explore the potential sources of variation and understand the meaning of safety climate for nursing practice in acute hospital settings in the UK. Design A sequential mixed methods design included a cross-sectional survey using the Safety Climate Questionnaire (SCQ) and thematic analysis of focus group discussions. Confirmatory factor analysis (CFA) was used to validate the factor structure of the SCQ. Factor scores were compared between nurses working in operating theatres, critical care and ward areas. Results from the survey and the thematic analysis were then compared and synthesised. setting A London University. Participants 319 registered nurses working in acute hospital settings completed the SCQ and a further 23 nurses participated in focus groups. results CFA indicated that there was a good model fit on some criteria (χ=1683.699, df=824, p<0.001; χ/df=2.04; root mean square error of approximation=0.058) but a less acceptable fit on comparative fit index which is 0.804. There was a statistically significant difference between clinical specialisms in management commitment (F (4,266)=4.66, p=0.001). Nurses working in operating theatres had lower scores compared with ward areas and they also reported negative perceptions about management in their focus group. There was significant variation in scores for communication across clinical specialism (F (4,266)=2.62, p=0.035) but none of the pairwise comparisons achieved statistical significance. Thematic analysis identified themes of human factors, clinical management and protecting patients. The system and the human side of caring was identified as a meta-theme. conclusions The results suggest that the SCQ has some utility but requires further exploration. The findings indicate that safety in nursing practice is a complex interaction between safety systems and the social and interpersonal aspects of clinical practice. IntrODuctIOn There is a growing consensus in healthcare safety research that organisational culture is critical for patient safety and that safety management should move away from depending on lagging indicators of safety issues, such as incident reports, and move towards leading indicators, such as measures of safety climate. Patient safety culture is defined as aspects of organisational culture that are ‘the product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to and the style and proficiency of an organisations’ health and safety management’. Safety climate is defined as a measurable feature of staff’s attitudes and perceptions of an organisations underlying safety culture at any point in time. There is evidence that safety climate is open to change and has an impact on individual safety behaviour and an important factor in improving patient safety. 6 The Safety Climate Questionnaire (SCQ) developed in the UK has been used extensively in the National Health Service (NHS) by the Royal College of Nursing. However, the SCQ was originally developed for use in the UK petroleum industry as part of a tool kit to measure safety climate. The SCQ measures nine factors that contribute to safety climate, Comparing safety climate for nurses working in operating theatres, critical care and ward areas in the UK: a mixed methods study Maggie Tarling, Anne Jones, Trevor Murrells, Helen McCutcheon To cite: Tarling M, Jones A, Murrells T, et al. Comparing safety climate for nurses working in operating theatres, critical care and ward areas in the UK: a mixed methods study. BMJ Open 2017;7:e016977. doi:10.1136/