Safety climate strength: a promising construct for safety research and practice.

To cite: Vogus TJ. BMJ Qual Saf 2016;25:649–652. Despite some notable advances in patient safety (eg, an average 17% reduction across a set of hospital-acquired conditions including adverse drug events and urinary tract infections in the USA between 2010 and 2015), substantially reducing or eliminating harm remains elusive for nearly every healthcare organisation. One consistent recommendation for becoming harm-free is developing a strong safety climate or shared employee perceptions that safety is organisationally rewarded, supported, valued and prioritised relative to other organisational goals. 3 Safety climate is closely related to safety culture in that the former represents perceptions of leader actions and organisational practices reflective of the underlying basic assumptions and beliefs comprising culture. Ginsburg and Oore, like much of the research in healthcare, focus on safety climate and its measurement through surveys. There is growing empirical evidence in healthcare that safety climate matters to multiple indicators of safety including patient safety indicators, 7 hospital readmissions and treatment errors. 9 10 More recently, studies suggest that a safety climate can serve as a resource to those delivering care, helping to reduce burnout. 12 Consequently, there have been efforts by accreditors (eg, the Joint Commission in the USA) and advocacy organisations (eg, the Leapfrog Group) to encourage regular efforts to survey their employees regarding safety climate and benchmark those results/learn from the data. The study from Ginsburg and Oore presents evocative findings suggesting that despite the importance of safety climate, our approach to assessing it is incomplete at best and misguided at worst. They helpfully illustrate that how we conceptualise and measure safety climate shapes our understanding of it and the resulting interventions we deploy often in ways that might be inimical to actually producing a strong safety climate. In other words, current approaches to measurement and interpretation paint, at times, an inaccurate picture of safety climate. Specifically, the exclusive focus on the level of safety climate derived from survey measures for organisations (eg, a hospital, unit or clinic) that exhibit strong consensus (ie, pass a threshold level of within entity agreement) can be misleading. Focusing on consensus leads us to misrepresent or omit entities exhibiting disagreement about their safety climate. This can lead to biased findings and perhaps even excluding the entities in most need of interventions. Therefore, Ginsburg and Oore propose evaluating the ‘safety profile’ for each of the organisation surveyed that captures the level of safety climate, its ‘strength’ or the variability of safety climate perceptions among members and its ‘shape’ or an illustration of the spread of responses within a given organisation. They argue that assessing climate strength provides insight into the consistency of behavioural expectations and actual safety behaviours in a work unit. The authors offer the SD as a simple measure of strength and the more sophisticated rWG(J) that they expertly detail in their technical appendix as an alternative. Strong climates are seen to enhance performance by energising employees around a meaningful, unified goal and shaping and coordinating employees’ behaviour. Research also demonstrates that strong climates are more likely to persist and produce more consistent, uniform behaviour. They also encourage viewing the shape of by plotting a simple histogram of EDITORIAL