Factors Associated with Health Care Worker Compliance with Procedure Manuals and Rules

Background: Health care workers in hospitals are expected to comply with procedure manuals and rules. We investigated factors associated with compliance with procedure manuals and rules among health care workers classified by type of compliance behavior. Methods: In 2012, all health care workers (n = 12076) in 18 Japanese hospitals were asked to complete an anonymous, self-administered, cross-sectional, questionnaire survey. Respondents were categorized into four groups according to their responses to two questions regarding their understanding and compliance with manuals and rules in their hospital. The four groups were safe worker, intentional violator, overconfident worker, and reckless worker. A generalized linear mixed model was used to identify factors associated with classification in the latter three groups. Results: The response rate was 75.6% (9124/12076). Being an intentional violator or reckless worker was associated with lower job satisfaction (odds ratios [ORs]: 1.67 for intentional violator, 1.65 for reckless worker) and lesser perceived supervisor reliability (ORs: 1.96 for intentional violator, 1.62 for reckless worker). The number of night shifts worked in a month was associated with being an intentional violator (OR for 〓 five shifts, 2.02). Being a physician (OR, 2.21), perception of staffing as insufficient (OR, 1.33), and participation in in-house patient safety workshops during the previous year (OR, 0.49) were associated with being a reckless worker. Conclusions: Rules compliance among health care workers was associated with job satisfaction, perceived reliability of the supervisor, number of night shifts worked in a month, being a physician, perception of staffing, and participation in in-house patient safety workshops during the previous year.