Interactive Qualitative Assessment of Patient Safety Culture Survey Scores

Objective: To compare the results of a qualitative assessment of safety culture as a social system in a hospital surgical unit with results obtained through application of a typical safety culture assessment tool to identify areas best suited to a plan for improvement. Methods: The study was conducted in 2 separate but related phases. Phase 1 used a validated survey instrument, the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture. Comparative data in phase 2 involved a focus group of occupationally representative employees using the techniques of interactive qualitative analysis (IQA). Results: Typical safety culture drivers such as management support or feedback and communication influence those dimensions that are identified by interactive qualitative analysis as outcomes in a safety system. The discrete system elements relate to and have influence over other linked elements or even have recursive relationships within a larger system of patient safety. Conclusions: The results demonstrate that plans for improvement should be developed only after considering both ranked patient safety culture dimension scores and how specific dimensions of patient safety culture relate to and influence each other as interactive elements within a larger system of patient safety. Therefore, the efficiency of plans for improvement may be best maximized if resources are directed toward those dimensions of patient safety culture that are identified as the primary and secondary upstream drivers (as opposed to downstream outcomes) that have the most direct positive influence on the identified dimensions within a system of patient safety culture.