title: Patient safety in surgery.
abstract: BACKGROUND
  Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist.
  
  
  METHODS
  We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis.
  
  
  RESULTS
  The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (alpha = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%.
  
  
  CONCLUSIONS
  Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety.
authors.affiliation: Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD 21224, USA. mmakary1@jhmi.edu
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
authors.forename: E Anne
authors.initials: EA
authors.lastname: Millman
authors.forename: David
authors.initials: D
authors.lastname: Pryor
authors.forename: Christine
authors.initials: C
authors.lastname: Holzmueller
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
mesh_terms: D000704:Analysis of Variance; D006801:Humans; D009873:Operating Rooms / Q000592:standards*; D015279:Organizational Culture; D012449:Safety; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires