Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.
BACKGROUND
Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality.


METHODS
Surveys were administered to staff on general/vascular surgery services during a year. Surveys included multiitem scales measuring OCSFs. Additionally, perceived levels of communication and collaboration with coworkers were assessed. The National Surgical Quality Improvement Program was used to assess risk-adjusted morbidity and mortality. Correlations between outcomes and OCSFs were calculated and between outcomes and communication/collaboration with attending and resident doctors, nurses, and other providers.


RESULTS
Fifty-two sites participated in the survey: 44 Veterans Affairs and 8 academic medical centers. A total of 6,083 surveys were returned, for a response rate of 52%. The OCSF measures of teamwork climate, safety climate, working conditions, recognition of stress effects, job satisfaction, and burnout demonstrated internal validity but did not correlate with risk-adjusted outcomes. Reported levels of communication/collaboration with attending and resident doctors correlated with risk-adjusted morbidity.


CONCLUSIONS
Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity. This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.
Department of Surgery, University of Kentucky, Lexington, KY 40536-0298, USA. dldave0@email.uky.edu
Daniel L
DL
Davenport
William G
WG
Henderson
Cecilia L
CL
Mosca
Shukri F
SF
Khuri
Robert M
RM
Mentzer
D000046:Academic Medical Centers / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D002055:Burnout, Professional / Q000453:epidemiology; D003142:Communication; D003299:Cooperative Behavior; D013502:General Surgery / Q000458:organization & administration* / Q000592:standards; D019538:Health Care Surveys; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000458:organization & administration* / Q000592:standards; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011183:Postoperative Complications / Q000453:epidemiology*; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D017751:Safety Management / Q000458:organization & administration*; D013514:Surgical Procedures, Operative / Q000401:mortality*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology