title: Recruitment of hospitals for a safety climate study: facilitators and barriers.
abstract: BACKGROUND
  Despite increasing emphasis on safety culture assessment, little is known about the factors that affect hospitals' participation in such studies. Factors affecting recruitment of 30 Department of Veterans Affairs (VA) hospitals into a study to evaluate perceptions of safety culture, or safety "climate," were examined.
  
  
  METHODS
  To minimize selection bias, hospitals were recruited that represented the spectrum of safety performance on the basis of Patient Safety Indicator scores. Invitations and additional mailings, informational conference calls, and personal contact with hospitals were used to encourage participation. Investigators worked closely with hospitals' key stakeholders to obtain support and buy-in for the study. Relationships among safety performance, organizational culture, and other hospital characteristics with hospitals' participation and ease of recruitment were examined. Findings were compared with those of a companion study in the non-VA setting.
  
  
  RESULTS
  Despite attempts to optimize recruitment, it was necessary to contact more than 90 hospitals to obtain a 30-hospital sample. Having a more entrepreneurial culture (associated with risk-taking, innovation, and quality improvement) was significantly related to shorter recruitment time in VA and non-VA settings. Safety performance was significantly related to participation in the VA (that is, "better-performing" hospitals were more likely to be recruited than "lower-performing" hospitals), but not in the non-VA study, where recruitment was based on size and region.
  
  
  CONCLUSIONS
  Researchers should recruit representative samples of hospitals based on measures of safety performance. Hospital selection bias could lead to erroneous findings, ultimately impeding efforts to improve safety within organizations.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Department of Veterans Affairs Center of Excellence, Bedford, MA, USA. akrosen@bu.edu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: David M
authors.initials: DM
authors.lastname: Gaba
authors.forename: Mark
authors.initials: M
authors.lastname: Meterko
authors.forename: Priti
authors.initials: P
authors.lastname: Shokeen
authors.forename: Sara
authors.initials: S
authors.lastname: Singer
authors.forename: Shibei
authors.initials: S
authors.lastname: Zhao
authors.forename: Alan
authors.initials: A
authors.lastname: Labonte
authors.forename: Alyson
authors.initials: A
authors.lastname: Falwell
mesh_terms: D006739:Hospital Administration; D006742:Hospital Bed Capacity; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D012107:Research Design; D012449:Safety; D013997:Time Factors; D014481:United States