title: What causes an improved safety climate among the staff of a dialysis unit? Report of an evaluation in a large network.
abstract: BACKGROUND
  Clinical staff's safety perception is considered an important indicator of the implementation level of safety climate and safety culture. For this purpose, the Safety Climate Survey Questionnaire was submitted to the dialysis clinics staff of the Fresenius Medical Care (FME) network in Italy. Moreover, to explore how standard procedures implementation influences staff opinion of safety levels, the Universal Hygiene Precautions Questionnaire was also submitted.
  
  
  METHODS
  Safety Climate Survey and Universal Hygiene Precautions questionnaires were based on 19 and 14 statements, respectively. Staff members (n=346) of 33 dialysis units were involved: 21.4% physicians, 58.1% registered nurses and 20.5% health care assistants (HCAs).
  
  
  RESULTS
  Safety Climate mean total score was 81.9%. Medical directors (91.5%) and quality-responsible head nurses (QHRNs) (87.4%) showed higher scores in comparison with staff physicians (82.4%), nurses responsible for hygiene (81.1%) and HCAs (78.8%). Staff nurses (78.9%) showed a significant difference (p<0.05) compared with medical directors. Universal Hygiene Precautions mean total score was 90.8%, not significantly different among medical directors (92%), staff physicians (91.4%), QHRNs (93.2%), nurses responsible for hygiene (91.7%) and staff nurses (91.4%). Only HCAs reported a significantly (p<0.05) lower score (83.6%) compared with medical directors. As the respondents were asked to complete both questionnaires anonymously, a direct correlation between the 2 questionnaires was not possible.
  
  
  CONCLUSIONS
  A relatively high value for Safety Climate was evaluated within the FME network of Italian dialysis clinics. Management showed higher Safety Climate scores than frontline staff. Fostering communication and implementation of training programs are considered valid tools to improve safety.
authors.affiliation: Fresenius Medical Care, NephroCare Italy, Naples, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Benedetto
authors.forename: Francesco
authors.initials: F
authors.lastname: Pelliccia
authors.forename: Manuela
authors.initials: M
authors.lastname: Moretti
authors.forename: Wanda
authors.initials: W
authors.lastname: d'Orsi
authors.forename: Fernando
authors.initials: F
authors.lastname: Starace
authors.forename: Laura
authors.initials: L
authors.lastname: Scatizzi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Parisotto
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
mesh_terms: D000488:Allied Health Personnel / Q000458:organization & administration; D000554:Ambulatory Care Facilities; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007558:Italy; D007857:Leadership; D009740:Nursing Staff / Q000458:organization & administration; D015279:Organizational Culture; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D010820:Physicians / Q000458:organization & administration; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration*; D006435:Renal Dialysis / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000078329:Workforce