title: Patient safety culture in a Dutch pediatric surgical intensive care unit: an evaluation using the Safety Attitudes Questionnaire.
abstract: OBJECTIVE
  Nowadays, the belief is widespread that a safety culture is crucial to achieving patient safety, yet there has been virtually no analysis of the safety culture in pediatric hospital settings so far. Our aim was to measure the safety climate in our unit, compare it with benchmarking data, and identify potential deficiencies.
  
  
  METHODS
  Prospective longitudinal survey study at two points in time.
  
  
  METHODS
  Pediatric surgical intensive care unit at a Dutch university hospital.
  
  
  METHODS
  All unit personnel.
  
  
  METHODS
  To measure the safety climate, the Safety Attitudes Questionnaire was administered to physicians, nurses, nursing assistants, pharmacists, technicians, and ward clerks in both May 2006 and May 2007. This questionnaire assesses caregiver attitudes through use of the six following scales: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition. Earlier research showed that the Safety Attitudes Questionnaire has good psychometric properties and produced benchmarking data that can be used to evaluate strengths and weaknesses in a given clinical unit against peers.
  
  
  RESULTS
  The response rates for the Safety Attitudes Questionnaire were 85% (May 2006) and 74% (May 2007). There were mixed findings regarding the difference between physicians and nurses: on three scales (i.e., teamwork climate, safety climate, and stress recognition), physicians scored better than nurses at both points in time. On another two scales (i.e., perceptions of management and working conditions), nurses consistently had higher mean scale scores. Probably due to the small number of physicians, only some of these differences between physicians and nurses reached the level of statistical significance. Compared to benchmarking data, scores on perceptions of management were higher than expected (p < .01), whereas scores on stress recognition were low (p < .001). The scores on the other scales were somewhat above (job satisfaction), close to (teamwork climate, safety climate), or somewhat below (working conditions) what was expected on the basis of benchmarking data, but no persistent significant differences were observed on these scales.
  
  
  CONCLUSIONS
  Although on most domains the safety culture in our unit was good when compared to benchmark data, there is still room for improvement. This requires us to continue working on interventions intended to improve the safety culture, including crew resource management training, safety briefings, and senior executive walk rounds. More research is needed into the impact of creating a safety culture on patient outcomes.
authors.affiliation: Department of Pediatric Surgery, Erasmus University Rotterdam, Rotterdam, The Netherlands. poley@bmg.eur.nl
authors.forename: Marten J
authors.initials: MJ
authors.lastname: Poley
authors.forename: Cynthia
authors.initials: C
authors.lastname: van der Starre
authors.forename: Ada
authors.initials: A
authors.lastname: van den Bos
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008137:Longitudinal Studies; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D009426:Netherlands; D015279:Organizational Culture; D061214:Patient Safety; D011446:Prospective Studies; D013503:Surgery Department, Hospital; D011795:Surveys and Questionnaires / Q000706:statistics & numerical data*