title: Neonatal intensive care unit safety culture varies widely.
abstract: BACKGROUND
  Variation in healthcare delivery and outcomes in neonatal intensive care units (NICUs) may be partly explained by differences in safety culture.
  
  
  OBJECTIVE
  To describe NICU care giver assessments of safety culture, explore variability within and between NICUs on safety culture domains, and test for association with care giver characteristics.
  
  
  METHODS
  NICU care givers in 12 hospitals were surveyed using the Safety Attitudes Questionnaire (SAQ), which has six scales: teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and working conditions. Scale means, SDs and percent positives (percent agreement) were calculated for each NICU.
  
  
  RESULTS
  There was substantial variation in safety culture domains among NICUs. Composite mean score across the six domains ranged from 56.3 to 77.8 on a 100-point scale and NICUs in the top four NICUs were significantly different from the bottom four (p<0.001). Across the six domains, respondent assessments varied widely, but were least positive on perceptions of management (3%-80% positive; mean 33.3%) and stress recognition (18%-61% positive; mean 41.3%). Comparisons of SAQ scale scores between NICUs and a previously published adult ICU cohort generally revealed higher scores for NICUs. Composite scores for physicians were 8.2 (p=0.04) and 9.5 (p=0.02) points higher than for nurses and ancillary personnel.
  
  
  CONCLUSIONS
  There is significant variation and scope for improvement in safety culture among these NICUs. The NICU variation was similar to variation in adult ICUs, but NICU scores were generally higher. Future studies should validate whether safety culture measured with the SAQ correlates with clinical and operational outcomes in NICUs.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, VA HSR&D, 2002 Holcombe Boulevard, Houston, TX 77030, USA. profit@bcm.edu
authors.forename: Jochen
authors.initials: J
authors.lastname: Profit
authors.forename: Jason
authors.initials: J
authors.lastname: Etchegaray
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
authors.forename: Sylvia J
authors.initials: SJ
authors.lastname: Hysong
authors.forename: Minghua
authors.initials: M
authors.lastname: Mei
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration* / Q000592:standards; D007588:Job Satisfaction; D008297:Male; D009784:Occupational Diseases / Q000209:etiology; D016272:Occupational Health / Q000592:standards; D015279:Organizational Culture; D010348:Patient Care Team / Q000592:standards; D010564:Personnel, Hospital / Q000523:psychology; D017751:Safety Management / Q000458:organization & administration* / Q000592:standards; D013315:Stress, Psychological / Q000209:etiology; D014481:United States