Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics.
OBJECTIVE
To use multilevel modelling to compare the patient safety cultures of types of services across a health system and to determine whether differences found can be accounted for by staffs' professions, organizational roles, ages and type of patient care provided.


METHODS
Application of a hierarchical two-level regression model.


METHODS
All services in the South Australian public health system.


METHODS
Approximately half of the health staff (n = 14 054) in the 46 organizations, classified into 18 types of service, which made up the South Australian public health system.


METHODS
Staff completed the Safety Attitudes Questionnaire.


METHODS
Attitudes regarding Teamwork Climate, Safety Climate, Job Satisfaction, Stress Recognition, Perception of Management and Working Conditions in participants' workplaces.


RESULTS
All SAQ indices showed statistically significant although modest variations according to service type. However, most of these differences were not accounted for by the differences in the demographic composition of services' staff. Most favourable safety attitudes were found in the breast screening, primary/community health services, community nursing and metropolitan non-teaching hospitals. Poorer cultures were reported in the psychiatric hospital, mental health, metropolitan ambulance services and top-level teaching hospitals. Demographic differences in safety attitudes were observed; particularly, clinical, senior managerial, aged care and older staff held more favourable attitudes.


CONCLUSIONS
Differences in staff attitudes have been demonstrated at a macro-level across the type of health services but for the most part, differences could not be explained by staffing composition.
Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, NSW 2052, Australia.
Blanca
B
Gallego
Mary T
MT
Westbrook
Adam G
AG
Dunn
Jeffrey
J
Braithwaite
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006302:Health Services Research; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D061214:Patient Safety; D011787:Quality of Health Care / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration*; D012959:Socioeconomic Factors; D013021:South Australia; D013222:State Medicine / Q000458:organization & administration*; D013315:Stress, Psychological / Q000523:psychology; D017132:Workplace / Q000523:psychology; D055815:Young Adult