[The safety culture and the quality of care: obscured by self-report].
Recently, Smits M et al. investigated whether the relationship between certain medical specialties and patient safety is mediated by a 'safety culture', based on culture surveys conducted on wards in 20 Dutch hospitals (internal medicine, surgery, emergency medicine) and 1885 self-reported 'unintended' events (Journal of Clinical Nursing, 21, 3392-401). Based on the results, the authors conclude that medical specialties do not differ in 'performance' because of their safety cultures and that safety culture is not a key factor affecting patient safety. We counter that bias exists because the variables of safety culture as well as the events reported were based on self-report, mainly by nurses. Many events were minor process deviations (medication expired, delay in lab results) rather than adverse events and unlikely to be affected by a safety culture. Knowledge of a possible relationship between a particular medical specialty and adverse outcomes is important, but would also be a generalization that denies the differences in outcome between similar departments at different hospitals.
Universitair Medisch Centrum Utrecht, afd. Anesthesiologie, Utrecht, the Netherlands. c.j.kalkman@umcutrecht.nl
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D015984:Causality; D006761:Hospitals; D006801:Humans; D019300:Medical Errors; D015279:Organizational Culture; D061214:Patient Safety