title: Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes.
abstract: BACKGROUND
  Patients have the potential to provide feedback on the safety of their care. Recently, tools have been developed that ask patients to provide feedback on those factors that are known to contribute to safety, therefore providing information that can be used proactively to manage safety in hospitals. The aim of this study was to investigate whether the safety information provided by patients is different from that provided by staff and whether it is related to safety outcomes.
  
  
  METHODS
  Data were collected from 33 hospital wards across 3 acute hospital Trusts in the UK. Staff on these wards were asked to complete the four outcome measures of the Hospital Survey of Patient Safety Culture, while patients were asked to complete the Patient Measure of Safety and the friends and family test. We also collated publicly reported safety outcome data for 'harm-free care' on each ward. This patient safety thermometer measure is used in the UK NHS to record the percentage of patients on a single day of each month on every ward who have received harm-free care (ie, no pressure ulcers, falls, urinary tract infections and hospital acquired new venous thromboembolisms). These data were used to address questions about the relationship between measures and the extent to which patient and staff perceptions of safety predict safety outcomes.
  
  
  RESULTS
  The friends and family test, a single item measure of patient experience was associated with patients' perceptions of safety, but was not associated with safety outcomes. Staff responses to the patient safety culture survey were not significantly correlated with patient responses to the patient measure of safety, but both independently predicted safety outcomes. The regression models showed that staff perceptions (adjusted r(2)=0.39) and patient perceptions (adjusted r(2)=0.30) of safety independently predicted safety outcomes. When entered together both measures accounted for 49% of the variance in safety outcomes (adjusted r(2)=0.49), suggesting that there is overlap but some unique variance is also explained by these two measures. Based on responses to the Patient Measure of Safety it was also possible to identify differences between the acute Hospital Trusts.
  
  
  CONCLUSIONS
  The findings suggest that although the views of patients and staff predict some overlapping variance in patient safety outcomes, both also offer a unique perspective on patient safety, contributing independently to the prediction of safety outcomes. These findings suggest that feedback from patients about the safety of the care that they receive can be used, in addition to data from staff to drive safety improvements in healthcare.
  
  
  BACKGROUND
  ISRCTN07689702.
authors: Institute of Psychological Sciences, University of Leeds, Leeds, UK Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK.
authors: Rebecca
authors: R
authors: Lawton
authors: Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK.
authors: Jane Kathryn
authors: JK
authors: O'Hara
authors: Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK.
authors: Laura
authors: L
authors: Sheard
authors: Department of Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK.
authors: Caroline
authors: C
authors: Reynolds
authors: Department of Health Sciences, York Trials Unit, York, UK.
authors: Kim
authors: K
authors: Cocks
authors: School of Health, University of Bradford, Bradford, UK.
authors: Gerry
authors: G
authors: Armitage
authors: Department of Epidemiology and Public Health, Royal Infirmary Bradford, Bradford, UK.
authors: John
authors: J
authors: Wright
mesh_terms: D000328:Adult; D005260:Female; D000068156:Formative Feedback; D019538:Health Care Surveys; D006761:Hospitals / Q000592:standards / Q000639:trends; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D061214:Patient Safety; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D017751:Safety Management / Q000592:standards*; D006113:United Kingdom
keywords: Health services research; Patient safety; Patient-centred care; Safety culture; Surveys