title: Association of Safety Culture with Surgical Site Infection Outcomes.
abstract: BACKGROUND
  Hospital workplace culture may have an impact on surgical outcomes; however, this association has not been established. We designed a study to evaluate the association between safety culture and surgical site infection (SSI).
  
  
  METHODS
  Using the Hospital Survey on Patient Safety Culture and National Healthcare Safety Network definitions, we measured 12 dimensions of safety culture and colon SSI rates, respectively, in the surgical units of Minnesota community hospitals. A Pearson's r correlation was calculated for each of 12 dimensions of surgical unit safety culture and SSI rate and then adjusted for surgical volume and American Society of Anesthesiologists (ASA) classification.
  
  
  RESULTS
  Seven hospitals participated in the study, with a mean survey response rate of 43%. The SSI rates ranged from 0% to 30%, and surgical unit safety culture scores ranged from 16 to 92 on a scale of 0 to 100. Ten dimensions of surgical unit safety culture were associated with colon SSI rates: teamwork across units (r = -0.96; 95% CI [-0.76, -0.99]), organizational learning (r = -0.95; 95% CI [-0.71, -0.99]), feedback and communication about error (r = -0.92; 95% CI [-0.56, -0.99]), overall perceptions of safety (r = -0.90; 95% CI [-0.45, -0.99]), management support for patient safety (r = -0.90; 95% CI [-0.44, -0.98]), teamwork within units (r = -0.88; 95% CI [-0.38, -0.98]), communication openness (r = -0.85; 95% CI [-0.26, -0.98]), supervisor/manager expectations and actions promoting safety (r = -0.85; 95% CI [-0.25, -0.98]), non-punitive response to error (r = -0.78; 95% CI [-0.07, -0.97]), and frequency of events reported (r = -0.76; 95% CI [-0.01, -0.96]). After adjusting for surgical volume and ASA classification, 9 of 12 dimensions of surgical unit safety culture were significantly associated with lower colon SSI rates.
  
  
  CONCLUSIONS
  These data suggest an important role for positive safety and teamwork culture and engaged hospital management in producing high-quality surgical outcomes.
authors.affiliation: School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Fan
authors.affiliation: Department of Surgery, The Johns Hopkins University, Baltimore, MD.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Quality and Patient Safety, Minnesota Hospital Association, St Paul, MN.
authors.forename: Tania
authors.initials: T
authors.lastname: Daniels
authors.affiliation: Department of Quality and Patient Safety, Minnesota Hospital Association, St Paul, MN.
authors.forename: Nora
authors.initials: N
authors.lastname: Vernon
authors.affiliation: Department of Quality and Patient Safety, Minnesota Hospital Association, St Paul, MN.
authors.forename: Katie
authors.initials: K
authors.lastname: Banks
authors.affiliation: Department of Quality and Patient Safety, Minnesota Hospital Association, St Paul, MN.
authors.forename: Peggy
authors.initials: P
authors.lastname: Westby
authors.affiliation: Department of Surgery, The Johns Hopkins University, Baltimore, MD.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
authors.affiliation: Department of Psychiatry, Duke University Health System, Durham, NC.
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
authors.affiliation: Department of Surgery, The Johns Hopkins University, Baltimore, MD. Electronic address: mmakary1@jhmi.edu.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
mesh_terms: D003082:Colectomy / Q000009:adverse effects; D003142:Communication; D003430:Cross-Sectional Studies; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D008910:Minnesota; D015279:Organizational Culture; D061214:Patient Safety; D017751:Safety Management; D013530:Surgical Wound Infection / Q000453:epidemiology*