title: Modifying head nurse messages during daily conversations as leverage for safety climate improvement: a randomised field experiment.
abstract: BACKGROUND
  Recent literature reviews lament the paucity of high-quality intervention studies designed to test safety culture improvement in hospitals. The current study adapts an empirically supported strategy developed for manufacturing companies by focusing on patient care and safety messages head nurses communicate during daily conversations with nurses.
  
  
  METHODS
  The study was designed as randomised control trial coupled with before-after measurement of outcome variables. We randomly assigned 445 nurses working in 27 inpatient departments in a midsize hospital in Israel to experimental and control groups. Ten randomly chosen nurses in both groups filled a brief questionnaire referring to last conversation with head nurse. One month later, head nurses in the experimental group received individual feedback, comparing individual with mean hospital scores, coupled with self-set goals for the following feedback session. Head nurses in the control group received no feedback, except for a summary report by the end of intervention.
  
  
  RESULTS
  Patient care messages increased by 16% and professional development messages by 12%, accompanied by 17% decline in nurse-blaming messages in the experimental group, remaining unchanged in the control group. Such changes led to statistically significant increase in patient care behaviours (17%), safety climate (13%), teamwork (9%) and supervisory leadership quality (18%). Rule-compliance messages and workaround behaviours remained unchanged in experimental and control departments.
  
  
  CONCLUSIONS
  These data support the utility of our intervention strategy for improving patient safety climate and resultant caring behaviours in healthcare organisations. The fact that our intervention used easy-to-deliver feedback requiring only two sessions minimised its organisational costs.
authors.affiliation: Faculty of Management, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Dov
authors.initials: D
authors.lastname: Zohar
authors.affiliation: Faculty of Management, Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Yaron T
authors.initials: YT
authors.lastname: Werber
authors.affiliation: Emek Medical Center, Afula, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Marom
authors.affiliation: Emek Medical Center, Afula, Israel.
authors.forename: Bruria
authors.initials: B
authors.lastname: Curlau
authors.affiliation: Emek Medical Center, Afula, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Blondheim
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking; D003142:Communication; D005246:Feedback; D005260:Female; D006126:Group Processes; D006801:Humans; D007557:Israel; D008297:Male; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D009745:Nursing, Supervisory / Q000458:organization & administration* / Q000592:standards; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration* / Q000592:standards
keywords: Healthcare quality improvement; Patient safety; Safety culture