Variation in staff perceptions of patient safety climate across work sites in Norwegian general practitioner practices and out-of-hour clinics

RESEARCH ARTICLE Variation in staff perceptions of patient safety climate across work sites in Norwegian general practitioner practices and out-of-hour clinics Ellen Catharina Tveter Deilkås ID1,2*, Dag Hofoss3, Elisabeth Holm Hansen4, Gunnar Tschudi Bondevik5,6 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 The Norwegian Directorate of Health, Oslo, Norway, 2 Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway, 3 Lovisenberg Diaconal University College, Oslo, Norway, 4 University of South-Eastern Norway, Notodden, Norway, 5 Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway, 6 National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway * OPEN ACCESS Citation: Deilkås ECT, Hofoss D, Hansen EH, Bondevik GT (2019) Variation in staff perceptions of patient safety climate across work sites in Norwegian general practitioner practices and outof-hour clinics. PLoS ONE 14(4): e0214914. https://doi.org/10.1371/journal.pone.0214914 Editor: Iratxe Puebla, Public Library of Science, UNITED KINGDOM Received: June 19, 2017 Abstract Introduction Measuring staff perceptions with safety climate surveys is a promising approach to addressing patient safety. Variation in safety climate scores between work sites may predict variability in risk related to tasks, work environment, staff behavior, and patient outcomes. Safety climate measurements may identify considerable variation in staff perceptions across work sites. Accepted: March 23, 2019 Published: April 10, 2019 Objective Copyright: © 2019 Deilkås et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. To explore variation in staff perceptions of patient safety climate across work sites in Norwegian General Practitioner (GP) practices and Out-of-hours clinics. Data Availability Statement: The datasets generated and analyzed during the current study are available as supplement files to this article. The Norwegian Safety Attitudes QuestionnaireAmbulatory Version (SAQ A) was used to survey staff perceptions of patient safety climate across a sample of GP practices and Outof-hours clinics in Norway. We invited 510 primary health care providers to fill out the questionnaire anonymously online in October and November 2012. Work sites were 17 regular GP practices in Sogn & Fjordane County, and seven Out-of-hours clinics, of which six were designated as “Watchtower Clinics”. Intra–class correlation coefficients were calculated to identify what proportion of the variation in the five factor scores (Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions) were at work site-level. Funding: This work was supported and funded through employment of an author; Health Services Research Unit, Akershus University Hospital, Norway; Institute of Health and Society, University of Oslo, Norway; University College of Southeast Norway; Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway and National Methods PLOS ONE | https://doi.org/10.1371/journal.pone.0214914 April 10, 2019 1 / 10 Variation in patient safety climate across work sites in Norwegian primary care Centre for Emergency Primary Health Care, Uni Research Health, Bergen. The Norwegian medical associations Fund for quality and patient safety paid for the English editing. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Results Of the 510 invited health care providers, 266 (52%) answered the questionnaire. Staff perceptions varied considerably at the work site level: intra–class correlation coefficients (ICCs) were 12.3% or higher for all factors except for Job satisfaction–the highest ICC value was for Perceptions of management: 15.5%. Conclusion Although most of the score variation was at the individual level, there was considerable response clustering within the GP practices and OOH clinics. This implies that the Norwegian SAQ A is able to identify GP practices and OOH clinics with high and low patient safety climate scores. Patient safety climate scores produced by the Norwegian version of the SAQ A may, thus, guide improvement and learning efforts to work sites according to the level of their scores. Introduction For more than a decade, the landmark report, “An organisation with a memory,” has emphasised how the mindset, values and priorities of employees and management influence patient safety [1]. The report acknowledged that adverse events must be valued as sources of useful information for health care organisations to learn and improve. It concluded that improvement in patient safety depends on how healthcare organisations are able to encourage staff to speak up about hazards, risks and adverse events. This requires that staff feel safe and trust that admitting mistakes and adverse events will not be held against them [2]. Since the report was published, widespread efforts to address safety culture in healthcare organisations have emerged [3, 4]. Most have been related to hospital care, but efforts to address safety culture in primary care have also been noted [5–9]. Safety culture refers to individual and group values, priorities, attitudes, perceptions, and patterns of behaviour that specifically determine an organization’s commitment to and management of safety [10, 11]. Typical statements that may reflect staff perceptions of a positive safety culture in healthcare are: “It is easy for personnel in this clinic to ask questions when there is something that they do not understand” or “I am encouraged by my colleagues to report any patient safety concerns I may have”. Lack of acknowledgment and respect between professions are examples of cultural characteristics that may create barriers in the way teams are able to cooperate to reduce risks in patient care [12]. The approach through which leaders facilitate time for teams to define goals, initiate action, reflect and adjust their work processes is another cultural trait that may determine learning processes and team success [2]. Typical questions for reflection are, “What should we learn from this?”, “What can we improve?” and “What should we change?” Reflections may be done on a daily basis, at regular meetings, or related to project milestones [13]. In organisational psychology research, safety culture can be studied by using both qualitative and quantitative methods [14]. A promising approach to addressing variation in safety culture between organisational units is to survey staff perceptions [4]. Valid measurements of (...truncated)