Association of Safety Culture with Surgical Site Infection Outcomes

Caleb J. Fan, Timothy M. Pawlik, Tania Daniels, Nora Vernon, Katie Banks, Peggy Westby, Elizabeth C. Wick, J. Bryan Sexton, Martin A Makary

Research output: Contribution to journalArticle

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). Study Design 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.

Original languageEnglish (US)
Pages (from-to)122-128
Number of pages7
JournalJournal of the American College of Surgeons
Volume222
Issue number2
DOIs
StatePublished - Feb 1 2016

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Safety Management
Surgical Wound Infection
Colon
Patient Safety
Safety
Communication
Hospital Design and Construction
Community Hospital
Workplace
Learning
Delivery of Health Care

ASJC Scopus subject areas

  • Surgery

Cite this

Association of Safety Culture with Surgical Site Infection Outcomes. / Fan, Caleb J.; Pawlik, Timothy M.; Daniels, Tania; Vernon, Nora; Banks, Katie; Westby, Peggy; Wick, Elizabeth C.; Sexton, J. Bryan; Makary, Martin A.

In: Journal of the American College of Surgeons, Vol. 222, No. 2, 01.02.2016, p. 122-128.

Research output: Contribution to journalArticle

Fan, CJ, Pawlik, TM, Daniels, T, Vernon, N, Banks, K, Westby, P, Wick, EC, Sexton, JB & Makary, MA 2016, 'Association of Safety Culture with Surgical Site Infection Outcomes', Journal of the American College of Surgeons, vol. 222, no. 2, pp. 122-128. https://doi.org/10.1016/j.jamcollsurg.2015.11.008
Fan, Caleb J. ; Pawlik, Timothy M. ; Daniels, Tania ; Vernon, Nora ; Banks, Katie ; Westby, Peggy ; Wick, Elizabeth C. ; Sexton, J. Bryan ; Makary, Martin A. / Association of Safety Culture with Surgical Site Infection Outcomes. In: Journal of the American College of Surgeons. 2016 ; Vol. 222, No. 2. pp. 122-128.
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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). Study Design 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.",
author = "Fan, {Caleb J.} and Pawlik, {Timothy M.} and Tania Daniels and Nora Vernon and Katie Banks and Peggy Westby and Wick, {Elizabeth C.} and Sexton, {J. Bryan} and Makary, {Martin A}",
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AU - Westby, Peggy

AU - Wick, Elizabeth C.

AU - Sexton, J. Bryan

AU - Makary, Martin A

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N2 - 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). Study Design 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.

AB - 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). Study Design 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.

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