In pursuit of a safety culture in New Zealand public hospitals

Abstract

Pursuing a safety culture enhances human performance; focusing on error control doesn't. This thesis investigates New Zealand public hospitals' institutional culture and safety using policy analysis and checklist/questionnaire surveys of management and professional ICU staff from twenty hospitals-a national survey. Survey data was compared with data from 106 ICUs in the United Kingdom. Analysis showed that present policies focus on managing blame more than enhancing performance and ignore pertinent paradigms/concepts, such as complex adaptive systems and highly reliable organisations. Hospital management was unable, with few exceptions, to provide comprehensive safety policies. The twenty middle management resilience checklists showed a wide spread of safety environments and significant lack of communication about safety issues between top and middle management. Successful hospitals recognised and depended on staff trust. ICU staff safety attitudes showed statistically significant (p= .02- .03) agreement between poor or good resilience scores and survey safety and teamwork climates, parameters shown to influence mortality and morbidity. NZ ICUs, as a group, ranked significantly lower than UK ICUs. The correlation of cultural aspects-institutional safety resilience with staff teamwork and safety climates-suggests that institutional culture can be measured; influences staff effectiveness and that policy enhancing professionalism and teamwork reliably improves patient safety.