A hospital's safety culture — not just a surgeon's skills or the equipment available — has a measurable effect on surgical outcomes, according to a new study in the Journal of the American College of Surgeons.
Martin Makary, MD, a professor of surgery and health policy and management at Johns Hopkins University School of Medicine in Baltimore and an author of the study, says the piece "affirms what many of us have known for a long time" — that organizational culture matters for patient outcomes.
Dr. Makary and the team of researchers partnered with seven hospitals from the Minnesota Hospital Association to evaluate their safety culture and surgical site infections for colon surgeries as a measure of surgical outcomes. The study is one of the first to evaluate the effect of an organization's safety culture on outcomes.
To determine the level of safety culture in each hospital, employees in each hospital's surgical unit responded to the Hospital Survey on Patient Safety Culture, available from the Agency for Healthcare Research and Quality. The survey measures 12 safety culture factors.
The study found that hospitals with a higher patient safety culture score had lower SSI rates. Additionally, it found that of the 12 factors in the survey, 10 were found to influence SSI rates after colon surgery in hospitals:
- Overall perceptions of patient safety
- Teamwork across units
- Organizational learning
- Feedback and communication about error
- Management's support for patient safety
- Teamwork within units
- Communication openness
- Supervisor or manager expectations of actions promoting safety
- Nonpunitive response to error
- Frequency of events reported
For hospitals looking to improve safety culture, the study suggests efforts such as OR briefings, preoperative checklists, TeamSTEPPS and the Comprehensive Unit-based Safety Program.
However, Dr. Makary says, "The No. 1 driver of good safety, in my opinion, is the leadership of a unit or service line and the hospital." When leaders are frequently on the unit and helping solve disputes or interacting with staff and acting on their recommendations, that indicates a hospital is invested in safety, he says.