Patient safety climate strength: a concept that requires more attention.

BACKGROUND: When patient safety climate (PSC) surveys are used in healthcare, reporting typically focuses on PSC level (mean or per cent positive scores). This paper explores how an additional focus on PSC strength can enhance the utility of PSC survey data. SETTING AND PARTICIPANTS: 442 care providers from 24 emergency departments (EDs) across Canada. METHODS: We use anonymised data from the Can-PSCS PSC instrument collected in 2011 as part of the Qmentum accreditation programme. We examine differences in climate strength across EDs using the Rwg(j) and intraclass correlation coefficients measures of inter-rater agreement. RESULTS: Across the six survey dimensions, median Rwg(j) was sufficiently high to support shared climate perceptions (0.64-0.83), but varied widely across the 24 ED units. We provide an illustrative example showing vastly different climate strength (Rwg(j) range=0.17-0.86) for units with an equivalent level of PSC (eg, climate mean score=3). CONCLUSIONS: Most PSC survey results focus solely on climate level. To facilitate improvement in PSC, we advocate a simple, holistic safety climate profile including three metrics: climate level (using mean or per cent positive climate scores), climate strength (using the Rwg(j), or SD as a proxy) and the shape of the distribution (using histograms to see the distribution of scores within units). In PSC research, we advocate paying attention to climate strength as an important variable in its own right. Focusing on PSC level and strength can further understanding of the extent to which PSC is a key variable in the domain of patient safety.

Building empowering work environments that foster civility and organizational trust: testing an intervention.

BACKGROUND: Creating supportive and empowering workplace conditions is important, not only because these conditions are related to improved nurse health and well-being but also because they are important for retaining top performing nurses. The current nursing shortage emphasizes the need to create such conditions. OBJECTIVES: The aim of this study was to examine the impact of a workplace intervention (Civility, Respect, and Engagement in the Workplace [CREW]) on nurses' empowerment, experiences of supervisor and coworker incivility, and trust in nursing management. METHODS: Registered nurses (Time 1, n = 755; Time 2, n = 573) working in 41 units across five hospitals in two provinces completed measures of workplace empowerment, supervisor and coworker incivility, and trust in management before and after a 6-month intervention. Eight units participated in the intervention, and 33 units were control groups. Multilevel modeling was used to test the impact of the intervention. RESULTS: A significant interaction of time by intervention was found for the access to support and resources empowerment structures, total empowerment, supervisor incivility, and trust in management. DISCUSSION: Compared with the control group, nurses who experienced the intervention program reported significant improvements in empowerment, supervisor incivility, and trust in management. Despite methodological challenges experienced in this study, the CREW process appears to be a promising intervention approach to enhance quality of nursing work environments, which may contribute to the retention of the nursing workforce.

When respect deteriorates: incivility as a moderator of the stressor-strain relationship among hospital workers.

AIM: To test whether incivility at work exacerbates the relationship between stressors and strain for hospital workers. BACKGROUND: A climate of incivility and disrespect among colleagues was expected to heighten the impact of work stressors on the mental and physical health of care providers. METHODS: Members of 17 care-providing units from five hospital systems in Canada completed surveys, before and after a civility intervention (eight intervention vs. nine comparison units). Analyses tested whether (1) incivility moderated the stressor-strain relationship at baseline (n=478), and (2) the stressor-strain relationship decreased for the intervention units relative to comparison units 6 months later (n=361). RESULTS: (1) Pre-intervention, individuals reporting more incivility on their unit showed a stronger stressor-strain relationship. (2) The negative relationship between work overload and mental health was mitigated among intervention group staff 6 months after the introduction of a colleague-based civility programme. CONCLUSIONS: Besides being a stressor itself, incivility exacerbates the relationship between existing job role stressors and strain among health care workers. IMPLICATIONS FOR NURSING MANAGEMENT: Colleague civility and respect have an important ripple effect of buffering inevitable work stressors, helping health care providers respond to stress with greater health and resiliency.