What is patient safety culture? A review of the literature.

PURPOSE: To organize the properties of safety culture addressed by many studies and to develop a conceptual culture of safety model. DESIGN AND METHODS: A comprehensive review of the culture of safety literature within the U.S. hospital setting. The review was a qualitative meta-analysis from which we generated a conceptual culture of safety framework and developed a typology of the safety culture literature. FINDINGS: Seven subcultures of patient safety culture were identified: (a) leadership, (b) teamwork, (c) evidence-based, (d) communication, (e) learning, (f) just, and (g) patient-centered. CONCLUSIONS: Safety culture is a complex phenomenon that is not clearly understood by hospital leaders, thus making it difficult to operationalize. We found senior leadership accountability key to an organization-wide culture of safety. CLINICAL RELEVANCE: Hospital leaders are increasingly pressured by federal, state, regulatory, and consumer groups to demonstrate an organizational safety culture that assures patients are safe from medical error. This article defines a safety culture framework that may support hospital leadership answer the question "what is a patient safety culture?"

Barriers to women's cardiovascular risk knowledge.

Cardiovascular disease (CVD) is the leading cause of death for women in the United States, resulting in a greater emphasis on research and methods for addressing issues relating to this health problem both nationally and worldwide. The authors' purpose was to identify barriers to women's cardiovascular risk knowledge, both personal and organizational, through key informant interviews of health leaders at 10 community health organizations. Analysis showed an overall lack of awareness of CVD risk for women. Culture, finance, and lack of awareness and easily accessible programs implicated the importance of physicians as health care providers and educators for women patients.

Organizational culture in a terminally ill hospital.

This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a "Shared Vision" of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The results from the study suggest an increase in PS due to the shared vision of one subculture within the hospital. There were powerful subcultures in this organization based on occupation and specialization, and their interests and functional orientations were not conducive to a systems approach. Hospital management was conducted in "silos" and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the health care market.

Case studies in medical futility.

Technology has provided means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient. This study presents two case histories, compiled from historical patient charts, staff notes and observations, that illustrate the variety of ethical issues involved and the role culture plays in the decision making process related to possible futile medical treatment. Ethical and cultural issues related to the cases are discussed and processes are presented that can help hospitals to avoid, or decrease the level of, medically futile care, and improve the cultural appropriateness of medical care and relationships with patients.

An employee assistance program for caregiver support.

The Comprehensive Caregiver Choices Program provided support for employee caregivers of elderly people for employees at a hospital in Fort Worth, Texas. Key informant interviews and focus groups provided direction for program development and implementation. A full-time MSW and professionals with expertise in gerontology/geriatrics provided education and care coordination services to caregivers. Approximately 4% of the hospital's workforce participated in the program. Attendees evaluated educational sessions and follow-up interviews were conducted with program participants. Caregiver support programs must continue to seek innovative and creative marketing and service delivery methods to reach out and assist working caregivers in need of support.

Characteristics of osteopathic physicians choosing to practice rural primary care.

As increasing numbers of women and osteopathic physicians enter medical practice, it is important to identify their choices in medical specialty and practice location and the implications these choices have for the future of healthcare in the United States. In 2003, data from the Texas Medical Board and the Office of the [Texas] State Demographer were aggregated to compare the rates at which physicians differed in their choices to practice primary care specialties in a rural location. In addition, the impact of sex and type of medical degree on these choices was examined. Analyses revealed that male osteopathic physicians were 2.3 times more likely than all other physician groups to practice rural primary care. Analyses also revealed that female osteopathic physicians were more likely than other physicians to choose primary care as a specialty and were 2.5 times more likely than female allopathic physicians to practice primary care in a rural location. Policies intended to produce primary care or rural primary care physicians should take into account the effects of gender and osteopathic training.

An analysis of osteoporosis-related hip fractures using hospital discharge data.

The purpose of this study was to assess whether physicians in practice inadequately diagnose osteoporosis in a high-risk population of postmenopausal women who have sustained hip fractures. Using the Texas Hospital Discharge Data-Public Use Data File (PUDF) provided through the Texas Health Care Information Council, the authors conducted a review of all postmenopausal women older than 55 years with fractured hips discharged from Texas hospitals during 1999. A total of 13,628 patients meeting these criteria were found using the PUDF. In their diagnoses, physicians for 2233 (16.3%) of these 13,628 women also specified the code for osteoporosis (P < .001) from the ninth revision of the International Classification of Diseases. It is estimated that between 40% and 50% of postmenopausal women have osteoporosis. Therefore, women with fragility fractures form an even more at-risk subset of the population--so much so that one would expect a majority of these women to carry diagnoses of osteoporosis. The age distribution in each group was comparable, implying that receiving a coded diagnosis for osteoporosis was not related to the age of the patient when she was admitted to the hospital. Further, when data was analyzed by race or ethnicity, percentages for each group (ie, diagnosed with hip fracture only versus diagnosed with hip fracture and osteoporosis) were comparable. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high-risk population of postmenopausal women who were admitted to hospitals with fractured hips. Future analysis of subsequent annual databases will identify whether continuing medical education efforts cause physicians to diagnosis osteoporosis in this high-risk population more frequently.