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Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey
Örebro University, School of Health Sciences. Department of Anesthesia, Intensive Care Unit, Falu Lasarett, Falun, Sweden; Centre for Clinical Research, Falun, Sweden. (Centre for Perioperative Nursing (CPoN))
Department of Orthopedics, Danderyd Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. (Centre for Perioperative Nursing (CPoN))
Örebro University, School of Health Sciences. (Centre for Perioperative Nursing (CPoN))ORCID iD: 0000-0001-5403-4183
Örebro University, School of Health Sciences. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. (Centre for Perioperative Nursing (CPoN))ORCID iD: 0000-0002-3964-196X
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 9, article id e015607Article, review/survey (Refereed) Published
Abstract [en]

Background: A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors’ estimations of their staffs’ attitudes to patient safety.

Methods: A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate.

Results: Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors’ estimations of their staffs’ ratings of the safety climate cohered fairly well.

Conclusions: This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017. Vol. 7, no 9, article id e015607
National Category
Nursing
Research subject
Caring sciences
Identifiers
URN: urn:nbn:se:oru:diva-59446DOI: 10.1136/bmjopen-2016-015607ISI: 000412650700060PubMedID: 28864690Scopus ID: 2-s2.0-85029118920OAI: oai:DiVA.org:oru-59446DiVA, id: diva2:1137976
Note

Funding Agency:

Centre for Clinical Research Dalarna

Available from: 2017-09-03 Created: 2017-09-03 Last updated: 2019-04-30Bibliographically approved
In thesis
1. Open the door to complexity: Safety climate and work processes in the operating room
Open this publication in new window or tab >>Open the door to complexity: Safety climate and work processes in the operating room
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A complex adaptive system such as the operating room (OR), consists of different safety cultures, sub-cultures and ways of working. When measuring, a strong safety climate has been associated with lower rates of surgical complications. Teamwork is an important factor of safety climate. Discrepancies among professionals’ perceptions of teamwork climate exists. Hence it seems crucial to explore if diversity exists in the perception of factors related to safety climate and between managers and front-line staff in the OR. Complex work processes including multitasking and interruptions are other challenges with potential effect on patient safety. However, multitasking and interruptions may have positive impact on patient safety, but are not well understood in clinical work. Despite challenges a lot of things go well in the OR. Thus, the overall aim of this thesis was to evaluate an instrument for assessing safety climate, to describe and compare perceptions of safety climate, and to explore the complexity of work processes in the OR.

To evaluate the Safety Attitudes Questionnaire-operating room (SAQ-OR) version and elicit estimations of the surgical team a cross-sectional study design was used. How work was done was studied by observations using the Work Observation Method by Activity Timing and by group interviews with OR professionals.

The results show that the SAQ-OR is a relatively acceptable instrument to assess perceptions of safety climate within Swedish ORs. OR professionals´ perceptions of safety climate showed variations and some weak areas which cohered fairly well with managers' estimations. Work in the OR was found to be complex and consisting of multiple tasks where communication was most frequent. Multitasking and interruptions, mostly followed by communication, were common. This reflects interactions and adaptations common for a complex adaptive system. Managing complexity and creating safe care in the OR was described as a process of planning and preparing for the expected and preparedness to be able to adapt to the unexpected.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 100
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 193
Keywords
Patient safety, operating room, complexity, safety climate, psychometrics, cross-sectional, observations and qualitative
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-73093 (URN)978-91-7529-285-4 (ISBN)
Public defence
2019-05-24, Föreläsningssalen Falu Lasarett, Lasarettsvägen 10, Falun, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-05-06Bibliographically approved

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Göras, CamillaNilsson, UlricaEhrenberg, Anna

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