Understanding the Impact of Safety Climate, Teamwork Climate, and Mindful Organizing on Safety Outcomes at a Large Community Hospital - A Mixed-Methods Study

Aim: The current study examined the impact of staff perceptions of safety climate (i.e., senior and supervisory leadership support for safety), teamwork climate, and mindful organizing on three self-reported measures of safety outcomes (i.e., overall perceptions of patient safety, overall patient safety grade, and turnover intention) at a large community hospital in Southern Ontario.

Methods: Survey and interview data were collected from nurses, allied health professionals, and unit clerks working on one of four units: ICU, general medicine, adult mental health, or the ED. In total, 183/247 eligible clinical staff returned a completed survey (response rate = 74%); 4-6 semi-structured interviews were conducted on each unit.

Results: Hierarchical regression analyses showed teamwork climate was significantly associated with all three studys predictor variables while senior leadership was significantly associated with overall perceptions of patient safety and overall patient safety grade. Non-significant associations were found between supervisory leadership, mindful organizing and the three outcome variables. The qualitative findings corroborated the survey results while also providing important insights into why certain statistical relationships were found to be non-significant e.g., interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey. In addition, the qualitative findings helped expand the characteristics of the studys key concepts e.g., interviewees highlighted the prevalent negative impact of unit and profession boundaries on teamwork climate.

Practice Implications: Healthcare organizations should recruit into leadership roles and retain individuals who prioritize safety and possess adequate relational competencies. Furthermore, it is important to provide on-site workshops on topics (e.g., conflict and stress management) that can strengthen working relationships across professional and unit boundaries. The frontline clinicians would also benefit from on-site clinical training and presence of adequate staffing levels so they can provide high quality patient care.

Conclusions: There is increasing empirical evidence regarding the importance of context-specific factors for patient and staff safety, however, certain literature gaps still remain e.g., an over-reliance on non-theory driven quantitative research. The current study has addressed some of these gaps, together with adding to our understanding of how context influences safety.