This article, titled “Safety culture, safety climate, and safety performance in healthcare facilities: A systematic review,” was authored by Intan Suraya Noor Arzahan, Zaliha Ismail, and Siti Munira Yasin. It was published in Safety Science in 2022 and is an open-access review.
The primary objective of this systematic review is to investigate the relationship between safety culture or climate and safety performance specifically within healthcare facilities. The authors also aimed to identify the indicators and assessment methods used for safety culture, safety climate, and safety performance in this sector. This research is particularly relevant as healthcare facilities are considered to be in the early stages of safety performance development, unlike high-risk industries where the impact of safety culture on performance has been extensively studied.
Key Concepts Explored:
- Safety Culture: This term is most commonly defined as “the result of individuals and groups’ beliefs, attitudes, competencies, and behavior patterns. It defines the commitment to and the style and efficiency of an organization’s safety and health (S&H) management”. It is considered a fundamental concept for enhancing safety performance and aims to create an environment where employees are aware of hazards and accident prevention.
- Safety Climate: Often used interchangeably with safety culture, safety climate is described as a more superficial perspective. It is considered the measurement of safety culture and reflects how individuals in an organization perceive safety in their work environment, including workplace safety rules, procedures, and practices. The dimensions of safety climate can vary across industries.
- Safety Performance: There is no universal consensus on this concept in the literature. However, academics often define it based on their experiences, such as an organization’s capacity to prevent work-related accidents or injuries.
Methodology of the Review:
The authors conducted a systematic review (SR) using the Preferred Reporting Items for Systematic Reviews (PRISMA) technique.
- Databases Searched: Scopus, Web of Science (WoS), Dimensions, ScienceDirect, and Google Scholar.
- Keywords: A comprehensive set of keywords was used, including ‘safety culture’, ‘safety climate’, ‘safety performance’, ‘injury’, ‘incident’, ‘healthcare’, ‘hospital’, ‘clinic’, ‘health office’, ‘health division’, and ‘health authority’. Notably, ‘patient safety’ was specifically excluded as the focus was on health professionals’ safety and health.
- Inclusion Criteria: Studies were selected if they were:
- Conducted in healthcare facilities and linked safety culture or safety climate with safety performance.
- Published in English.
- Published in peer-reviewed journals within a five-year timeframe (2016 to 2020).
- Quality Assessment: The quality of the selected studies was assessed using the EPHPP-Quality Assessment Tool (Effective Public Health Practices Project), which evaluates aspects such as selection bias, study design, confounders, blinding, data collection techniques, and drop-out rate. Out of 11 reviewed studies, one was rated strong quality, six were moderate, and the remaining four were weak.
Key Findings and Insights:
- Relationship between Variables: The review examined the influence of safety culture, climate, and safety performance in 11 research studies.
- Nine out of the eleven publications investigated the link between safety climate and safety performance, while the remaining two focused on safety culture.
- The review found a negative correlation between safety culture/climate and reactive safety performance metrics (e.g., incident/injury rates).
- Conversely, there is a significant positive correlation between safety culture/climate and proactive safety performance metrics.
- Assessment of Safety Performance:
- Proactive measures (e.g., safety behavior, safety compliance, safety engagement) were utilized in six of the eleven studies and are favored among researchers in healthcare due to their significant relationship with safety culture or safety climate. These measures are considered beneficial for low-risk organizations like healthcare due to the consistency of conditions and habits over time.
- Reactive measures (e.g., incidence and injury rates) were used in four studies. While common in high-risk industries, these measures are highlighted for their weaknesses, such as ignoring risk exposures, lack of sensitivity, questionable accuracy, and the potential for underreporting due to legal or financial consequences.
- The review suggests that safety satisfaction could be included as an additional safety measure in future studies, especially for industries still developing their safety culture and in lower-risk settings.
- Dimensions and Methods of Assessment:
- The most frequently utilized dimensions for measuring healthcare facilities’ safety culture/climate were management commitment/supervision/participation/involvement (73%) and safety resources/policies/training (82%).
- The most common method of assessment was self-reported questionnaires. Quantitative approaches, often using a five-point Likert scale, were primarily used.
- Implications: The authors conclude that despite the importance of this field, quality research on the link between safety culture, safety climate, and safety performance in healthcare facilities is still insufficient. Additional research is needed to further explain these relationships, particularly in healthcare and other low-risk industries. The findings suggest that safety competence, which includes good safety knowledge, may moderate the effects of safety culture and climate on safety performance.
Reference: Arzahan, I. S. N., Ismail, Z., & Yasin, S. M. (2022). Safety culture, safety climate, and safety performance in healthcare facilities: A systematic review. Safety Science, 147, 105624. https://doi.org/10.1016/j.ssci.2021.105624
