Attending physicians and trainees' perspective of patient safety culture in operating room: A mixed methods study

Abstract

Background: Regulatory quantitative assessments are routinely undertaken to understand the patient safety culture within an organization. However, adjunctive qualitative approaches to explore low-scoring areas of safety culture in the operating room (OR) are lacking and may provide additional insight. Thus, we explored OR patient safety culture perceptions of pediatric surgical providers, specifically among attending physicians and trainees. Methods: A cross-sectional survey was pilot-tested by pediatric surgical attending physicians and surgical trainees from one academic hospital OR. The “Safer Culture” survey was developed using validated survey measures of concepts from the Safer Culture framework and modified by cognitive interviews with subject-matter experts. The survey was electronically administered, and the results were analyzed descriptively, and percent positive scores were computed. Semi-structured interviews with a purposive sample of participants were then conducted and thematically analyzed. Results: Of the 144 participants, 67 completed the survey (response rate: 46.5 %). Safety competence (>95 %) and individual commitment & prioritization of safety (>90 %) were rated highest by attending physicians and trainees. Trainees rated policies & resources for safety and cohesion the lowest (<60 %). Attending physicians and trainees rated just culture the lowest (<56 %). Interview data revealed three overarching themes explain the lowest ratings: 1) feedback and fear influence incident reporting, 2) lack of accountability and learning affect just culture, and 3) individual and group preparedness impact safe surgical care. Conclusions: Safer Culture survey identified low-performing issues affecting OR safety culture by pediatric surgical providers. Their perceptions specified areas to focus initiatives to improve OR safety culture. Levels of evidence: Level III.

Keywords

• Surgical patient safety
• Patient safety
• Safety culture
• operating rooms
• Mixed-methods