Variation in staff perceptions of patient safety climate across work sites in Norwegian general practitioner practices and out-of-hour clinics

IntroductionMeasuring staff perceptions with safety climate surveys is a promising approach to addressing patient safety. Variation in safety climate scores between work sites may predict variability in risk related to tasks, work environment, staff behavior, and patient outcomes. Safety climate measurements may identify considerable variation in staff perceptions across work sites.ObjectiveTo explore variation in staff perceptions of patient safety climate across work sites in Norwegian General Practitioner (GP) practices and Out-of-hours clinics.MethodsThe Norwegian Safety Attitudes QuestionnaireAmbulatory Version (SAQ A) was used to survey staff perceptions of patient safety climate across a sample of GP practices and Out-of-hours clinics in Norway. We invited 510 primary health care providers to fill out the questionnaire anonymously online in October and November 2012. Work sites were 17 regular GP practices in Sogn & Fjordane County, and seven Out-of-hours clinics, of which six were designated as “Watchtower Clinics”. Intra–class correlation coefficients were calculated to identify what proportion of the variation in the five factor scores (Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions) were at work site-level.ResultsOf the 510 invited health care providers, 266 (52%) answered the questionnaire. Staff perceptions varied considerably at the work site level: intra–class correlation coefficients (ICCs) were 12.3% or higher for all factors except for Job satisfaction–the highest ICC value was for Perceptions of management: 15.5%.ConclusionAlthough most of the score variation was at the individual level, there was considerable response clustering within the GP practices and OOH clinics. This implies that the Norwegian SAQ A is able to identify GP practices and OOH clinics with high and low patient safety climate scores. Patient safety climate scores produced by the Norwegian version of the SAQ A may, thus, guide improvement and learning efforts to work sites according to the level of their scores.

引言：通过安全氛围调研评估医护人员感知，是改善患者安全的有效路径。不同工作场所的安全氛围评分差异，可用于预测任务、工作环境、医护行为与患者结局相关风险的变异程度。安全氛围测评可识别不同工作场所中医护人员感知的显著差异。
研究目的：探究挪威全科医生（General Practitioner, GP）诊所与非工作时段门诊中，医护人员对患者安全氛围的感知差异。
方法：本研究采用挪威版门诊安全态度调查问卷（Safety Attitudes Questionnaire Ambulatory Version, SAQ A），对挪威范围内的全科医生诊所与非工作时段门诊样本中的医护人员患者安全氛围感知开展调研。2012年10月至11月，我们邀请510名基层医疗服务提供者匿名完成线上问卷。本次调研的工作场所包括松恩-菲尤拉讷郡的17家常规全科医生诊所，以及7家非工作时段门诊，其中6家被定为“瞭望塔门诊”。研究计算了组内相关系数（intra-class correlation coefficients, ICCs），以明确5个维度评分（团队氛围、安全氛围、工作满意度、管理感知与工作条件）的变异中，有多少比例来自工作场所层面。
结果：在受邀的510名基层医疗服务提供者中，266名（占比52%）完成了问卷调研。医护人员的感知在工作场所层面存在显著差异：除工作满意度维度外，其余所有维度的组内相关系数均达到12.3%及以上，其中管理感知维度的ICC值最高，为15.5%。
结论：尽管绝大多数评分变异来自个体层面，但全科医生诊所与非工作时段门诊仍存在明显的应答聚类现象。这表明挪威版SAQ A可有效识别患者安全氛围评分高低各异的全科医生诊所与非工作时段门诊。因此，基于挪威版SAQ A得到的患者安全氛围评分，可根据各工作场所的评分水平，指导其开展针对性的改进与学习工作。