Academic journal article Human Factors

Differences in Safety Climate between Hospital Personnel and Naval Aviators

Academic journal article Human Factors

Differences in Safety Climate between Hospital Personnel and Naval Aviators

Article excerpt


Safety in industries of high intrinsic hazard, such as aviation, military operations, nuclear power, and health care, is known to be a property primarily of systems rather than individuals. Organizations that perform successfully under very challenging conditions, with very low levels of failure, are termed high-reliability organizations (HROs; Gaba, 2001; Roberts, Rousseau, & La Porte, 1994; Rochlin, La Porte, & Roberts, 1987; Sagan, 1993). Based on direct observation of HROs, investigators have determined that a key element of high reliability is a "culture of safety" permeating the organization (Gaba, Howard, & lump, 1994; Roberts, 1993; Weick, 1987). Such a culture is presumed to depend largely on shared values and norms of behavior articulated by senior management and translated with high uniformity into effective work practices at the front line.

Although there is widespread acceptance of cultural influences on safety, there has been considerable debate concerning safety culture as an independent concept and whether the attitudes and experiences expressed by personnel on questionnaires measure "culture" versus "climate" (Cox & Flin, 1998; Flin, Mearns, O'Connor, & Bryden, 2000; Guldenmund, 2000; Hale, 2000). According to Flin et al. (2000), "safety climate can be regarded as the surface features of the safety culture discerned from the workforce's attitudes and perceptions at a given point in time. It is a snapshot of the state of safety providing an indicator of the underlying safety culture of a work group, plant or organization" (p. 178). We follow this usage in the remainder of the paper.

Health care institutions strive to be HROs, providing technically challenging and intrinsically hazardous modalities of medical care to patients efficiently and safely (Gaba, 2001). The past 20 years have seen an increased emphasis in health care in human factors and systems-oriented approaches to organizational safety, which were originally pioneered in the transport and energy sectors (Bogner, 1994; Cooper, Newbower, Long, & McPeek, 1978; Gaba, 1994; Gaba, Maxwell, & DeAnda, 1987; Gosbee, 2002; Helmreich & Merritt, 1998; Kohn, Corrigan, & Donaldson, 1999; Leape, 1994; Lin, Vicente, & Doyle, 2001; Reason, 1995, 2000; Weinger & Englund, 1990; Xiao et al., 1996).

The degree to which these health care organizations have a culture of safety supportive of high reliability and patient safety has been explored only recently. Considerable work has focused on occupational safety for health care workers, particularly concerning needlestick exposure to blood-borne pathogens such as HIV (Clarke, Rockett, Sloane, & Aiken, 2002; Gershon et al., 2000; Vredenburgh, 2002). More generally, surveys have been done classifying institutions into predefined cultural types (Wakefield et al., 2001) and relating these categorizations of a workplace organizational culture to specific care practices or patient outcome for specific diseases (Shortell et al., 2000; Shortell, Rousseau, Gillies, Devers, & Simons, 1991; Shortell et al., 1994; Zimmerman et al., 1993, 1994). Others have looked at specific issues such as production pressure (Gaba et al., 1994) or teamwork in particular work environments, such as the operating room and intensive care unit (Helmreich & Merritt, 1998; Sexton, Thomas, & Helmreich, 2000).

We recently reported data on safety-related attitudes and experiences of personnel (i.e., safety climate) in a diverse set of hospitals in or near California, including public and private, for-profit and nonprofit, teaching and nonteaching, and large and small organizations (Singer et al., 2003). This survey included a 100% sample of senior management and physicians as well as a 10% sample of all hospital employees in all work units. We found that although the majority of respondents answered in ways indicating a good safety climate, a substantial minority of respondents (18% on average) gave answers that suggested the absence or antithesis of a safety climate; another 18% of respondents were neutral. …

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