Patient Safety and Quality

Veterans Administration hospitals have a generally positive safety climate, but there is room for improvement

Veterans Administration (VA) hospitals have a positive safety climate, but there is room for improvement, concludes a new study. A team of researchers surveyed all senior managers and physicians and a 10 percent random sample of other employees at 30 VA hospitals over a 6-month period about the safety climate in their hospitals. They also surveyed all employees working in high-hazard units (HHUs) at 10 randomly selected VA hospitals.

A lower percentage of responses to questions about safety issues considered problematic indicated a better safety climate. Overall, 83 percent of responses did not indicate safety concerns, suggesting a generally positive safety climate. The percentage of problematic responses ranged from 12 to 23.7 across hospitals (mean of 17.5 percent). Ten percent or more survey respondents considered 34 out of 42 safety issues problematic, and 25 percent or more considered 10 safety issues to be problematic.

Half of survey respondents indicated that their workgroups did not recognize individual safety achievement through rewards, nor were they rewarded for timely action to identify a serious mistake. Workgroups in the emergency departments, intensive care units, and operating rooms/postanesthesia care units cited the most problematic safety areas. On average, senior managers considered fewer issues to be safety problems than others (9.8 vs. 18.3 percent). On 5 of the 11 scales, workers who were not senior managers, including frontline staff in direct contact with patients (and with the most exposure to potential safety issues), had significantly more problematic responses than senior managers, whose work is by nature removed from the direct patient care environment. The study was supported in part by the Agency for Healthcare Research and Quality (HS13920).

See "An overview of patient safety climate in the VA," by Christine W. Hartmann, Ph.D., Amy K. Rosen, Ph.D., Mark Meterko, Ph.D., and others, in the August 2008 HSR: Health Services Research 43(4), pp. 1263-1284.

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