Interplay Between Quantifiable and Unquantifiable Safety Climate as Affected by Successful Systems Approach to Medication Safety Improvement:Primary Care Settings

The authors examine interrelation of safety attitude constructs measured with an Ambulatory Safety Attitudes Questionnaire(SAQ-A) and a successful intervention designed to reduce medication errors. This paper responds to WHO All Expert Working Group’s 2012 call to understand this interrelationship. Authors set out to measure safety attitude changes in relation to the changes in Adverse Drug Events using a cluster randomized trial in which 12 Upstate New York Practice-based Research Network practices were each randomized to one of 3 states(4 practices each):(1)Team resource management intervention based on FMEA approach;(2)Team resource management intervention with Practice Enhancement Assistants;(3) No intervention(comparison group). Combined pre- and post-intervention scores of the safety attitudes constructs were: (a)stress recognition: 62 vs 64.8, (b)perceptions of management:64.3 vs 61.5,(c)working conditions: 68.1 vs 63.9,(d) teamwork climate: 75.4 vs 72.9,(e) safety climate: 73.3 vs 75.2, and (f) job satisfaction: 78.4 vs 77.0. Despite anecdotal reports to the contrary, the efficacious TRM intervention appeared to have had no significant effects on measured safety attitudes.The authors describe limitations of the work and put forward a concept of context-sensitive culture of safety.