Leadership across all levels of a health system plays an important role in patient safety. In this study, researchers administered the Safety, Communication, Operational, Reliability, and Engagement (SCORE) survey to 31 Midwestern hospitals to evaluate how leadership behaviors influenced burnout, safety culture, and engagement. Findings indicate that local leadership behaviors are strongly associated with healthcare worker burnout, safety climate, teamwork climate, workload, and intentions to leave the job.

The COVID-19 pandemic increased symptoms of physician burnout, including emotional exhaustion, which can increase patient safety risks. This cross-sectional study examined emotional exhaustion among healthcare workers at two large health care systems in the United States before and during the COVID-19 pandemic. Respondents reported increases in emotional exhaustion in themselves and perceived exhaustion experienced by their colleagues. The researchers found that emotional exhaustion was often clustered in work settings, highlighting the importance of organizational climate and safety culture in mitigating the effects of COVID-19 on healthcare worker well-being.

Psychological safety (PS) is integral to ensuring healthcare workers feel comfortable asking questions and raising patient safety concerns. A novel PS assessment was administered to over 10,000 healthcare workers and support staff in one academic health system. The scale showed a significant correlation with safety culture, especially among those exposed to institutional PS programs (i.e., Safety WalkRounds and Positive Leadership WalkRounds).

Teamwork is an essential component of patient safety.  This cross-sectional study of 50,000 healthcare workers in four large US health systems found that the teamwork climate worsened during the COVID-19 pandemic. Survey findings indicate that healthcare facilities with worsening teamwork climate had corresponding decreases in other measured domains, including safety climate and healthcare worker well-being. The researchers suggest that healthcare organizations should proactively increase team-based training to reduce patient harm.

Safety WalkRounds involve health care leadership or managers visiting frontline staff and engaging in discussions about safety concerns. One university hospital in Switzerland combined WalkRounds with structured in-person observations which helped identify safe care practices and deficits in patient safety. However, there were no significant changes in safety and teamwork climate nine-months after implementation.  

Health system leadership practices can influence patient safety. Using a cross-sectional survey of clinical and non-clinical healthcare workers, this study found that Positive Leadership WalkRounds – where leadership conduct rounds and ask staff about what is going well and what can be improved – was associated with improved safety culture and healthcare worker well-being. Healthcare workers exposed to Postive Leadership WalkRounds were more likely to report readiness to engage in quality improvement activities, positive perceptions of teamwork and work-life balance norms and were less likely to report emotional exhaustion in themselves and their colleagues. 

High levels of healthcare worker (HCW) burnout may be associated with lower levels of patient safety and quality. In June 2020, three months into the COVID-19 pandemic, 288 maternity and neonatal HCWs were asked about their perspectives on well-being and patient safety. Two-thirds of respondents reported symptoms of burnout and only one-third reported adequate organizational support to meet these challenges. Organizations are encouraged to implement programs to reduce burnout and support HCW well-being.

… highlighting the importance of support programs . … Sexton JB, Adair KC, Profit J, et al. Perceptions of …

This study used a brief survey to evaluate disruptive behaviors in one large health system, and its relationship to safety culture. Disruptive behaviors (most commonly bullying and inappropriate discontinuation of communication, such as hanging up the phone) were noted by more than half of individuals surveyed and occurred in nearly all work settings. Greater exposure to disruptive behaviors was associated with poorer teamwork climate, safety climate, and job satisfaction

Prior research has found that perceptions about safety climate varies across neonatal intensive care units (NICUs). This large cross-sectional study examining the impact of caregiver perceptions of safety climate on clinical outcomes found that stronger safety climates were associated with lower risk of healthcare-associated infections, but climate did not affect mortality rates.

Medical errors are a concern across the economic spectrum worldwide. This commentary describes an educational effort to develop champions to lead patient safety, quality improvement, and infection control initiatives in health systems in low- and middle-income countries. The authors highlight the importance of contextualizing training to consider local needs and resources.

Prior research has shown that health care worker perceptions of safety culture may vary across different neonatal intensive care units (NICUs). Less is known as to how perceptions of NICU safety culture relate to NICU quality of care. In this cross-sectional study involving 44 NICUs, researchers found a significant relationship between safety climate and teamwork ratings and a lack of health care–associated infections, but no relationship with regard to the other performance metrics examined in the study.

Burnout is a highly prevalent patient safety issue. This survey study examined work–life balance and burnout. Researchers validated a novel survey measure for work–life balance by asking participants to report behaviors like skipping meals and working without breaks. Residents, fellows, and attending physicians reported the lowest work–life balance, and psychologists, nutritionists, and environmental services workers reported the highest work–life balance. Time of day and shift length also influenced work–life balance: day shift had better scores compared to night shift, and shorter shifts had better scores than longer shifts. The work–life balance score also clustered by the work setting: individuals with different roles within a given setting (such as the intensive care unit, the emergency department, or the clinical laboratory) had more similar work–life balance. Those with higher work–life balance reported better safety culture and less burnout. The authors suggest that burnout interventions target work settings rather than individuals, because work–life balance seems to function as a shared experience within health care settings.

… the relationship between burnout and patient safety. … Sexton JB, Adair KC, Leonard MW, et al. Providing feedback …

… In a previous PSNet interview , the lead author, J. Bryan Sexton, discussed resilience, burnout , and safety culture . …

Health care organizations measure safety climate by surveying providers and staff at all levels. Investigators assessed safety culture and teamwork in 44 neonatal intensive care units using two different survey tools—the Safety Attitudes Questionnaire and the Hospital Survey on Patient Safety Culture. They found significant variation in safety and teamwork climate scales of both tools, indicating that the instruments should not be used interchangeably.

Safety culture is widely measured and discussed, but its link to patient outcomes has not been consistently demonstrated. Surgical site infections are considered preventable adverse events. In this cross-sectional study, investigators found that better safety culture was associated with lower rates of surgical site infections after colon surgery. Specifically, aspects of safety culture associated with teamwork, communication, engaged leadership, and nonpunitive response to error were linked to fewer infections. Although this work does not establish a clear cause-and-effect relationship between safety culture and patient outcomes, it suggests that efforts to enhance safety culture could improve patient outcomes.

This pre-post study found improvements in safety culture, as measured by the Safety Attitudes Questionnaire, following the implementation of AHRQ's TeamSTEPPS tools. These findings add to the body of research supporting teamwork training as a way to enhance safety.

Leadership WalkRounds, in which senior leadership visits directly with frontline staff on their clinical units with the goal of identifying and addressing safety concerns, has shown potential as a means of improving safety culture. However, initial enthusiasm for this approach has been tempered by a recent qualitative study and a randomized trial—both showed that walkrounds had little effect on safety culture. Conducted in 44 neonatal intensive care units, this cross-sectional study found that units who received feedback from walkrounds had lower rates of burnout and more positive perceptions of safety culture. The results of this investigation may help explain why walkrounds were not associated with improvements in other studies—when walkrounds are performed in a perfunctory fashion or when senior leadership does not systematically follow up on issues identified, frontline workers may become cynical and perceptions of safety culture may actually worsen.